{"id":43163,"date":"2018-10-03T16:50:18","date_gmt":"2018-10-03T15:50:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43163"},"modified":"2018-11-07T10:16:50","modified_gmt":"2018-11-07T09:16:50","slug":"prescribing-personalised-social-pharmacological","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/10\/03\/prescribing-personalised-social-pharmacological\/","title":{"rendered":"Anya de Iongh: Prescribing should be #personalised, whether it\u2019s social or pharmacological"},"content":{"rendered":"<p class=\"standfirst\">All prescribing conversations should feel like a person centred conversation, says Anya de Iongh<\/p>\n<p><!--more--><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-41070 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/anya-deiongh.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/anya-deiongh.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/01\/anya-deiongh-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><span style=\"font-size: 1rem\">The semantics of healthcare is a never ending source of discussion, providing both fascination and frustration in equal measure. The rising profile of \u201csocial prescribing\u201d has not escaped the common nomenclature debate.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As the wider social determinants of health and non-medical issues such as loneliness (and their impacts) are more recognised, prescribing non-clinical options like gardening groups, walking groups, and community support <\/span><span style=\"font-weight: 400\"><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/social-prescribing\">are being considered<\/a> alongside pharmacological prescriptions.\u00a0<\/span><span style=\"font-weight: 400\">It is a core part of the model for personalised care <a href=\"https:\/\/www.england.nhs.uk\/personalised-health-and-care\/social-prescribing\/\">being championed by NHS England<\/a><\/span><span style=\"font-weight: 400\">, and happens across a number of innovative services across the country. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The principles of connecting people with community based sources of support is only to be welcomed, but the branding of this process as \u201cprescribing\u201d has caused some debate. <\/span><\/p>\n<p><span style=\"font-weight: 400\">It is clear that there are medical connotations with the phrase \u201cprescribing.\u201d On the one hand, these medical connotations can help this non-clinical approach gain traction among a clinical workforce\u2014something much needed if this is to be embedded and integrated within primary care for example. On the other hand, this medicalisation can lead to inappropriate and unjustified labelling of normal aspects of humanity, and overlook the role of communities and the community based principles of social support. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">I\u2019m interested in how the reasons put forward for the latter\u2014that we don\u2019t want the person centred nature of connecting people with social support to be contaminated by the medical approach of &#8220;prescribing&#8221;\u2014make assumptions about the process of prescribing generally. <\/span><\/p>\n<p><span style=\"font-weight: 400\">No matter how successful social prescribing is, the harsh reality is that our NHS will still be making many times more pharmacological prescriptions than social prescriptions. In 2017, there were over 1 billion pharmacological prescriptions (<a href=\"https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/prescription-cost-analysis\/prescription-cost-analysis-england-2017\">NHS Digital<\/a><\/span><span style=\"font-weight: 400\">). So rather than trying to find a better word for social prescribing, why not make all \u201cprescriptions\u201d something person centred? <\/span><\/p>\n<p><span style=\"font-weight: 400\">Whether it is warfarin or walking that we are being prescribed, the conversation should be based on the same principles. Prescribing shouldn\u2019t be a \u201cdirty\u201d word, if done well. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The principles of a conversation that results in someone being supported to access non-clinical sources of support have the following key components: starting with the person, what matters to them, having time and space to explore all the options, supporting their confidence to take the next step, and opportunities to follow up and review how it is working. That feels relevant, and should be relevant, whatever we are prescribing. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Reading the guidance on prescribing from <a href=\"https:\/\/bnf.nice.org.uk\/guidance\/guidance-on-prescribing.html\">NICE\/BNF<\/a><\/span><span style=\"font-weight: 400\">, I was struck by how person centred their definition was: \u201c<\/span><i><span style=\"font-weight: 400\">the prescriber and the patient should agree on the health outcomes that the patient desires and on the strategy for achieving them.<\/span><\/i><span style=\"font-weight: 400\">\u201d That applies whether we are talking about health outcomes met by a book group or bisoprolol. <\/span><\/p>\n<p><span style=\"font-weight: 400\">There is always a risk that it is used as a proxy\u2014with \u201cpseudo person centred\u201d approaches masking a directive approach to changing people\u2019s behaviour. This was captured in <a href=\"https:\/\/www.theguardian.com\/society\/2018\/sep\/06\/nhs-should-expand-social-prescribing-says-health-secretary\">a recent comment from the health secretary<\/a>, <\/span><span style=\"font-weight: 400\">Matt Hancock,<\/span><span style=\"font-weight: 400\">\u00a0\u201canybody can suggest to somebody that they do a social activity. My wife regularly tells me to do more exercise.\u201d<\/span><span style=\"font-weight: 400\">\u00a0I don\u2019t know whether exercise is personally important to Mr Hancock or not, but I do know that \u201ctelling people to do things\u201d doesn\u2019t feature as part of social prescribing as I understand it. We already know that telling people to take medications probably isn\u2019t that effective either. This strikes me as an opportunity to share learning and skills around developing shared understandings, exploring confidence to follow through, and supporting people to take ownership. \u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Shared decision making and co-production apply whether we are prescribing citalopram or coffee mornings and gardening or gabapentin. All prescribing conversations should feel like a person centred conversation. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Prescribing isn\u2019t just about the conversation though, it is also about the resources, and herein does lie a considerable difference. <\/span><span style=\"font-weight: 400\">Prescribing medications is authorising access to a restricted product, and the physical commodity of tablets is a far cry from the living and breathing communities that form the backbone of social prescribing. Keeping stocks of medications may require temperature controlled storage, but keeping communities thriving requires more than just referrals\u2014asset based approaches and investment are essential. <\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Anya de Iongh<\/strong> is patient editor for <\/span><\/em><span style=\"font-weight: 400\">The BMJ <\/span><em><span style=\"font-weight: 400\">and works nationally and locally around person centred workforce development and self-management support services.<\/span><\/em><\/p>\n<p><strong>Competing interests<\/strong>: <a href=\"http:\/\/www.bmj.com\/about-bmj\/advisory-panels\/patient-panel-members\/anya-de-iongh\">Full details here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>All prescribing conversations should feel like a person centred conversation, says Anya de Iongh [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/10\/03\/prescribing-personalised-social-pharmacological\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":43164,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5749],"tags":[],"class_list":["post-43163","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-patient-perspectives"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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