A number of new roles have been introduced into primary care over recent years. In this blog, I’ll focus on two ways that social prescribing is delivered, in particular, the active sign-poster referred to here as a care navigator, and the social prescribing link worker.

Care navigators are often primary care reception staff who have received appropriate training on options they can provide patients. The care navigator role should be seen as complimentary to social prescribing when viewed in terms of ‘as well as social prescribing’ not ‘instead of social prescribing’ (NHSE, Social Prescribing and Community Based Support 2019).

The four levels of social prescribing

Social prescribing as care navigation was identified as the first of four levels by Kimberlee (2015), who notes a growing evidence base for providing online information or leaflets in GP practices to help patients choose the most appropriate service.

The key aspect of differentiating the care navigator role, from other types of social prescribing, is the time the care navigator has with the patient. For the care navigator, it’s often a brief intervention with 30 seconds to a couple of minutes for the care navigator to identify the need and, if appropriate, offer the patient a choice between a GP appointment and an alternative healthcare professional.

Kimberlee (2015) goes on to say that ‘social prescribing light’ was the second level, led by the voluntary sector, including providing a point of contact and addressing a specific need, but no direct links with general practice.

‘Social prescribing medium’ is the third level identified by Kimberlee (2015) and includes a health-focused role, with a set number of visits, addressing healthy lifestyle choices through applied behaviour change techniques.

Finally, the fourth level of social prescribing identified by Kimberlee (2015) is ‘social prescribing holistic’ with a direct primary care referral to social prescribing link workers who may be based in general practice, but are employed by a local social prescribing community provider and focus on the persons self-identified needs.

What is the evidence social prescribing works?

Social prescribing can reduce demand for GP appointments.

A recent study published in the BMJ open journal by Kellezi et al (2019), asked 630 patients to complete a survey at the point of referral and again four months after they had received social prescribing.

There was a reported 25% reduction in healthcare appointments and decreased feelings of loneliness.

Dr Chris Dayson from Sheffield Hallam University has contributed towards the evidence base with several evaluations in Yorkshire, such as in Rotherham in 2014, Doncaster in 2016 and Bradford in 2017. These evaluations show a return on investment to the healthcare system, reductions in primary and secondary care demand as well as improvements in individual mental wellbeing scores.

Despite this, social prescribing evaluations often draw criticism for their lack of methodological rigour (Evidence to Inform the Commissioning of Social Prescribing, 2015).

Social prescribing, as signposting or care navigation, builds on the GP receptionist role, who for many years have helped patients choose a doctor or nurse appointment.

As the extended primary care team grows under the NHS Long Term Plan (2019), social prescribing link workers will benefit from spending time with care navigators:

• By listening to the needs of patients who request GP appointments, they can flag appropriate referrals.
• Working together GPs, link workers and care navigators can co-develop the systems and processes so that everyone feels confident for direct signposts away from GP appointments to a link worker.
• There’s also the option of working with a care navigation training providerConexus Healthcare have trained over 10,000 care navigators across England and Wales, with an accredited care navigation training programme. Appropriate training and support is available to social prescribers with the introduction of a level 3 social prescribing qualification.

So, in a nutshell.

Working together, care navigators and link workers are able to play a greater role in helping patients access social prescribing.

So Mr Williams can directly access a social prescribing link worker, via a care navigator, for welfare and benefits advice. Miss Jenkins can feel less anxious about her housing issues because she’s being supported through each step of talking to her housing association. And Mrs Rupinder could wait just days, rather than weeks, to get extra help with her carer duties, thanks to both a care navigator and link worker.

An integrated care navigation and social prescribing service in primary care makes perfect sense. Patients can get the help they need sooner without the need to see a GP first and save finite GP appointments for patients with medical needs.

Dayson, C. (2014) The Social and Economic Impact of Social Prescribing. Available from: https://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/social-economic-impact-rotherham.pdf

Dayson, C. (2016) Doncaster Social Prescribing Service. Understanding Outcomes and Impact. Available from: https://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/eval-doncaster-social-prescribing-service.pdf

Dayson, C. (2017) Evaluation of HALE Community Connectors. Available from: https://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/eval-HALE-community-connectors-social-prescribing.pdf

Evidence to Inform the Commissioning of Social Prescribing (2015) University of York. Centre for Reviews and Dissemination. Available from: https://www.york.ac.uk/media/crd/Ev%20briefing_social_prescribing.pdf

Kellezi et al (2019) The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision. BMJ Open Journal. Available from: https://bmjopen.bmj.com/content/9/11/e033137

Kimberlee, R. (2015) What is social prescribing? Advances in Social Science Research Journal. Vol 2, No 1. Available from: https://blogs.ncvo.org.uk/wp-content/uploads/2016/02/what-is-social-prescibing.pdf

NHS England (2016) High Impact Action Case Study. Available from: https://www.england.nhs.uk/publication/west-wakefield-reception-care-navigation/

NHS England (2019) Social Prescribing and Community Based Support: Summary Guide. Available from: https://www.england.nhs.uk/publication/social-prescribing-and-community-based-support-summary-guide/

NHS England (2019) Long Term Plan. Available from: https://www.longtermplan.nhs.uk/