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Primary care push for a social prescribing scheme

Social prescribing is popular with both doctors and patients but the infrastructure and funding are lacking, according to a new report calling for the practice to become a routine part of primary care in Australia.

The report, which draws upon a roundtable convened by the Royal Australian College of General Practitioners (RACGP) and the Consumers Health Forum (CHF) last November, makes the case for social prescribing as “valuable addition” to Australia’s health care system as it grapples with the twin challenges of population ageing and a growing burden of chronic disease.

Surveys conducted as part of the roundtable scoping process revealed that 88% of consumers felt community services and programs could support their health and wellbeing, and 70% of GPs believed referral to such programs could improve outcomes.

Yet most primary care doctors surveyed said they did not have links to appropriate services, and 57% of consumers reported that their GP never discussed such approaches as part of their management.

“With the huge challenges we face regarding rising chronic illness, mental health issues, isolation and loneliness and the resulting costs, we urgently need to consider our approach to healthcare in Australia. Social prescribing offers an innovative solution,” said RACGP president Dr Harry Nespolon.

“We’ve seen this approach used successfully internationally, such as in the United Kingdom, and promising trials in Canada and Singapore. It could help shift the balance to focus to prevention and early intervention for patients.”

The report describes social prescribing as “a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services”. Such services could include:

  • disease-specific or mental health support groups
  • health and fitness programs
  • library events
  • yoga, pilates, tai chi, meditation
  • men’s shed
  • community volunteering or gardening
  • bushwalking
  • social sport
  • book or movie clubs
  • community choir
  • dance classes

Barriers to accessing such services reported by consumers included cost, timing, distance, transport, or carer responsibilities. GPs surveyed said availability could be impacted by resources constraints at the local government level, with poorer communities missing out.

“Social prescribing offers a huge opportunity to improve patient health and wellbeing and cut the costs of chronic disease, but it won’t happen unless everyone can access it,” Nespolon said.

Strategic and systematic approach

The report calls for a “strategic and systematic approach” to incorporating social prescribing into Australian health care provision, starting with the primary care sector, and provides a road map (below).

It also emphasises that certain groups are most likely to benefit and should be targeted, including people experiencing mental health issues, people with chronic physical conditions and multimorbidity, people experiencing social isolation including young people, older people, and children in their first 1,000 days of life.

CHF CEO Leanne Wells said social prescribing was not only valuable for individuals, but would reduce burden on the system:

Social prescribing can help to address the social determinants of health, such as low education and income, which can affect people’s health and wellbeing. It has become particularly important given rising rates of chronic illness, mental health issues, social isolation and loneliness, many of which cannot be treated effectively with a medical approach alone.

Health expenditure also shows that health care has increasingly shifted to expensive hospital settings.  As our population ages and we see rising rates of obesity and chronic disease, the demand for such acute services will only increase if we continue on this same trajectory.

We need to find more effective ways to keep people out of hospital in order for our health system to remain stable.”

The report calls for social prescribing to be embedded in Australia’s primary care and preventative healthcare strategies as part of a health-in-all-policies framework which could include a New Zealand-style wellbeing budget.

To support the rollout of a social prescribing scheme, it urged the funding of link workers and collaboration with peak bodies and local councils to identify services and groups for inclusion, as well as bundling of payment arrangements across the health and community sectors. It also called for the funding of pilot programs nationally to test the scalability of and evidence for a social prescribing rollout.

The roundtable heard from a number of organisations where social prescribing is being trialled locally, including at IPC Health in Melbourne, Brisbane’s Inala Primary Care and the Mount Gravatt ‘Ways to Wellness‘ pilot targeting social isolation, also in Brisbane. Participants in these initiatives said they had helped with their conditions, reducing reliance on medications and other health services.

The report notes that social prescribing is already happening in Australia, giving primary care nurses, occupational therapists and NDIS community support workers as just a few examples of professionals incorporating it into their practice.

“But it is not supported or recognised by the funding mechanisms and structures in the health system,” the report says. “We recognise the dedication and expertise of these people and seek to build on the work that is currently happening in a way that is informed by consumers’ and health professionals’ lived experience.”

The roundtable and report were produced in collaboration with the NHMRC Partnership Centre for Health System Sustainability. You might be interested in reading their literature review on social prescribing.

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