Introduction [last update: 25 Jan 2021]
This document will develop over time. We are still learning about how culture, creativity and social prescribing can work together. If there are things you feel are missing here, please get in touch with us. We know how complex this rapidly developing area is. You may find some answers below, but please contact us if you have specific questions or concerns and we will do our best to answer them or forward your enquiry to relevant partners.
What is social prescribing?
The term 'social prescribing' is mainly used in relation to primary care (general practice). It describes the practice of referring patients to social activities instead of or as complementary to more ‘conventional’ forms of medicine.
A new National Academy for Social Prescribing (NASP) was launched by Health and Social Care Secretary Matt Hancock on 23 October 2019. This independent charity was developed in a cross-government partnership including Sport England, Natural England and Arts Council England. It is chaired by Profesor Helen Stokes-Lampard (former chair of the Royal College of GPs). You can read about its board here.
NASP will be an important source of information as it seeks to standardise practice, provide training and increase awareness.
NASP is currently appointing regional coordinators and launched a new Thriving Communities Programme on 10 November 2020. A small amount of funding was made available at the end of 2020 for community sector partnerships to pursue social prescribing via the Thriving Communities Fund (deadline 8 Jan 2021), co-funded by NASP and Arts Council England. You can watch a video about this fund here.
The free UCL Life Learning course developed by the Culture, Health & Wellbeing Alliance includes a helpful introduction to social prescribing. You can find the course here. (NB The course is called Museums as Spaces for Wellbeing, but it applies equally across the arts and heritage sectors, as well as to libraries and other public and cultural spaces.)
The NHS Long-Term Plan (2018) says that
Within five years over 2.5 million more people will benefit from ‘social prescribing’, a personal health budget, and new support for managing their own health in partnership with patients' groups and the voluntary sector.
Social prescribing, arts-on-prescription, museums-on-prescription, and our members
Arts-on-prescription and museums-on-prescription are types of social prescribing.
Museums on Prescription was an award-winning three-year research project (2014-17) led by Professor Helen Chatterjee and funded by the Arts and Humanities Research Council investigating the value of heritage encounters in social prescribing. Its website contains numerous extremely useful resources including powerpoints and a systematic review of 86 social prescribing schemes.
Four creative social prescribing initiatives are described here in a press release from the All-Party Parliamentary Group for Arts, Health & Wellbeing: Arts on Prescription Gloucestershire (Artlift), Arts & Minds, START Inspiring Minds and the Community Connector Scheme. The press release also summarises the evidence generated by Arts on Prescription Gloucestershire:
The scheme has shown a 37% drop in GP consultation rates and a 27% reduction in hospital admissions. A social return on investment of between £4 and £11 has been calculated for every £1 invested in arts on prescription.
Results from our 2019 annual survey suggested that just under 40% of respondents are working with social prescribing. Activities range from a Local History Café targeting loneliness and social isolation in older people to a choir in a doctor’s surgery.
Support, funding and structures
Government support – and some risks
Social Prescribing is currently being championed by both the Department of Health and NHS England in its Long-Term Plan. The Secretary of State for Health and Social Care, Matt Hancock, spoke about culture and creativity in relation to social prescribing in November 2018 at the King’s Fund. He said
The arts can help keep us well, aid our recovery and support longer lives better lived.
And I want to say this very frankly, social prescribing reduces the over subscription of drugs. It can lead to the same or better outcomes for patients without so many pills and it saves money for the NHS because many of these social cures are either free or cheaper.
While many of us have long campaigned for the demedicalisation of care and support the basic aims of social prescribing, there remain concerns about funding for community (VCSE) providers. The Secretary of State for Health & Social Care has worried the sector in the past (see his own video from the launch of the NASP) by referring to provision as cheap by comparison to medical interventions, or even free. He has more recently said, however, that as with pharmaceutical products, funding should follow the patient need to the intervention delivered. (Unfortunately no transcript was made of this speech at the Southbank Centre in early 2020.)
More organisations are articulating the need to support the delivery organisations actually providing the 'prescriptions': A Feb 2020 report from the National Lottery Community Fund, for example, says
It’s essential that the services and activities recommended to patients are also adequately and sustainably funded.
The September 2020 National Voices report Rolling Out Social Prescribing articulates the importance of improving linkworkers' roles and management, and also supporting the infrastructure of voluntary and community sector so that it can meet the health sector on equal terms:
Some concerns relate directly to the current NHS rollout and recruitment of link workers:
- The funding and management arrangements, role descriptions and performance expectations that are being put in place for new link workers
- The measures being used to assess the outcomes of social prescribing
Respondents also raised structural issues underpinning successful social prescribing:
- The need for funding to help the VCSE sector meet increased demand
- The need to ensure that social prescribing actively tackles inequality
- The need to invest in relationships and support ongoing collaboration and partnership (p.6)
In August 2018 the government announced funding for 23 pilot schemes across the country, to a total of £4.5m. Some cultural work was included in this phase but to the best of our knowledge this represents a relatively small proportion of the social prescribing activities funded. You can read about the schemes here.
Further funding was announced to support 1,000 link workers (see below) in January 2019. The NHS Long Term Plan says that
Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24, with the aim that over 900,000 people are able to be referred to social prescribing schemes by then.
It now seems likely that NHS England is aiming to employ roughly 4,500 link workers in the medium term, although as far as we know there has been no official announcement of this larger number.
National funding for ‘providers’ (i.e. organisations or individuals providing the activities) is so far limited to the Thriving Communities Fund detailed above. In some areas Clinical Commissioning Groups (CCGs) provide funding for work through their own budgets. In other areas, organisations have funded this work through arts/cultural funding. You can read more about how the sector is funded from our May 2020 survey.
The National Academy for Social Prescribing is being funded to the tune of £5m including some support from Arts Council England.
Link workers: "the glue in health and social care"*
Link workers are currently seen as the key to social prescribing. They will work with GPs and Primary Care Networks (PCNs - see below) to direct people visiting the GP into local activities. To understand more about link workers, read Christiana Melam's blog on link workers (Christiana is Chief Executive Officer of National Association of Link Workers, a member of the BME Leadership Network and National Primary Care Network Stakeholder group.) And listen to this podcast from the General Practice Podcast with Marie-Anne Essam.
You can read the link worker job description here, as part of this document from NHS England:
There are many different names used to describe the link worker role. These include wellbeing advisor, community connector, community navigator, community health worker, community health agent, health advisor, depending on local preference. Whilst the names may be different, the core elements of the role remain the same, hence the generic ‘link worker’ term.
NHS England's summary guide for Social Prescribing and Community-Based Support says:
Link workers typically work with people over 6-12 contacts (including phone calls and meetings) over a three-month period (depending on what the person needs) with a typical annual caseload of up to 250 people, depending on the complexity of people’s needs and the maturity of the social prescribing scheme.
Thus far, however, it seems the caseload is likely to be far higher than this. Link workers will also be responsible for assessing what community activities are suitable and available where they work, and will likely be very important contacts for any cultural organisations wanting to connect with social prescribing.
During covid, link workers have been required to provide emergency community support and have been unable to maintain 'normal' link worker duties.
Primary Care Networks (PCNs)
PCNs are new networks; they are made up of GP practices and community, mental health, social care, pharmacy, hospital and voluntary services in the local area. They cover populations of 30,000 to 50,000 people. Based on the population of England that means there will be about 1,400 of these networks. In some areas these already exist, in some areas they are just being developed. Read more about PCNs here.
What about ethics and risk?
A Quality Assurance Guide for social prescribing has been developed by Craig Lister (Green Gym) with support from an advisory panel and the University of Westminster – and endorsed by the Royal Society for Public Health. It suggests a three-tier approach that distinguishes between levels of ‘acute risk’ from low to high – but some of the work here does seem to sit with providers rather than commissioners. The Guide states that
Organisations providing support and activities to people with more complex health needs, especially where there is an acute (current and potentially immediate) risk to health or life, will need to meet a more vigorous quality assurance in terms of particularly health and safety and escalation procedures.
The ideal model is about building relationships and developing community partnerships - risk is mitigated through these relationships. But there may be more work to be done to unpack the question of lines of responsibility.
- The Social Prescribing Network
- The National Academy for Social Prescribing
- NHS England’s information on social prescribing
- TNL Community Fund report on social prescribing pilots (Feb 2020)
- A BMJ clinical update on social prescribing with useful infographics!
- Loneliness and Social Prescribing - a blog from the Campaign to End Loneliness
- Museums on Prescription
- APPG for Arts, Health & Wellbeing Press release on Social Prescribing
- Twitter account for the Social Prescribing Student Network: @SP_champScheme
- The General Practice Podcast: This is a very helpful podcast if you want to understand GPs’ perspectives on the work they do, which has a number of episodes devoted to Social Prescribing
- Video of the London Assembly meeting on Social Prescribing (November 2018)
- Animation about Primary Care Networks (PCNs)
- NHS Long-Term Plan
- "Making sense of social prescribing" (University of Westminster research)
- King’s Fund writing on Social Prescribing
- The Heritage & Wellbeing evidence base
- How arts interventions can achieve health outcomes (Aesop)
You can read a blog by the Chair of the Culture, Health and Wellbeing Alliance, Alex Coulter, about government and social prescribing, and the work of the All-Party Parliamentary Group for Arts, health and Wellbeing here. The blog also has useful examples of good practice. (You can find out more about the APPG here.) There is also blog here by the Director of the Culture, Health & Wellbeing Alliance.