Having just returned from the Beyond Pills Campaign launch I am feeling inspired and positive about the future of social prescribing and the beauty of connecting with the community using an asset based approach. The Beyond Pills Campaign launched by the College of Medicine with recommendations and reports following the government’s national overprescribing review report. (National overprescribing review report - GOV.UK (www.gov.uk)
The Beyond Pills Campaign l addresses some of the issues described in the report. Having been on heavy doses of medication for most of my life, I know the impact and how much it takes from the person’s ability to function and thrive in life. I never knew what each specific medicine was for, or the side-effects of each one, nor the interaction being on the cocktail of such medication would impact me (both positively and negatively).
The campaign looks at solutions of prescribing medication as a last resort rather than the first. It describes social prescribing as one of the key factors in a person’s health and well-being. Having benefited and used an art class to not only get me off the medication, give me my life back and allow me to thrive with my health conditions I was only too happy to help and back this campaign.
There are six calls to action from the campaign these are;
- Improving medical and healthcare training. Social prescribing and a psychosocial approach to treatment needs to be embedded throughout the curriculum
- Addressing financial incentives within the NHS. Financial incentives in the system should centre around community health. For those patients already on a cocktail of pills, medication reviews and appropriate deprescribing need to be emphasised
- Increasing the number of social prescribing link workers. Primary Care
- Networks need to employ more link workers to enable access to social prescribing for everyone who could benefit
- Increasing support for the voluntary sector. Government departments need to fund and support voluntary initiatives that encourage healthy communities
- Empowering individuals and communities. Informing individuals about social prescribing and collaborating with volunteers involved in social prescription and local health creation and showcasing benefits
- Further systematic research. Mobilising the research community to develop a fully-fledged programme review into topics including the therapeutic efficacy of social prescribing
There are some practical tips for professionals to extend appointment times for medication reviews, stating they should be at least 30 minutes long. Whilst there are several thousand clinical pharmacists who have been asked to focus on medication reviews, there are some 8000 GP practices that still have some way to go to achieve at least one clinical pharmacist when ideally, they should be six or seven per primary care network (PCN). Whilst this seems encouraging it is still some way to start addressing the issues and really looking at the patient’s medication, why it was prescribed and if this really is the best way to treat the patient.
Anyone can of course ask for their medications to be reviewed, but another issue that I feel might need addressing is the electronic summary care record (SCR). Doctors can see and write in this record, but the community pharmacist can only read it. Whilst this might not seem too much of an issue it is not always stated what medications have been prescribed for what condition, thus not always helpful to the community pharmacist. While some medications can be prescribed for several different conditions and ailments, the pharmacist will not know specifically which one the doctor has prescribed the medication for. Just by ensuring the doctor adds what the medication has been prescribed for can the pharmacist get the bigger picture and see if that medication is the best, interacts the least with other medications and offer advice for the condition that may be treated very differently. If we are employing community pharmacists for medication reviews this must be implemented immediately to allow them the access and information to provide a comprehensive and trustworthy review.
The use of social prescribing link workers is a much more personalised way of dealing with a patient holistically. The link workers look at the practicalities of the patients’ lives, rather than just their conditions. They have the time to listen, respond, signpost and action any issues that the patient is facing which might not be medical, or could have an impact the condition. This is more realistic, supportive and productive for the patient whilst offering the personalised holistic approach that the NHS is trying to achieve. Whilst I had some reservations about link workers in the beginning, they have proved their worth especially throughout covid and lockdown.
My concern with link workers is the sporadic nature across the country. They are employed by PCN, local authorities and through contracts via NHS trusts. This leads itself to a postcode lottery where some areas get the gold standard and others are left struggling to bumble along. Whilst there are recommendations to employ more link workers I would like to see a standard of practice across all employed agencies to train, support and fund the link workers so that regardless of which area you live, or where they are employed in and who is funding them, it is more equal to offer consistency and equal services to all.
Whilst I’m realistic that not everybody will benefit from social prescribing the side-effects of an art class, football group knitting, or singing (for examples) are negligible to the side-effects of prescribing or overprescribing of medications. With creativity offering cradle to the grave projects, with no religious, cultural, sexual or prejudices of any kind it is easy to see why it can (and should) be used so widely to assist in improving the strain on the NHS.