It’s a Wednesday lunch time at the Felling Community Centre in Gateshead, in the North East, and Brenda Johnston, a community link worker, is about to meet seven of her patients at the weekly Feeding the Community event.
Outside the centre she meets one of them: a man with his hood up against the cold December air, eating chocolate from a packet. He tells of not being able to afford his rent after a shoulder injury prevented him from working. He says he is estranged from his children and unable to move in with his mother for fear of affecting her Universal Credit payments. He attempted suicide twice last year. Johnston naturally starts asking him: “How does he feel now? What kind of support does he need?”
As a community link worker she has spent years supporting local people at their lowest ebb to access lifesaving services. Inside the community centre, people say to me that without Johnston, they wouldn’t still be here.
This is social prescribing: a system of supporting vulnerable people to access support from the public and voluntary sector by introducing them to a community link worker. It’s part of a shift in NHS policy towards thinking of healthcare at a neighbourhood level, before medical intervention. As such, it is one of the key healthcare policies in the Conservative manifesto and part of the NHS’s 10-year plan, announced in January, as a way to reduce the burden on GPs.
By 2023/24, the NHS plans for 900,000 patients to have access to social prescribing services by recruiting 1,000 link workers over the next financial year.
Matt Hancock, the health secretary, sees it as a way to save money in the NHS by prescribing arts and social activities. “So things like: dance classes for elderly people, choirs for loneliness and mental health reading groups,” he said, when he announced the policy in November 2018. He went on to pay tribute to a charity that creates personal playlists of music for people with dementia: “This is the kind of cheap, easy to use social prescription that I’m fully behind.”
But the move has infuriated some GPs.
Farrah Jarral, a GP in central London, says at least half of her patients are suffering from health complications brought on by structural problems after a decade of austerity and poor investment in basic services, like health care, child care and housing.
She describes social prescribing as “a sticking plaster”.
“People struggle to live healthy lives because of cuts to their benefits, difficult working circumstances, overcrowding, air pollution – these environments are not conducive to eating healthily and exercise,” Dr Jarral says.
“It’s a little bit patronising to say: ‘I’m going to give you a prescription of five aside football twice a week, and that’s going to help you get better,’ when if that person had a job that was stable, decent place to live, reasonable work life balance, then they would naturally be able to do those things.”
In Gateshead, the social prescribing offered by Brenda Johnston and the team at local community centre Edberts House is far more acute and complex than those outlined by Hancock. Edberts House started a social prescribing pilot in 2015, joint-funded with a local GP surgery. Like Dr Jarral, Dr James Taylor, the local GP, had found himself overwhelmed with patients facing non-medical but complex social problems, including debt, hunger and housing. “A lot of the time you’re with a patient and you think, ‘Why have you come to me?’” Dr Taylor says. “This isn’t medical, it’s a social issue, it’s a benefits issue.”
Over the course of a year, social prescribing reduced the number of GP appointments among patients accessing the service from Edberts House by 24%. Edberts House has the equivalent of five full-time community link workers supporting 13 surgeries and 700 patients. In the next year it will expand across most of Gateshead, a total of 27 surgeries.
At the Felling Community Centre, 58-year-old Kathy Turner (not her real name) takes a break from manning a stall of second-hand kids clothes to join Johnston for a cup of tea. Turner trembles as she describes first meeting Johnston in April, not long after she had left an abusive partner. “I had hit rock bottom,” she says. She was referred to Johnston by her GP, after making an appointment to talk about her mental health, which was deteriorating under the stress of being homeless and without a bank account for basic transactions like rent or benefits.
Now she has a small council flat and a volunteer job in a charity shop while she builds up the confidence to get a job in retail. “I’m liking life again,” Turner says, quietly. “I’m not a bad person, I’ve just had bad things happen.”
Johnston has helped patients with needs so acute that sometimes she spends weeks simply encouraging someone to leave the house. It’s clear that this is community work at the sharp end of austerity, some distance from the poetry and dance classes promoted by Matt Hancock in his speeches. And yet funding is tight. Sarah Gorman, chief executive, says Edberts House is working with NHS England to access social prescribing funding that was made available in July. “Everyone that comes over says this is great, how would the area survive without it?” she says. “And yet we struggle for funding. That’s a frustration.”
Across the country, community link workers are being hired to work across as many as five different GP practices – but without the support of a voluntary organisation like Edberts House. NHS guidance suggests that link workers will be expected to work with around 250 patients a year, far more than the 160-patient caseload at Edberts House, plus take on responsibility for assessing the quality of voluntary organisations. “From our point of view, these are distinct roles,” says Jackie Jamieson, community link project manager at Edbert’s House. “Once you get into the case work as a link worker, that’s your whole job. There’s only so many hours in the day.”
Jamieson and Gorman have taken on a regional role with the NHS establishing peer support for community link workers who might find themselves in a surgery where no one knows who they are, what they do, or how to get referrals.
“Being a link worker can be very isolating,” Jamieson says. “If it’s not done right social prescribing could be a lot of hard work with little impact, but if it is implemented well, it could be a real game changer.”