Imagine going to your doctor’s office and leaving with a prescription – and support – for dance lessons or community gardening. The idea, called social prescribing, provides a structured way of referring people who access primary care to a range of local, non-clinical services.
In the United Kingdom, social prescribing is changing how primary care is delivered, showing promising results at achieving positive outcomes for clients, providers, and the broader community.
Here in Ontario, an ambitious project is underway to leverage Community Health Centre (CHC) staff to guide clients to connect with their wider community and others. The Alliance for Healthier Communities is leading a Social Prescribing pilot in 11 CHCs to adapt and measure its impacts in an Ontario context. Running from September 2018 to December 2019, the project aims to bring sustainable service innovation to the front lines of primary health care.
We had a chance to catch up with Kate Mulligan, Director of Policy and Communications at the Alliance for Healthier Communities to learn more about the pilot.
What makes the CHC model a good fit for social prescribing?
Community Health Centres (CHCs) and other Alliance members share a strong commitment to advancing health equity and addressing the social determinants of health, which include social supports. CHCs provide comprehensive primary health care, which includes both integrated, interprofessional medical and non-medical support. Interprofessional medical support includes family physicians, nurses, dietitians, physiotherapists, social workers, and so on. It might also include interventions like diabetes education. Non-medical supports for a patient with diabetes might include a community garden, a cooking class, and an exercise group. Other non-medical supports our members offer include help with paperwork to access housing, social assistance or immigration; literacy training; and peer-support groups for youth, seniors, LGBTQ persons, new parents, or newcomers.
To deliver these programs, our members often work hand-in-hand with other community agencies or help the client access resources available elsewhere. As a result, the CHCs have a pretty thorough knowledge of the local supports available, and they have established relationships with community partners. So the principles of social prescribing are already part of the CHCs’ DNA – they’re deeply embedded in the everyday work.
Social prescribing formalizes these principles and builds on these existing strengths. This means that appropriate care for clients’ social needs is included in the care plan by design. Doctors and nurse practitioners are able to connect the client with appropriate programs and resources from CHCs and their partners, and this is tracked and monitored just like a medical intervention would be
So how does social prescribing work?
Broadly speaking, social prescribing creates a structured clinical pathway – a treatment option – in which an individual is connected with appropriate non-medical supports and services in the community. On the ground, social prescribing looks different in different communities, because it’s locally designed to meet the needs of the community but also subject to local capacity.
In general, the journey starts when a family physician or nurse practitioner refers a client to a navigator or link worker. This person works closely with the client and connects them with the most appropriate community support. It could be just about anything - a peer-support group, an exercise class, a ticket to an art gallery, community gardening, a supper club, or something else.
The link worker will also ask the client about their skills and interests. This is important, because a big part of being connected to a community is having something to contribute. So the link worker may connect the person to volunteer opportunities. Some of them go on to become what we call “health champions” -- these are volunteers who identify issues and gaps and then work with staff to co-design solutions.
How does social prescribing fit with the needs of our evolving healthcare system?
More and more, we’re seeing how important social connectedness is for health and wellbeing. Ontario’s Chief Medical Officer of Health recently identified loneliness and social isolation as significant health threats. He noted that people who have weak sense of community belonging are more likely to be in the top five per cent of users of health care services. That same five per cent accounts for more than 50 per cent of total health care spending. By connecting these people with their communities so they get that feeling of belonging, we can reduce their healthcare costs. In the same report, it was noted that people with strong social relationships have a 50 per cent lower risk of premature death than those with poor relationships. So social prescribing can help people live longer, healthier lives and make our health system more sustainable.
We know the healthcare system is under strain. We also know that “downstream” solutions, such as hospitalization, are costly to the system and difficult for the individual. So it’s important that we start looking “upstream” for solutions. This includes primary care. But even further upstream, it includes programs that address the social determinants of health and give people a sense of belonging. Social prescribing is one way to do this. It means people get the right care, with right provider, at the right time. And it can mean they’re shifted away – when it’s appropriate – from unnecessary medical care. This frees up physician and acute care resources.
What kind of health impacts are we hoping social prescribing to have?
Since we know that social connectedness is associated with better health outcomes, we hope to see that reflected in the health of clients who receive social prescriptions. In the UK, social prescribing has been in place for the past few years and there are studies coming out of that country which show improvement especially in areas of social isolation, loneliness, depression, and anxiety. Clients who’ve received social prescriptions say they feel more connected to other people. They feel more confident, and they have a sense of purpose and belonging. And in one community where social prescribing was introduced, they saw a 14% deduction in unplanned hospital admissions over four years.
We hope to see similar results in the current pilot in Ontario. In addition, we hope to make primary health care centres more inviting places to be. As clients become more empowered and connected to one another, this will make the centres more warm and welcoming. People who go there will feel like they belong. Staff will be happier. And there will be more community program happening in clinical spaces.
Are there benefits for providers and communities?
Absolutely. Providers have often expressed frustration with being unable to help patients with social needs. In this recent CBC article, a family physician noted that a third of the work he does every day could be done by other people. He’s having to do the work of a counsellor or a social worker, but that’s not his training.
With social prescribing, physicians can work collaboratively with other team members to connect clients with appropriate non-medical resources and supports for their needs. The physician knows the patient is being supported and their needs will be met. With this burden gone, the physician can focus their time and energy on treating medical issues.
As for how it helps communities, social prescribing involves working with community partners, which helps build a network of local relationships between healthcare and community sectors. These networks leverage existing assets in the community. They create innovative, sustainable solutions that make sense in the local context. Then there’s the fact that many social prescribing clients end up giving back as community volunteers and health champions. This not only helps the individual gain confidence, but it increases the resilience and connectedness of the community.
How are we tracking the impact of this work?
In the Ontario pilot, we want to understand not only the health impact of this work, but also where it is working, who it works for, and in what contexts it works best. So we’ve built a robust evaluation plan into our social prescribing to answer these questions. We’ll be capturing quantitative data such as the number and reasons for social prescribing referrals, the types of non-medical supports prescribed, and changes in self-reported health outcomes. We will also capture qualitative results by conducting focus groups and interviews with both clients and health care providers to more fully understand their experiences.
We hope this project will enable us to demonstrate, in a data-driven and evidence-informed way, what we already know anecdotally – that people are healthier when they’re connected to social and community supports, and when they are empowered to play meaningful roles in both their own health and the health of their wider community.