The unsustainability of current social prescribing models

Power to Change’s Health & Social Care, Community of Practice (CoP) is a group of community business leaders from around the country working together to highlight the potential for community businesses to transform the delivery of health and social care services, and the barriers to its uptake. Here, they look at the unsustainability of current social prescribing models.

For decades, voluntary and community sector (VCS) organisations have provided significant preventative interventions such as coronary, renal, weight loss, welfare rights and debt services. As austerity measures and increase in demand start to impact the NHS, there is a growing desire among hospitals, care trusts, CCGs and primary care networks to refocus and reinvent health services. There is also a growing expectation among patients that services be on their terms.

This drive to provide financially efficient and high impact services has led to innovative partnerships with the VCS to deliver services at the community level. This includes social prescribing, which is thought to lead to a reduction in the use of NHS services and GP workload. Under social prescribing, patients are referred to services provided by the VCS for health and/or social care related presentations including social determinants .

For example, a patient with borderline type 2 diabetes can be referred to a VCS organisation who are contracted to provide a diabetes prevention and management programme. However, VCS organisations usually adopt a holistic, person-centred approach, thus will invariably end up providing additional health and social interventions (e.g. mental health, debt, housing, employment services) as required by the patient.

The Long Term Plan commits the NHS to building the infrastructure for social prescribing in primary care, but the majority of funding only pays for the direct salary costs for the Link Worker (LW): it aims for 1,000 LWs by 2020/21 and at least 900,000 people referred to social prescribing by 2023/24. It makes the assumption that the issue is solely one of demand; that VCS organisations have the capacity to deliver preventative services, but lack the necessary referrals. This is very rarely the case, and with the increasing cuts to traditional grants, these organisations are already stretched. The increase in social prescribing activity is likely to push many to the edge, or even over it.

Some social prescribing programmes are funded on a ‘pay-as-you-go’ basis. They are prescriptive in relation to health interventions and cover the costs of staff delivering the service. Rarely do we see the costs being paid for services tackling other social determinants, staff training, management, premises or additional services that the person may require. And due to the nature of many of these contracts, VCS organisations employ staff on a sessional basis, or on zero hour contracts. As a result, there is no job security.

Social prescribing has the potential to provide a valuable platform for developing seamless health pathways, but it needs to be properly and fully funded and flexible enough to meet the people’s needs. It will only work if the budget follows the patient. Without adopting a principle of full cost recovery, VCS organisations will be subsidising the health sector and find themselves struggling financially. 

The social prescribing model should be further developed, fully resourced and sit alongside a drive for systemic change which brings clinical, primary, public and social care and the VCS together as a seamless health service which is fit for the twenty-first century.

Find out more about our Health & Social Care, Community of Practice here.