Social Prescribing in the North West

Social prescribing considers the context in which people live their lives, those wider determinants that are so important in predicting and supporting levels of wellbeing as well as levels of inequality. Health inequalities are those unfair and avoidable differences in health across the population, and between different groups within society. 

People in lower socio-economic groups are more likely to have long-term health conditions, and these conditions tend to be more severe than those experienced by people in higher socio-economic groups. We also know that these disadvantaged and or marginalised groups are more likely to experience over prescribing. Targeted proactive social prescribing provides an additional mechanism to address health inequalities and support alternative patient journeys which reflect what matters to the person, not just what is the matter with the patient.

Proactive social prescribing builds on the Tackling Neighbourhood Health Inequalities (TNHI) service specification which recommends that a PCN must identify a population within the PCN experiencing inequality in health provision and/or outcomes and develop a plan to tackle their needs.  It also aligns with the “PLUS” component of the national CORE20PLUS approach.  80% of health outcomes are impacted by social determinants of health.  By taking a targeted approach to increase access to social prescribing and community support, this helps to improve health outcomes, enhances patient experience, and reduces health inequalities.

Check out HEE's e-Learning for Healthcare 'Social Prescribing - Learning for Link Workers' programme available  here. This e-learning resource has been developed for social prescribing link workers and includes the core elements and skills required to do the job and deliver social prescribing as part of a PCN multi-disciplinary team.

The NHS England North West Social Prescribing Network (NW SP Network) was one of seven regional networks supported by NHS England and the NHS Futures Platform. It was dissolved in April 2022 as part of the movement towards place based working and reflected a movement of resource from national to local NHS teams.

The Cheshire and Merseyside and Lancashire and South Cumbria ICS personalised care groups have subsequently continued to work together to enable a peer support network through the appointment of consultants charged with the ongoing development of the social prescribing workforce with the work of Health Coaches and Care Coordinators embedded through supporting the implementation of the workforce development frameworks, commencing with the SPLW Workforce Development Framework.Greater Manchester Health Care Partnership continues to coordinate a network across their ten local authorities.

In response to changes in the NHS direct network support and reach in each locality the University of Central Lancashire has been actively encouraged to fill the space created by changes in working arrangements within the ICS.UCLAN manages an activie social prescribing unit. Likewise, in Cheshire and Merseyside Edge Hill University and Chester University are currently developing a similar model to UCLAN.

The NW SP Network core objective was to be at the forefront in social prescribing and aimed to:

• Maximise the opportunity to impact on regional health inequalities through social prescribing throughout the life course
• Highlight the value of early intervention with a specific focus on women and children
• Champion innovation and the VCSE
• Engage and support health and social care leaders and decision-makers
• Engage and support Primary Care Networks to establish social prescribing services
• Develop the evidence base for excellence in social prescribing
• Build stronger working relationships between acute, primary, community and social care and establish effective, sustainable, local community action
• Build a strong and resilient link worker workforce which is well understood and well regarded and seen as integral to public health.

These objectives still drive many of the social prescribing development in each ICS. However, the current focus is much more about:

1. Extending and embedding commitments to delivering personalised care as business as usual and ensuring wider understanding about the value of ARRS roles, specifically -social prescribing , health and wellbeing coaches and care coordinators-likewise activity to identify and harness levers to support this commitment is seen as key
2. This work will include the production of a specific directory of resources to support Additional Roles Reimbursement Scheme (ARRS) which provides funding for 26,000 additional roles to create bespoke multi-disciplinary teams in primary care. The ARRS implementation and success (for example: embedding the national Maturity Framework ) will include any ICS developed resources which support activity and more specifically highlight any C&M and LSC generated content
3. Peer support infrastructure will include local (place based) and subregional considerations and engagement with C&M and LSC infrastructure and networks including encouragement of Higher Education Institutions (HEIs) to develop social prescribing hub presence
4. Social prescribing developments will be linked to a HEE led health student placement expansion programme and encourage culture change linked to salutogenic principles at pre-registration and subsequently link back to HEI partnerships.

Regional strategic leads

Yvonne Clarke and Jo Ward currently support a programme of work directed at Primary Care Link workers across both Cheshire and Merseyside and the Lancashire and South Cumbria(LSC) ICS.

Yvonne Clarke MBE is the founding Managing Director of Pathways Community Interest Company; currently Yvonne is Managing Director of the Personalised Care Training Academy, an arm of Pathways CIC delivering PCI accredited training; she is an appointed PCI Ambassador, VCFSE Lead for SMASH care community; joint VCFSE Lead for CHAW care community and Crewe and Nantwich & Rural care Community; she is a recognised VCFSE leader for Cheshire East Place and Cheshire and Merseyside. 

Yvonne has led Pathways to be a Gold Investors in People organisation, which is a nationally accredited standard for people management, and where Pathways has demonstrated effectiveness in improving performance and realising objectives through the management and development of Pathways’ people.  Previously Yvonne held the NW Regional Associate Social Prescribing Support Coordinator post, NW Regional PCN Advisor role and was the Interim Regional SPLW Learning Coordinator.  Yvonne has gained a national reputation for innovation and commitment to improving community outcomes, gaining an MBE in 2020 New Year’s Honours List.  Yvonne completed two decades within the NHS, having been the Associate Director for Learning and Development at St Georges Hospital in Stafford, Co-led the award-winning Employment and Health Work-stream for Wolverhampton Health Action Zone.  In 2006, upon leaving the NHS, she established Pathways CIC to reduce inequalities and support the bringing about of social change.  Yvonne led Pathways to develop a primary care facing social prescribing service in 2015 (Alternative Solutions) which was identified as a model of international best practice in 2018 and by design, delivers personalised care, focusing on ‘what matters’ to patients.  Yvonne has led the establishment of the Personalised Care Training Academy in 2021 to specifically support the embedding of personalised care as ‘business as usual’ and support the delivery of the NHS Long Term Plan.  Yvonne recently completing a piece of work commissioned by NHSE to develop examples of good practice in employment of SPLWs in line with the SPLW Workforce Development Framework.   Through the Regional Associate roles Yvonne has both worked at PCN and practitioner level to support the implementation of the DES requirements and NHS Long Term Plan by provide clear and consistent standards for SPLW, HWbC and CC practice including providing guidance on support supervision and learning and development.

Jo Ward has been supporting the development of social prescribing scale and spread for NHSE since 2014/15, working across the North West, as a consultant for both NHSE and Health Education England (HEE) and as such uniquely positioned at the interface between primary care education, employment and patient experience. As a consultant tasked with developing an online resource to increase health sector understanding of the role and opportunity presented by social prescribing Jo wrote the HEE workforce guide, Social Prescribing at a Glance. As a member of the HEE widening participation in healthcare education working group Jo led the development of Success in Practice an unique exploration in to the role of apprenticeships in GP practices. Originally devised as a practical guide for GP surgeries to help them embed new models of care, it provided a platform to articulate the value of a clear commitment to train and develop the existing workforce with an emphasis on prevention. Likewise is presented as a clear opportunity to promote an investment in new roles within healthcare.

As a core member of the HEE NW Population Health and Prevention Network NW steering group, with HEE and PHE (now OHID), Jo has directly influenced the consideration of ARRS roles as core components of a public health landscape. This resulted in direct investment in the development of a Social Prescribing National Network for Nursing, midwifery and AHPs as well as Special Interest Group, and the national Personalised Care Interprofessional Education Group (PerCIE)through Placement Expansion funding and the promotion of Enabling Effective Learning Environments. This focus on network development has been designed to support reach and extend influence it has also supported cross fertilisation and highlighted common ground. Jo has directly cultivated higher education infrastructure to provide social prescribing hubs in both C&M and Lancs and S Cumbria with a view to ensure sustainable infrastructure. Most recently Jo was recruited to the CHAMPS steering group to support consideration of CORE 20 Plus 5 needs linked to ARRS roles.

Through work with NHS Estates and the Ministry of Justice Jo has directly influenced investment in social prescribing in Primary Care C&M , specifically the Wirral Flourish Wellbeing Hub. Jo continues to support social prescribing across C&M be it frontline staff requiring practical support and advice or at a more strategic level supporting Clinical Directors and practice managers or VCSE colleagues. Most recently Jo has sought to address concerns regarding the availability of wellbeing journeys, by brokering a commitment between the Combined Authority, Northern Rail and the ICS to deliver supported travel to warm hubs to address a cost-of-living crisis. Likewise as an adviser to the ICS women’s health and maternity programme, Jo has leveraged over significant investment in the last 12 months in to social prescribing and creative health interventions which are directly promoting the recruitment and retention of clinical staff into primary care through innovation.

Both Yvonne and Jo deliver a package of support for PCNs encompassing link workers, health coaches and care coordinators.

This consists of

1. A monthly bulletin.

2. Peer Network Meetings – January to March 23

• 27 January 1-2pm
• 21 February 12-1pm
• 16 March 12-1pm

All meetings focus on

• Implementation of the Workforce Development Framework
• Sharing of best practice across localities
• Discussing challenges of implementation
• Knotty issues people are facing.

At the meetings attendees are encouraged to share information about implementing the Framework.   These exchanges can be a physical presentations, or simply a chat through what is happening in a locality at the meeting.  Link workers are encouraged to share how their locality is implementing the workforce development framework and best practice including:

• How a caseload is managed
• How link workers, health coaches and care coordinators work with specific cohorts of patients
• How proactive social prescribing is being addresses
• Demonstrating work as part of MDTs
• How care coordinators and health and wellbeing coaches link with social prescribing and or each other
• How within patches do staff ensure reflective practice
• How to demonstrate the impact of social prescribing
• How continued professional development is implemented
• How supervision is delivered.

If you aren’t already engaged in the regional peer support network for C&M or LSC do get in touch with Yvonne Email yvonne.clarke@pathwayscic.co.uk or Jo Email jo@jowardchangemaker.org.uk

Greater Manchester

Greater Manchester is a devolved region and it therefore has a separate sub-regional social prescribing lead Charlotte Leonhardsen. Charlotte is the Programme Manager and Social Prescribing Lead at GMHSCP. Email c.leonhardsen@nhs.net

See GM video https://www.youtube.com/watch?app=desktop&v=WB9DHGwq8PQ

The GM team distribute a monthly link worker bulletin and host a link worker face book group https://www.facebook.com/groups/2736596353086102/ To register for the bulleting email gmhscp.pcca@nhs.net

The Workforce Development Framework for social prescribing link workers  is designed to help increase the understanding of the role and where link workers can have most impact in supporting and empowering people to improve their health and wellbeing. It also sets professional standards and competencies, give guidance on supervision, training, and continuous professional development.   I would be really interested in hearing your comments on the document. 

A key development in Lancs and South Cumbria will be the establishment of a Task & Finish Work group which will support the development of the ARRs roles and others as an Allied Health Professional group, covering the development and associated.

The Social Prescribing Network which has a national and international focus. It consists of health professionals, researchers, academics, social prescribing practitioners, representatives from the community and voluntary sector, commissioners and funders, patients and citizens. The membership work together to share knowledge and best practice, to support social prescribing at a local and national levels and to inform good quality research and evaluation. Over the past 5 years, the network has worked with many different organisations to launch an annual International Social Prescribing Day every March ,The Social Prescribing Network Awards and an annual international conference.

Special Interest Groups (SIG)

The NW region is also represented on two national social prescribing special interest groups covering nursing, midwifery, AHPs and medicine and children and young people (0-25) SIG. The NW SP Network was the first region to establish a commitment to focusing on women and children to address health inequalities where they start.

Nursing, Midwifery, AHPs and Medics (known as SIGSPN)

Dr Michelle Howarth chairs and hosts the nursing SIGSPN, the first social prescribing SIG. A burgeoning national network spanning academia, policy and practice: originally founded to reflect the role of nursing in driving wellbeing and health creation agendas which quickly expanded to reflect similar concerns in other clinical fields.

Twitter @sigspn

Focus: contemporary health care curricula design is heavily weighted towards a pathogenic model of health. The inequality between pathogenic and salutogenic models has also led to an over-reliance on NHS placements that typically reflect a pathogenic approach. There is a need to promote salutogenic approaches that encourage students to explore what matters to people, rather than what’s the matter with them.

However, the current curricula can limit student awareness of the wider determinants of health and wellbeing, personalised approaches and the role of the community in promoting and supporting healthy citizens. Continuation with the current model may exacerbate professional educational silos and reinforce a patient centric paradigm as opposed to a citizen/person centred approach.

Membership: university sector (HEIs), NHS organisations and providers, the social prescribing network, healthcare students, VCSE and Private and Public sector agencies (PIVO)

Activity:

1. Strengthen the nursing/AHP role within implementation of the Comprehensive Model for Personalised Care Model.
2. Develop a national inter-professional social prescribing framework to support collaborative, cross sector integrated working.
3. Widen access to healthcare education and enable students to develop the business and innovation skills to support personalised care models to transform future services.
4. Highlight and enhance how health care professionals can work alongside link workers across community and hospital care sectors to promote personalised care for all.
5. Help support and develop placement capacity within PCNs and third sector (non-governmental and non-profit-making organizations or associations, including charities, voluntary and community groups, cooperatives-PIVO).
6. To support the development of a robust evidence base.
7. Actively collaborate with the National Social Prescribing Academy and Institute for Personalised Care

Sub-groups: PERCIE framework working group- facilitates the development of an inter-professional framework to support students leaning in non-clinical settings supported through an Health Education England tariff.

Useful documents:Innovative partnership - Shaping learning through the Third Sector, Howarth, ML, Leigh, JA

Key contact: Dr Michelle Howarth

Improving Me the NHS Cheshire and Merseyside women’s health and maternity programme (an NHS maternity vanguard) works collaboratively with the Office For Health Improvement and Disparities , formerly Public Health England and NHS England’s Maternity Transformation team to advocate for social prescribing. This alliance believes social prescribing creates an opportunity which not only protects women at one of the most vulnerable times in their lives but equally recognises the value of early years investments. Social prescribing creates an opportunity to address health inequalities as well as stopping them before they start. Improving Me is the only Local Maternity and Neonatal System to have adopted a prevention workstream focused on social prescribing and creative health developments as part of NHS 70 celebrations in 2018. In response to COVID recovery Improving Me reached out to Better Start Bradford and Leeds Council to form a collaboration around an annual campaign Baby Week. This reflects the shared link between infant and maternal mortality rates and levels of deprivation .To find out more simply visit the Improving Me webpages and take a look at Baby Week the partnership’s annual campaign and webinar programme.

Baby Week 2023 will run from 14-19 November. Save the Date.

Young People’s SIG

The young people’s SIG believe if we adapt social prescribing to suit age-related needs there is no reason why we can’t deliver the same for young people. This SIG for Young People is a place where people can collaborate, share experiences, pass on tips and pool knowledge and resources about all aspects, from planning to promotion, and outcome measurement to quality assurance.

The purpose of the SIG is to save time and money by sharing knowledge and to give local organisations a support network to call upon. They produced a briefing paper from the Young People's Health Partnership on Social Prescribing for Young People which you may find helpful. A NHS England working group has also been established to develop a Children and Young people’s toolkit to facilitate the development of specialist link workers. It will be published in March 2023.

Thriving Communities Network

The Thriving Communities Network links local VCSE groups and organisations together in order to champion their vital role and the impact they have in society. The NW Thriving Communities Network is coordinated sub-regionally in Lancashire and South Cumbria by Christine Blythe and in Cheshire and Merseyside by Jan Campbell. Voluntary Sector North West provides region wide communications for the Thriving Communities activity.

Members can:

• submit queries, ideas and showcase their work and development,
• be part of a webinar series which celebrates reductions in health inequalities and,
• receive guidance and free resources.

It is FREE to join.

Global Social Prescribing Alliance: International Playbook

Improving Me: A Social Prescribing Concordat for Creative Health

 If you would like your locality best practice examples included within the resources please email Yvonne Clarke and Jo Ward

E: yvonne.clarke@pathwayscic.co.uk
E: jo@jowardchangemaker.org.uk 

• Dannys Story https://www.youtube.com/watch?v=J6WIOpnRJGI
• Pams Story https://www.youtube.com/watch?v=E4zqFZOu-sE
• Generic Social Prescribing Video https://www.youtube.com/watch?v=axI65SAZDxY

The role and value of proactive social prescribing is very clear as a driver for CORE 20 Plus activity in Primary Care. With a range of new specialist roles and workstreams coming on board the opportunity to influence smoking in pregnancy clearly aligns with the Core 20 Plus 5 maternity ambition and equally with the launch of the new Core 20 Plus 5 CYP resources which acknowledge the role of best start.

LINK: Social Prescriber Training One-Pager