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Emancipating ourselves from the tyranny of proof

“Social prescription is probably one of the most evaluated policy changes of the 21st century”. Those words from Chris Dayson ofSheffield Hallam University should be written on the heart of every health minister, policy advisor, commissioner and journalist from now on. Quite apart from the evidence, it is conceptually difficult to deny. So there is no excuse in holding the horses, when it comes to social prescribing and ensuring, as quickly as possible, that it becomes available to every GP and patient. It is time to emancipate social prescription from the tyranny of proof (to quote Chris again) and research from here on will need to focus on what works best for who, where and under what conditions.

Our forthcoming second national conference on social prescription at the King’s Fund on 6th November is entitled “Coming of Age”. In barely two years, social prescription, as a national movement, has reached what must surely now be the point of no return. It is ticking all the boxes whether it be about supporting general practice now under intolerable pressures, personalising care, focusing on inequalities, helping general practice and medicine out of its narrow biomedical box or supporting the hugely important work of volunteer and voluntary organisations. This probably explains its national popularity without, it seems, any opposition and why the second national conference in November was fully booked within a month of opening the box office and before we had time to publish a full programme!

So let there be credit where credit is due. Credit to those of you who have been researching social prescription, those who have been pioneering it and those who have recognised its value and are continuing to speak about it. It has been a wonderful example of a few committed individuals, up and down the home countries, coming together and changing the world. We are now no longer a few, as The Social Prescribing Network has over 2,000 members today. With our website, newsletter and increasing international interest, we have been able to progress things far faster than any of us ever imagined. Our relationship with NHS England has further enhanced our ability to realise our vision. Indeed the relationship between The Social Prescribing Network and NHS England is almost unique - linking central decisions makers and implementers with the energy and passion of those who have been leading social prescription from the front line.

Photo courtesy of Troy via Unsplash

So what does “coming of age mean”?

Is it an opportunity to celebrate or time for us to say that social prescription is now mainstream? Both, in a way, but also neither. Because social prescription may be intuitive, it may be helping many patients, saving NHS costs and valued wherever it exists but it is also extremely vulnerable. It is good news that almost 50% of CCGs are offering something, that 10 or so CCGs are offering universal cover for patients and GPs and that one STP (South Yorkshire) is now committed to universal provision.

In most places, however, the funding for social prescription is precarious and very rarely on any sustainable or recurrent footing. Too often and in too many places it depends upon the state of finances of the Clinical Commissioning Group or Local Authority and the enthusiasm of local clinicians, mangers and volunteer/voluntary organisations. That is hardly fair to patients, who need social prescription or to clinicians, who want it for their patients when it is not available. Just as social prescription addresses social inequalities and provides a Trojan horse for increasing social capital and enabling healthy communities, we must now address the inequalities in the provision of social prescription itself. With resources for health and the health service severely squeezed, we will need to be inventive as to how we enable the universal access to social prescription that Simon Stevens advocated in the national media last Christmas.