Social Prescribing and Self-care

1. Social Prescribing and Self-care Reimagining Care Closer to Home Partnership Meeting 4 22nd March 2018 @SocialEnt_UK @IVAR_UK #BHPselfcare

2. Introduction On the 22nd March 2018 the North Central London Building Health Partnership (BHP) group held its fourth partnership workshop to build on tangible projects, share knowledge and to develop the Care Closer to Home Integration Network (CHIN) model in a way that will: • Support people to self-care • Connect social prescribing and community initiatives across North London • Re-imagine how the system could work best for patients and residents • Establish the roles local voluntary sector organisations, commissioners and others can play The meeting was designed to look at progress made in each borough since the last session, towards social prescribing plans. The meeting was attended by representatives from voluntary and community organisations, local authorities, GPs, CCGs, patient representatives and the NHS from across the Sustainability and Transformation Partnership area. These slides were produced as a record of the event for those who attended and those who may not have been able to attend, as well as to aid the core group and borough project leads to progress action plans that were discussed during the third workshop.

3. Hearing from the Local Area Workshop structure: • National BHP update and “How we got here?- Katie Coleman, NCL Clinical Lead Primary Care and Care Closer to Home • An update from each borough on progress since the previous workshop (1st February) • Q&A with Nimet Tan, EPP (Expert Patient Programme) tutor, about her experience of ISMET (Feel yourself Able) • NHS England’s Social Prescribing Survey and Social Prescribing Strategy for London - Jason Tong, HLP • Group work (see details below) including prior guidance presentation • Elemental - An online Social Prescribing Platform- Andy Murphy, AgeUK Islington (not presented but included in presentation sent out to attendees) • Integrated Personal Commissioning update – Olivia Allen, Islington CCG Group work: • Group work 1 - Getting the Service User and Connector conversations right • Group work 2 – How do I get in? Connecting with Connectors Group work discussions were written down and the typed up version can be viewed on the following slides.

4. Barnet Update Feedback from Seher Kayikci (Barnet council) • i5 healthcare essential self-care and social prescribing tool – criteria used to select patient eligibility • EPP (Expert Patient Programme) is working with the Community Education Provider Network. Health champions are recruiting patients for the EPP. The EPP is working with CHINs (Care Closer to Home Integrated Networks. CHIN 1 in the West of Borough and with CHIN 2 (from April) in the East of the borough. • CHALLENGES – Money - there is limited funding to make it work. Need to work with the CEPN and target those who need it most. Modelling – ensuring the social prescribing model is sustainable. • Lack of understanding • Limited time - GPs and practices are busy • ONE THING TO TAKE FORWARD – How to engage more effectively with people on the ground. GPs are very busy and don’t know how to best engage around self-care.

5. Camden Update Feedback from Susanna Jordan from the CCG • Camden have developed a new model of social prescribing. They are aiming for one directory/portal to go through. The local authority is looking at what’s out there in terms of community asset-based resources. • Social prescribing is going out to procurement on 9th April, secure contract 1st June, mobilisation 3 months from 1st July, commence 1st October. • Tom O’Gorman is leading on the care strategy CHALLENGES • Camden are reducing funding which comes with difficulties when activity needs to increase – need to consider money following patient in the future. • Rent relief has been withdrawn from voluntary organisations and where funding has been reduced the LA is offering a £3k grant to help VCSEs business charges (Lisa Charalambous, Camden Local Government). • Length of the social prescribing procurement cycle will be just six months from start to finish (usually a year).

6. Enfield Update Feedback from Hinnah Gill, AgeUK Enfield • Enfield have a navigation service funded by the local authority for stroke, dementia, diabetes, falls, socially isolated and EOLC which is based in a GP surgery. It is important to be accessible in the community, so they regularly go into well-established charities and sign post people to relevant services. • Signposting – they’re looking at a person’s likes, abilities and capabilities. • There are four quadrants in Enfield, two parts deprived and two parts affluent CHALLENGES • The major worry is that VCSE services are being decommissioned (300 service providers reduced to 5). Will these services even exist for patients to be signposted to?

7. Haringey Update Feedback by Katherine Gerrans (Haringey CCG) • Haringey have not yet got a social prescribing system in place and are currently joining up all the dots. Haringey does have local area co-ordinators who focus not just on health, for example the public health team commissioned cooking classes. CHALLENGES • There are challenges around communications, finding out about events such as BHP (some emails were missed due to staff changes). There is also a need for care navigation and social prescribing to be joined together. What’s needed is a culture change - GPs not fully on board. • Inputting codes on the portal – adding Bridge Renewal Trust directory of VCSE services to the GP portal is proving to be more challenging than anticipated.

8. Islington Update Feedback by Philip Wrigley (Islington CCG) and Andy Murphy (AgeUk Islington). • A GP/clinical lead for collaborative care and support planning provides support for practices to implement care planning - as part of her in house “trouble shooting” sessions she raises awareness about social prescribing and how to access it. Most GPs have heard about social prescribing but many still don’t understand how to utilise it. • Requirement - A consistent, coherent, integrated approach, cultural change, behavioural change. Development of community to be proactive around social prescribing. Need shared recognition that it is possible. Everyone needs to contribute to developing and evolving the system. • Looking at the targets from the last workshop, the goal and challenge is to bring everything that has been happening into an integrated approach. There’s a need to ensure that social prescribing doesn’t exist in a silo – it needs to reach across the whole system. What’s needed is a population-based approach as well as looking at patients with complex/multiple needs. • Continual feedback, can help work out what works well. Footfall is a powerful indicator. • CHALLENGES – Time and the complexity of the issues and terminology.

9. Getting the service user/connector conversation right– Table 1 • Examples where it works well? • Health champions (Barnet) – trained volunteers, informed • Suggestions • Link to education, U3A • Publicity • Who are the people from the bottom that have been talked to • You need definitions – social prescribing, how is it best delivered, for how long, for whom • Only talking about GPs – how about other professionals and self referrals • What makes it work so well? • Empathy • Time • Experience • Different languages • Include family and friends • Multiple little conversations – not always all at once • Follow-up – planned • Focus • Informed connectors • Clarity • Coaching approach • Genuine interest • Passion for SP/ connecting • Cultural sensitivity • Use tools of conversation e.g. PAM • Some Principles for getting it right: • Use everyone available – receptionists, volunteers (training) • Use social capital/ strengths/ assent-based approach • Clear aim of SP • Buddy system/ support is vital • Proper system for recording

10. Getting the service user/connector conversation right– Table 2 • Examples where it works well? • GP asks “what could you do to help yourself…” “what do you want to achieve” “what you could actually do” “what’s important to you” • Variety of options available not just weight loss programmes • What makes it work so well? • Need time with GP to get the right sign posting • For patients to be better informed before GP visit • Patient advocate to support patient Some Principles for getting it right: More time for the conversation Few barriers as possible (interpreter) Start with “what matters to you?” Warm transfer to provider

11. Getting the service user/connector conversation right– Table 3 • Examples where it works well? • “How are things?” • Prompts/ guided conversation • Resident/ patient leads the conversation • What are aspirations • Not making assumptions • They’re the expert in their goals not me • What makes it work so well? • Keeping it local – but keeping it flexible i.e. looking outside borough • Keeping it personal • Careful recruitment • Personal knowledge & services & VCS sector • 4-week follow-up Some Principles for getting it right: Good relationship with trust Listening, acknowledging & understanding Keeping things safe – trained staff How you begin the conversation

12. How do I get in? (connecting with the connectors) - Table 4 • Where can I get connected to support to manage my health? • GP • A&E • Pharmacy • Schools/ children centre • Libraries • Tenants and residents • Counsellor surgeries • Community centres • Housing offices • Hairdressers, betting shops, laundrette • What would help me take the next step to get support? • Raised awareness • Conversations with other people/ social & cultural networks • Process is simple (single point of coordination) • Located in a GP surgery • What might get in my way? • Language – jargon, deafness, ESL terminology • Confusion as to how to access • Lack of awareness • Culture around medicalisation of care • Need general easy to follow knowledge

13. How do I get in? (connecting with the connectors) - Table 5 • Where can I get connected to support to manage my health? • Supermarkets • Library • Parks • Hairdressers • Sports areas • Pharmacists • Pubs • Cabs • Local shops • Food banks • Community/ religious venues • Council offices (e.g. Housing) • Job centre plus • Schools • What would help me take the next step to get support? • Knowledge and understanding of what support they can get • Personal connection/ feeling that I matter • Knowing what questions to ask • What might get in my way? • Anxiety/ low levels of activation or engagement • Stigma & fear • Service providers trying to find a solution without taking individual complex needs into account

14. How do I get in? (connecting with the connectors) - Table 6 • Where can I get connected to support to manage my health? • Who are the audience? • Need structure & targeted approach • Social worker may not have all the answers • Central place to promote services – what are they in the local community • Related to health literacy • All professional should know where to access info or who to refer to • Role models/ peers/ befriend • What would help me take the next step to get support? • Community notice board • Internet • Target specific • A&E survey/ checkout survey • Different access points outside of health i.e. JobCentre+, housing departments • What might get in my way? • Isolation • Lack of time/ knowledge • Passing the person from one service to another • Pigeon holing people • Lack of access

15. Other comments to Note: Would a National Event be beneficial? • What is the aim of the event i.e. to get ‘qualified answers’ • What needs to be included? Info from NHS England about how their different programmes/ initiatives can link together and not duplicate and how partners can engage and get involved Who is not here? • Some CCGs • Faith groups • Education • Community • Should consider rapid independent research – Patient representative • Need to move people from secondary care to primary care to self-care – clinical lead. • Social prescribing models needs to be built from the ground up. • People need to be kept warm, nourished (not mentioned) – Patient Representative • We haven’t stalked about welfare benefit advice, housing, immigration (HealthWatch Camden) • The biggest decline is in housing and keeping people safe – can’t provide what people really want (Age UK Enfield)

16. Silhouette Activity • “I feel lonely, is there some info about social groups I can join to socialise?” (similar conditions) • “How can I access the facilities to help me getting fit physically and mentally?” • Need confidence in the system – not passed from person to person • “Where do I go to get help with my physical needs?” • “How do I manage my daily moves with less ability?” • Increased insight that individuals have a right to take an active role in their own health care • When do we need to seek help and when can I help myself or use community support • What is social prescribing “get past the jargon” • Why will this help me • Need knowledge about their own condition • Need confidence – so many need help to even access a community centre • Bridging link between medical model and behavioural/ wellbeing interventions