What role can pharmacy play in the social prescribing revolution?

It would be easy to knock the ‘blokey-ness’ of the men’s sheds movement. The financial partner of its representative body, the UK Men’s Sheds Association, is Ronseal paint. It’s ‘Shed of the Year’ awards are sponsored by Triton, the power tool manufacturer.

But perhaps that’s the point. The idea behind men’s sheds is to offer – mostly men, though women are also welcome – a place to chat, develop friendships, or to just moan to whoever will listen.

By bonding over a cup of tea – and, perhaps, some woodworking – service users are made to feel as comfortable as they can. The shed can aid in reducing their isolation and potentially help with any mental health conditions they may have.

An example of such a place, is the Sunnyside Men’s Shed, based in Tower Hamlets, London, which won Shed of the Year 2019. Standing in the brick building hidden away down an east London back street, Ray Furness, one of the shed’s two organisers, explains: “We’re the third option for men, apart from the pub and the bookies.”

Sunnyside is open three days per week and provides a haven for men — often retired, sometimes isolated — where they can become part of a social network. They can spend their days using the shed’s high-quality woodworking equipment if they want, but users are equally welcome to just have a cup of tea and a chat.

Since the idea was first imported from Australia in 2013, men’s sheds have become something of a phenomenon in the UK — Britain’s 500^th shed was opened in June 2019 in the village of Blewbury, Oxfordshire.

And, most importantly, they work: a poll by the UK Men’s Sheds Association found that 89% of users reported a decrease in depression after becoming a regular ‘shedder’, and 97% said they had made friends through their local shed.

At Sunnyside, some people just turn up, but most shed users are referred by local GPs, mental health charities, cancer support groups and dementia organisations. This is part of a growing trend for “social prescribing”, enabling healthcare professionals to refer patients to non-clinical services in their local community, which can be anything from yoga classes to joining the village choir.

Developing the concept

The origin of social prescribing in the UK was described in a NHS-commissioned study, published by the Social Prescribing Network in 2017, as “starting in a beautifully organic way”.

It was not until the new millennium that wider ideas around social prescribing began to be embedded in healthcare policy

Sam Everington, a GP who is cited as one of the earliest pioneers of social prescribing, introduced the concept of multi-faceted wrap-around treatment for patients in his surgery, as part of the Bromley-by-Bow ‘Social prescribing for health and wellbeing’ scheme. The scheme is marking its 35th year in 2020.

Despite this, it was not until the early 2000s that wider ideas around social prescribing began to be embedded in healthcare policy, with the publication of the government’s 2006 white paper ‘Our health, our care, our say’. Following on from this, the ‘NHS five-year forward view’, published in 2014, and the ‘General practice forward view’, published in 2016, both reinforced the importance of prevention, wellbeing and the voluntary sector for healthcare, as well as introducing an extra benefit of social prescribing: its ability to reduce pressure on NHS services.

The ‘NHS long-term plan’ has the intent of propelling this movement. The document, published in January 2019, promises that 1000 social prescribing ‘link workers’ will be recruited by primary care networks by 2020/2021. Each link worker will be expected to contact someone needing help up to 12 times over a three-month period, connecting them to local community groups and helping them to develop “skills, friendships and resilience”. The plan says that at least 900,000 patients will have been referred to social prescribing by 2023/2024 — the most explicit requirement yet for the mainstreaming of social prescribing.

According to figures obtained by The Pharmaceutical Journal, the number of social prescribers employed across clinical commissioning group (CCG) areas has more than doubled in the past year, 

The number of whole-time equivalent (WTE) social prescribing staff among 82 CCGs that responded to a Freedom of Information (FOI) request was 395.7 in 2019/2020, compared with 190.0 in 2018/2019, and 138.8 in 2017/2018.

However, not all social prescribing staff are employed by CCGs — many work for local authorities or the voluntary sector and the numbers of social prescribing staff quoted in FOI responses do not yet include any of the link workers in the ‘NHS long term plan’.

There are now at least 100 social prescribing schemes running in different parts of the UK, but The Pharmaceutical Journal’s FOI request found huge variation in enthusiasm for the concept across the country.

Somerset CCG, for example, currently employs 60 social prescribers, at a cost of £1.92m; Dorset CCG funds a voluntary care sector provider to employ 15 health coaches and six link workers at a cost of £1m per year, and Sunderland CCG employs 17.5 WTE social prescribers, with a spend of £336,000. Many CCGs have no social prescribers working for them at all.

Helen Stokes-Lampard, a GP and former chair of the Royal College of GPs, is the newly appointed chair of the National Academy for Social Prescribing, which was launched in October 2019 by Matt Hancock, health and social care secretary, to increase awareness of the benefits of social prescribing and standardise provision and training.

She is keen, perhaps surprisingly, to de-medicalise the entire field of social prescribing, which she describes as “a social revolution to help people become the best they can”.

“In medical terms we talk about the biopsychosocial model, and a GP will focus on all those areas, but this is looking specifically at the social part of that model,” she says.

“A good GP will already do an element of this, but priests also do it, hairdressers are doing it, postal workers do it. It’s not new, we are just giving it a name and a bit more structure. Lots of local councils are also very good at this, and one of the things we need to do is map the services available so that referrers know what is available in their area.”

Stokes-Lampard says GPs are often cited as being vital to social prescribing because of the footfall in their surgeries and their place at the heart of the trusted NHS brand. However, she agrees that pharmacists have their part to play, along with other healthcare professionals and people outside the NHS.

“Success would be hundreds and thousands of people benefitting from it in a measurable way, with no-one asking what it is because it’s part of the fabric of society,” she says. “And GPs shouldn’t be the gatekeepers of social prescribing, just one of the ways in.”

Social prescribing in pharmacy

One of the advantages is its ad hoc nature

However, the use of social prescribing in pharmacy has yet to take off. A study published in Pharmacy, in March 2019, found that although support for pharmacy involvement in social prescribing was strong, with 95 (85.6%) of 111 pharmacists who took part in the survey agreeing that “pharmacy and pharmacists could have a role in social prescribing”, the same survey found that 36.7% (n=44) of pharmacists had not even heard of the term ‘social prescribing’.

According to the Pharmaceutical Services Negotiating Committee, there have been just two social prescribing schemes commissioned that include community pharmacy. One of these ran in Oxfordshire and was funded by the local authority, but it has since been decommissioned.

The other began in 2014 and is still operating. Delivered by voluntary sector organisations in the Doncaster area, the scheme was extended to include pharmacists.

Nick Hunter, chief officer for Doncaster, Rotherham and Nottinghamshire local pharmaceutical committees, says: “To support the roll-out [of the service], I did some training for the social prescribing team about community pharmacy and the sort of queries we get and can help with, and we then had the social prescribing team do a slot at one of our pharmacy team training sessions”.

Charlotte Wigglesworth, who works at Weldricks Pharmacy in Thorne, Doncaster, is one of the community pharmacists who has referred a patient to the service. She says one of the advantages is its ad hoc nature.

Patients can be referred by completing a form setting out the healthcare professional’s concerns, but it can also be done informally with a quick phone call to the social prescribing team. Hunter says its simplicity has been vital to the scheme’s success.

Wigglesworth gives an example of a patient she referred to the service. “A regular patient came in who seemed very down and withdrawn, so I just had a chat with him and he told me that his wife had developed dementia and that consequently he was finding it very difficult to get out of the house .”

“The patient came in the other day and said that the service had found someone to go to his house every day from Monday to Friday, normally around lunchtime, to help with the washing and cooking. He says it has made a huge difference to him.”

“I don’t do it very often and I have probably only referred three or four patients, but it can really help for people who can’t obviously be referred to other settings.”