Yesterday I suggested that one of the main themes of this blog will be about how, if it is going to thrive for its next 70 years, the NHS is going to need more help than just people’s tax money.
For the past few years I have been working with leaders of the Multi-Specialty Community Providers (MCP) Vanguards. Every couple of months we discuss how they are developing new models of care to provide a genuinely different experience for the public. This has involved a lot of changes for both the NHS and local government but one thing that unites all the MCPs is that over this period they have all developed broad and deep relationships with the voluntary sector.
Interestingly, whilst there may have been a passing reference to the voluntary sector in some of their original plans it has only been as they have developed new services in practice that the Vanguards have come to realise that the NHS cannot provide the services it needs without a close relationship with an active voluntary sector.
When you work with younger people with complex needs, or older people with co-morbidities, it soon becomes pretty clear that the NHS and social care can’t really solve their needs on their own. Everyone – clinicians, health care managers, members of the public and their carers, and social care organisers – knows that that the causes of disease and ill health go way beyond what medicine alone can solve.
But underlying this intellectual understanding is the expectation shared by clinicians and public alike that it is the NHS that will make them better.
As I said yesterday, we now know this doesn’t work. I also mentioned the many examples of the NHS actively working in partnership with other sectors of society to create new ways of improving care. Between the medical and the social.
Social prescribing is one such example.
For most of the last 70 years good primary care has been aware of the limitations of medicine to deal with many of the ills that come through the door. One of the greatest books written about health care was “A Fortunate Man”, by John Berger. A beautiful book with stunning pictures that outlines the day to day work of a rural GP. Whilst much of the book is about the battle with disease, it also chronicles the fight against damp housing, isolation and rural poverty. While the GP’s daily work may make a dent on the medical causes of their problems, his patients were confronted by much more than disease. The doctor tried to do something about this but the book is a record of failures.
Nearly all GPs recognised the limitations of medicine in dealing with the mental and physical lack of well-being they encounter. For many busy GPs there was not been much else they could do. In consultations they would suggest you might drink a little less or do more exercise or get out more, but generally such suggestions were nothing more than pious hopes. Nearly everyone in the primary care team realised that their behaviours would not have changed when they next saw the patient. But the knowledge and intention to go beyond what medicine could provide was always there.
Social prescribing now takes that intention further through a partnership with a major set of English institutions – the voluntary sector. It provides the primary care team with real concrete assistance in expanding the primary care offer to the patient. On their own, there is no way a local GP can discover the changing organisational offers the voluntary sector is making to the population. Keeping up with medicine is a full time job and then some. Keeping up with the fact that the local fishing group has now become a group of ‘Men in Sheds’ is just not going to happen. But if primary care practice wants to move beyond “You need to get out more” then this is what they need to know.
So primary care and the NHS need help.
The best forms of social prescribing will have someone (whose title may be different in different social prescribing structures but is essentially a ‘health trainer’) whom the GP can suggest they should see to talk about types of activity with which they would like to get involved. And at that moment of ‘prescription’ the NHS is saying “we need some help in assisting this patient”. It’s then up to the trainer to have a much longer motivational interview with the patients about where they are in their lives and what they want to do. It is the voluntary sector that organises the real activity.
As we shall see this partnership is not free but in every instance it is a lot less expensive that a ten day stay in an emergency bed. According to the Royal College of GPs 59% of GPs feel this saves them time. And, if we want the NHS to be here in another 70 years, it is the time of highly trained professionals that we need to save.