We need to provide patients and their GPs the time and space to build therapeutic relationships
Health secretary Matt Hancock’s vision for creating parity between physical and mental health, outlined in a speech this summer at West Suffolk Hospital, is a welcome step forward. On reading about his plans for social prescribing, however, it seems we’re taking two steps back.
Hancock promises a £4.5m investment to help set up social prescribing schemes to “improve patients’ quality of life and reduce pressure on other NHS services” and “reduce the overprescription of unsophisticated drugs.”
The problem is that mental illness is often intricately linked to chronic physical disease as well as social problems—applying a blanket approach belittles the complexity of an individual’s case. Working in partnership with patients to form a tailored management plan is what GPs do best. We need to increase GP time through primary care workforce expansion rather than resorting to diversion tactics.
I attended a STOP Suicide workshop recently. Training covered how to assess a patient’s risk of suicide and included identifying red flags that signify increasing risk. Chronic medical illness, pain, and substance misuse are among them. The process of assessing a patient and formulating a safety plan is inevitably time consuming. GPs strive to achieve person centred care within the limitations of appointment times and an ever increasing workload. I fear that social prescribing in this context is being sold as a way to keep patients out of GP surgeries; to “manage” an unmanageable workload instead of helping doctors to make the time that these patients need.
Voluntary sector services can have a positive impact within patient communities but there is a lack of clear evidence demonstrating the long term benefits of social prescribing for patients, a reduction in GP workload, or a decrease in antidepressant prescribing. As with any intervention in medicine, patient benefit must be at its heart, backed by high quality evidence. Furthermore, it is unhelpful to publicly dismiss antidepressant drugs as overprescribed and unsophisticated. There will be those that need them and this negative press serves to undermine GPs and adds to the stigma that many patients fear.
Social prescribing may well be a useful tool but it’s only part of the answer. There must be a greater evidence base to inform policy and resource allocation. We need to provide patients and their GPs the time and space to build therapeutic relationships. Increasing the primary care workforce and reducing time spent on paperwork would allow GPs to get back to delivering the continuity of care patients need.
Kathryn Harrison is a general practitioner in Cambridge, UK.
Competing interests: None declared.