1. Social PrecribingDeveloping effective interventions in the PrimaryCare environment based on health andsocioeconomic need. A Therapeutic Model

2. What is Social Prescribing?Social prescribing has been quite widely used forpeople with mild to moderate mental healthproblems, and has shown a range of positiveoutcomes, including emotional, cognitive andsocial benefits. Social prescribing may also be aroute to reducing social exclusion, both fordisadvantaged, isolated and vulnerablepopulations in general, and for people withenduring mental health problems (Bates 2002;Gask et al. 2000).

3. What are the advantages?Reduction in need for clinical or secondary careReduced need for prescriptive interventionDevelops patient autonomyIncreases awareness of alternative carepathways using non-clinical approachesAcknowledges patients socioeconomic andcomorbid health needs

4. When to prescribe?We all use assessment material to measure anindividuals mental well being, PHQ 9 for example.But what other information lies beyond the numbersthat are generated? Are we taking into accountother factors that are impacting on their lives? Dowe have the time? Do we have the skills to addressthese other factors, provide relevant information orknow where to sign post them? Social Prescribingfinds the issues that are underpinning andreinforcing these problems and finds non clinicalpathways to address them.

5. Based on a US model of deliveryHealth Leads is part of the clinic team.With Health Leads, doctors, nurses, and social workerscan focus on the complex clinical issues that they areuniquely trained to address. By providing an alternativeworkforce to connect patients with basicresources, Health Leads enables providers to delivercomprehensive patient care. In the States the modelcombines a paid worker who serves as the SocialPrescribing Coordinator with a team of volunteers whoare able to buddy with clients to guide them throughalternative service pathways and support their individualor family needs.

6. Health Leads The Health Leads model had a positive impact onreducing unmet social needs for low-income families. Thisinnovative multidisciplinary team-based model was able to connectthe medical home with community-based resources, often adaunting task within the current primary care modelLegalUtilitiesFoodEmploymentEducationHousingBenefits

7. Patient presentsin primary caresettingProviderscreens forneedsPatient bringsprescription toHealth LeadsDeskSocialPrescriber orVolunteerAdvocateenablesconnection toservicesFollow up bySocialPrescriber orAdvocateUpdatesprovided toclinical teamDeliveryModel

8. Alternativeto one toonetherapyMindfulnessCrisis CareSpecialistPsychology/PsychiatryHome ITAnxietyProgramConditionSpecificGroupReassessedfor FamilyTherapyMotivationGroupTherapySocialPrescriber

9. iCloudCentralSystemClient DiaryPsycho-educationTools todownloadClient NotesCentralBookingSystemEmailexchange &contactfacilityAccess toassessmentmaterialTherapyTools toaccess inthe home

10. What do Physicians think?4 out 5 of 1000 surveyed (690 from primary care 310 pediatricians)agree with the following statements with regard to socialprescribing;Unmet resource needs lead to worse health outcomesAre not confident in their capacity to address their patientsneedsSay that patients social needs are as important as their medicalconditions. This is especially true for physicians (95%) servingpatients in low-income urban communitiesDoes the US model reflect UK need and the experience of cliniciansworking in the primary and secondary sector?Our argument and experience at LincsTherapy is that the answer isunequivocally yes

11. What would Social Prescription look like in theprimary care setting?Embedding a project coordinator to sustain a social prescriptiveproject is as simple as providing a room and IT capacity.However, if the practice is committed to enabling social prescriptionthroughout the patients primary care experience then this has topermeate through each tier of the primary care model.Dissemination of information and training of staff is key to enablesign posting of patients prior to referral to a clinician. The voluntarysector model of the use of volunteers to provide much of the servicewill be key; not only economically but this will enable individuals andfamilies to navigate an often confusing system of health andsocioeconomic care system without the intervention of traditionalcostly secondary services.

12. Economic impact for the commissionerFull time coordinator would be based on the current 2013 Band5 NHS salary structureVolunteers would receive expenses and trainingManagement fees would constitute 15% of the total cost of theserviceProvision and price of other services i.e. therapy andconsultancy would be based on an ad hoc basis orcommissioned contractual arrangementProvision of IT capacity access to terminalsLincsTherapy is an eclectic organisation and provides services thatmeet need and expectations within the public sector and iscommitted to continuous growth identifying new and innovativeways to tackle the challenges that are representative of anincreasing demanding world and the complexities of 21st Centuryhealth care.

13. ConclusionIt is clear that there is a growing need to provide a servicewhich addresses the issues that are not evident within theclinical diagnostic environment yet are having a profoundimpact on individuals and families lives. It is also clearthat clinicians time can be used more effectively if thesenon-clinical issues are met within primary care andsupport physicians to meet the complex demands thatthey are faced with.Social Prescribing can provide the evidence basedeffective service that meets the growing socioeconomicburden people are faced with each day of their lives. It isnot a vehicle to relinquish personal responsibility whenmet with hardship; it recognizes that people need to beable to connect with services that improve well being andcompliment clinical delivery and this burden of need hasto be shouldered by all of those throughout thepublic, private and voluntary sector tasked with theprovision of care.