The opportunity for social prescribing in Australia
Is the time ripe for a new way to tackle social disconnection?
The emergence of social prescribing
Research suggests that around 20% of patients consult their GP for problems that are primarily social rather than medical. These problems might relate to loneliness, social isolation or a range of other social, environmental and economic factors.
In the absence of a clinical or pharmaceutical solution, primary health providers are increasingly turning to social prescribing, a means of referring patients “to a range of local, non-clinical services to support their health and wellbeing.”
Examples of such activities might include community gardening, art classes, choir, bushwalking, nature conservation, group exercise, book clubs, various sports and more.
The theory is that such community participation has the potential to improve personal wellbeing, save significant costs in primary care, and also reduce economic costs such as associated absenteeism and lost productivity.
There is some emerging evidence (particularly in the UK where social prescribing is more advanced) that social prescribing generates social benefits and reduces the demand on primary care, however the quality of the evidence is weak.
How Social Prescribing Works
1. Patient Needs
An individual patient presents to their local GP for a consultation. Based on the patient’s needs and situation, the GP might believe that social issues (rather than clinical) are the key drivers of the patient’s symptoms.
2. Referral
The GP might consider referral to some type of community activity, however this is highly dependent on the GP’s level of awareness and confidence in relevant community activities. They might provide an informal recommendation (a.k.a. signposting) or provide printed materials if available. The GP might or might not make a record of the social ‘prescription’.
In more sophisticated scenarios where a social prescribing service is in place, the GP might make the referral to a “link worker” (or other type of community navigator) who takes on the role of matching the patient to relevant community activities.
3. Participation
- Self-Directed Route
If the patient is directly referred (informally or formally) to a community activity, it is up to them to contact and initiate participation. For people with low motivation, or other barriers to involvement, this stage is potentially fraught with difficulty.
- Link Worker
The link worker’s role is to understand the person’s interests and needs, identify suitable community activities, provide some type of introduction, and to provide some level of ongoing support and motivation.
4. Tracking and Evaluation
It is important to collect data on the participation and impact on both the patient and their health, however this has proved difficult to achieve in overseas experiences. This has made it challenging to gather strong evidence on the efficacy of social prescribing activities.
The Situation in Australia
A recent report (Social Prescribing Roundtable Report) by the Consumers Health Forum of Australia, the RACGP and the NHMRC Partnership Centre for Health System Sustainability, investigated social prescribing in Australia. It remarked:
“Social prescribing is already happening in Australia, with small pockets of innovation
and a small number of trials underway across the country. Many health practitioners
already incorporate social prescribing into their daily practice, but it is not supported or recognised by the funding mechanisms and structures in the health system.”
The report delves into the opportunity for social prescribing for certain patient groups, as well as exploring implications for policy makers and funders.
Their conclusions include:
Social prescribing does provide an opportunity to improve health outcomes and increase consumer participation and engagement.
The key aspects of a social prescribing model include building trust and relationships, co-designing solutions, having flexibility and place-based approaches, and having strong evaluation frameworks to demonstrate value.
There is an appetite to build systems in Australia to increase social prescribing.
The recommendations outline a range of approaches to support system changes and promote social prescribing in Australia (including research and evaluation to contribute to the evidence base).
Synthesising the Problems to Solve
Based on initial input from medical practitioners, and drawing both from the Australian report and international literature, there are several core challenges to the adoption and growth of social prescribing in Australia:
GPs believe in social prescription but do not have (or are aware of) a reliable supply of suitable opportunities
Context: Nearly all GPs believe in the potential health benefits of community activities but less than half of them are very likely to employ social prescribing. Most GPs are only “somewhat” knowledgeable about potential opportunities and typically do not have established community links or partnerships (as this requires considerable effort).Potential Solution: If GPs had access to a simple, seamless and locally relevant referral service for social prescribing, they would have more confidence to make referrals.
People are open to community participation but actual engagement is difficult
Context: While most people express strong interest and enthusiasm for community participation, actually motivating and engaging people who might benefit most (e.g. those suffering from loneliness or social isolation) is a large challenge. Implicit within this is what type of community participation is suitable and of potential benefit to the individual.Potential Solution: If there was a more approachable, frictionless way to match, activate, support and engage people, the barriers to community involvement would be lowered.
Knowing and sourcing the right community activities takes time and effort
Context: Much of the international social prescribing experience revolves around local activities run by community and volunteering organisations. These activities are already accessible in theory to people in the community, which suggests there are existing barriers to participation which might not be meaningfully lowered by a GP referral.Potential Solution: If the barriers to community participation were lowered by creating less formal, peer-created participatory activities, it could help more people to become involved. These opportunities might exist alongside existing community activities.
Data tracking, measurement and evaluation is lacking
Context: While the narrative and enthusiasm for social prescribing is very positive, obtaining rigorous data and strong evidence of the social impact is a work in progress.
Potential Solution: If a unique referral key or token linked the patient to the community activity, there is the potential to close the loop on data capture and execute more effective evaluation frameworks.
The Opportunity
The quest to design and implement a successful social prescribing model - that is evidence-based, reliable and scalable - represents a promising opportunity to improve the health and wellbeing of people and communities across Australia.
The design of such a service needs to incorporate insights from overseas experiences, input from local health industry experts and primary care providers, involvement from existing community service providers, and dedicated attention by a team of social innovators, product designers, data scientists and technologists.
We believe that designing a service that provides a seamless and engaging experience for sourcing, referral, participation and tracking of social prescribing activities, would improve individual and community wellbeing as well as reduce the demand for primary care. We believe that digital technology has the potential to make such a service more accessible, scalable and measurable.
Given the nascent status of formalised social prescribing schemes in Australia, we believe the time is right to:
Create and validate a proof of concept for a social prescribing platform
Run a limited pilot to learn which elements work and why
Generate and share quality data to other stakeholders in Australia
Togather - the venture, team and roadmap
We are a small group of passionate health professionals, entrepreneurs and product designers who have come together to form a healthtech startup called Togather.
We plan to become a for-purpose entity dedicated to improving individual wellbeing through community participation.
The co-founders of Togather are husband and wife team Dr Meg McConochie and Justin McMurray. Meaghan has extensive medical experience across the fields of emergency medicine, executive health and hospital care. Justin is a highly experienced digital entrepreneur and product leader with expertise in community and health ventures.
We are currently speaking to outstanding experts who are interested in this fast-evolving field. If that’s you, please get in touch with Justin McMurray ;).