A better pill to swallow

Atypical visit to the GP often ends with a prescription. But a new campaign is urging family doctors to recommend a ‘social prescription’ where possible, rather than yet another blister pack of pills. This could be anything from proposing you join a dance class or choir to signing up for a walking or gardening group.

Instead of taking a written script to the chemist, patients are referred to a ‘link worker’ – variously called community connectors, wellbeing advisers or community navigators, depending on where you live. They’ll get to know you and suggest activities to help you manage your health, then keep in touch to see how you’re getting on.

Social prescribing is certainly having a moment across the UK, with NHS England alone recruiting up to 2,000 extra social prescribing link workers, coaches and care coordinators to help ease the pressure on GP surgeries this winter.

Why has it become so popular? Partly, it’s a recognition that many problems can’t be fixed by medicine alone. The current ‘diagnose, prescribe, send you away’ model doesn’t cut it for complex, serious or long-term conditions, or when several conditions exist at once and spill over into other aspects of life, such as relationships and mental health.

It’s also partly down to concern about overprescribing (and the ballooning drugs budget). A report from England’s chief pharmaceutical officer, Dr Keith Ridge, last year claimed that one in ten drugs prescribed in the community in England – as many as 110 million medicines – were unnecessary or did more harm than good.

More than three in five GP prescriptions are issued to people aged 60-plus. And by the age of 65, one in ten is on eight or more prescribed meds each week, rising to almost one in four by the age of 85. Meanwhile, adverse reactions to drugs account for one in five admissions to hospital for those aged over 65.

A campaign called Beyond Pills, launched by the College of Medicine in June, calls for a shift in mindset to tackle this situation – including better training for healthcare professionals and an increase in social prescribing. GPs are also being encouraged to call patients in for a medication review. And a new initiative led by the National Academy for Social Prescribing, Royal Voluntary Service, NHS England and NHS Improvement encourages voluntary providers to get together and share ways to build partnerships with health services.

Brighton GP Laura Marshall-Andrews, author of What Seems to be the Problem?, has seen multiple prescribing reduce by 10% since adopting social prescribing. Her practice of ten GPs serving 24,000 patients has a Healing Arts programme, offering singing, art, creative writing, photography walks, dance groups and other activities. ‘Many of our biggest successes are with patients with chronic illnesses,’ she says. ‘I had one patient who was really disabled by Crohn’s disease. He was always coming to the surgery but after going to our narrative workshops, which involve therapeutic reading and writing, he was transformed. He said it made him realise he was bigger than his illness. It sounds like soft stuff, but it isn’t. He doesn’t require anything like the amount of medication as before.’

‘The aim is to take an integrated personalised approach and tailor it to the person in front of you’

Conditions that cause pain and mental health problems such as anxiety also lend themselves to social prescribing. ‘We’ve seen a 30% reduction in opiate and tranquilliser prescriptions and a 40% reduction in GP attendance in people who have gone through the programme,’ says Dr Marshall-Andrews. She was inspired by a similar initiative she saw in the Bronx, New York, but insists it’s not a question of either pills or a social prescription. ‘The aim is to take an integrated personalised approach and tailor it to the person in front of you in the surgery.’

Former carer Jane, 54, who has multiple health problems, including fibromyalgia, chronic fatigue syndrome, an underactive thyroid, osteoarthritis and migraine, was surprised when one of the practice doctors suggested a social prescription. ‘The social prescriber suggested an online singing group called Sing for Better Health,’ she says. ‘I’d previously been in choirs so singing appealed and I liked that it was online. It’s been great for my mood and mental health, and I’d recommend anyone give it a go.’

Southport GP Dr David Unwin has seen his surgery’s spend on diabetes drugs plummet by £68,000 a year since ‘prescribing’ a low-carb diet to patients at risk of or with Type 2 diabetes. The diet includes ditching starchy carbs, such as potatoes, pasta, cereals, bread, cakes and other foods that push up blood glucose. Patients are given a diet sheet and can attend a monthly video meeting to share experiences, set goals and see what works for them.

‘I’d never seen drug-free remission of Type 2 diabetes in 25 years of practising medicine, but now it has become routine,’ he says. ‘Something that surprised me was that patients would come back and say, “Oh, my psoriasis is lots better” or that their eczema or joint pains had improved.’

Retired computer programmer Linda Milton, 73, who was diagnosed with Type 2 diabetes in her fifties, was taking 13 pills a day before registering with Dr Unwin’s practice. Since following a low-carb lifestyle, she has shed two stone and cut down her diabetes drugs to two tablets a day. ‘It was a real nuisance,’ she says. ‘Every morning I’d set out my tablets for the day and it limited my life because I had to take them with me everywhere or if I forgot I’d have to rush home.’

Linda’s husband, Drew, 66, has also benefitted, reducing his blood pressure and hoping to come off medication altogether. Not everyone can manage that, says Dr Unwin: ‘It’s about using the least number of drugs at the lowest dosage to achieve the best outcome.’

The Government first put social prescribing on the national policy agenda in 2018 as part of the NHS Long Term Plan, pledging that at least 900,000 people would be referred to social prescribing by 2023/24, a move that Devon GP Dr Michael Dixon, chair of the College of Medicine, applauds.

He blames a decline in personalised care and continuity as well as the practice of treating diseases in a fragmentary way rather than holistically as reasons hard-pressed GPs so often reach for the prescription pad. He also points to the sharp fall in the annual healthcare budget allocated to primary care from 11% in 2007 to just 7% today.

Cornwall-based psychologist Kevin Feaviour has set up several social prescribing initiatives in the South West. He finds that the chats his practitioners have with patients following a GP referral will often uncover a bigger picture. ‘They’ll illuminate other issues behind the presenting issue referred by the GP – for instance, anxiety or loneliness, exacerbated by poor living conditions, family disharmony or poverty,’ he explains. ‘This enables us to develop a holistic picture and to offer a variety of options rather than one prescription.’

Ultimately it comes down to a different way of thinking about healthcare that harks back to the golden age of general practice. As Dr Dixon says, ‘If you’ve got someone you trust, who you don’t think has a vested interest in anything else, you’re less likely to take unnecessary drugs, less likely to go to hospital and even less likely to fall ill in the first place.’

Helpful resources

Read

What Seems to be The Problem?
Dr Laura Marshall-Andrews (HarperCollins)
Time to Heal: Tales of a Country Doctor
Michael Dixon (Unicorn)

Listen

Episode 51 of Dr Rangan Chatterjee’s Feel Better, Live More podcast tackles depression and social prescribing

Visit

National Academy for Social Prescribing to learn more about progress in rolling out social prescribing across the UK
College of Medicine to discover more about the Beyond Pills campaign