Our third network meeting was held on the 9 September 2019 and focused on the ideal pathway through social prescribing.
We started with a brief presentation from Jane at Cordis Bright who conducted the review of Social Prescribing in Southwark. We discussed the recommendations and here are some of the comments:
- Recommendations largely aren’t surprising
- Does this report focus too much on GPs/ primary care? Can exclude people who aren’t registered – may be the most vulnerable people
- Social prescribing as a silo – how does this link to organisations as a whole? Every frontline worker is already a sort of link worker, especially in organisations that offer a wide variety of services. Need support for staff, whether or not they are called a link worker
Comments specific to funding
- Limitations of vol sector - funders require specific reporting, targeting demographics etc – how realistic is a cohesive offer?
- Top down - funders say “here is what to do” rather than VCS growing cohesive offer bottom up
- Funders focus on specifics, not necessarily holistic
- How do funders think about workers – are they considering the need to be able to pay them, train them, support (including clinical supervision etc), how else do we stop the turnover of staff?
- Need diversity of access, of ways of working, of measures of impact – this only happens when diversity is embedded in funders and decision makers
- Funders need to understand services need to have a level of autonomy to ensure can respond appropriately to the clients they support
- Balancing funding an infrastructure with funding services/ projects
- Need to keep provision local and not allow big organisations to come in and promise cheap delivery
We then looked at 5 vignettes of people who are typically referred for social prescribing. We discussed what we need to ensure is in place for the following key elements of the pathway:
- Access (how the person would access social prescribing)
- Referral (who and where would they be referred to)
- Discussions (between the person and the link worker)
- Activities (what would be available to them)
- Infrastructure (what else do we need to consider to make this an effective pathway)
Here are some of the themes that came up through our discussions:
- We need to be clear about financial envelope – where is funding coming from? Who is pooling?
Access and referral
- Need a single point of access - ensure referral is simple
- Explore different approaches to marketing – digital, non digital, strong awareness across southwark about activities and services, visible access in community – visible gateway. Ongoing marketing budget to keep things going
- Strong relationships in the system are vital
- Clarity for professionals to have one point of access perhaps through algorithm
- Need to ensure the communication and awareness is good enough so that Locum GP/ Nurse knows where to refer people
The role of digital
- Need to have a unified directory which is accessible, well publicised and updated. Supplemented with relationships and connections between services
- Self management tools
- Alerts and motivational prompts, reminders
- Link worker training hugely important– motivational interviewing, health coaching and support for people with mental health needs - ongoing CPD
- Link workers need to be embedded
- Making sure all link worker JDs are aligned
- Ensure good feedback loop to other professionals
- All staff to have navigation training – tagged onto JDs regardless of roles
- Managing, recruiting and training volunteers
- Clinical and peer supervision
- Mapping journey is key – service user perspective – digital services a part of this from the outset
- Peer support is vital
- Some people will need care coordinator – more in-depth skill set to manage their need and more time
- Need to consider wider support for those not named link workers
- Making every contact count training in all services working with members of the public
Some of the questions and concerns that came up were:
- Hubs – how do they interrelate?
- Outcomes framework - different services are meant to have different impact (eg income maximise vs socially connect)
- Concerns over the resilience of the vol sector, more demands, funding streams
- Risk of non person centred approach - Ensure high quality training for GPs, LAS and link workers
- How do we demonstrate the impact of our work beyond numbers?
- Risk of how much info can be shared across services
The project group's next steps are to bring together several task and finish groups that will use what we have worked through at the network sessions and do additional research to inform our model design. If you are interested in being part of a task and finish group please contact Rachel (firstname.lastname@example.org) who will send you further details.
We will have a session later this year to look at digital platforms and will aim to have our final network to look at our model and business case early next year.