Nine Principles for Building a Healthy Social Prescribing System with the VCFSE Sector (SP9)
VSNW and our NASP North West colleagues are committed to developing a Social Prescribing model that works with, champions, and appreciates the potential of our sector.
We recognize the tremendous role that the Department for Health and Social Care has played, with investment, to drive forward a new model of working in health neighbourhoods and through the rollout of Primary Care Networks. Many in the sector have campaigned for equal recognition of the role that the local VCSE sector can and must play in the development of healthy neighbourhoods, support for communities, and the development of an effective social prescribing model.
However, to date, we have seen investment in what the too familiar metaphor describes as ‘holiday agents’ (ie our extremely valuable and very busy network of link workers) without any commensurate investment in the ‘holiday destinations’ (ie the network of over 300,000 local VCSE groups and organisations accepting referrals from link workers).
While we do not expect the NHS to core fund or wholesale invest in 300,000 groups doing all the things they do to build happy, healthy, caring communities, there clearly needs to be some thought given to how we might better support (and yes, carefully and precisely invest in) the cornerstones of an effective Social Prescribing system.
In this paper, we outline 9 ways in which we can respect, include and build on the VCFSE sector’s role in a healthy social prescribing model. We ask that the NHS, Department for Health and Social Care, local health, council and other public sector partners commit to and promote the following Minimum Model VCFSE Social Prescribing System, based on these 9 principles.
Principle 1: Create an Open Social Prescribing System.
Build a clear, transparent open Social Prescribing system, which local partners/agencies can support and refer to and support by taking referrals. Social Prescribing is not just for GPs! Referral routes should be agreed upon locally and based on an integrated approach (that includes the strategic voices of the local VCFSE sector).
Principle 2: Contribute and support the local sector through £65m per annum for local Small Grant Pots.
We cannot finance the sector but we can recognise and contribute towards the costs incurred by groups and support activity in areas where the sector is facing stark pressures to keep going. In order to support referrals to VCFSE groups, a small grant pot of minimum £1 per capita pa should be made available to every neighbourhood (ie £50k pa in a health neighbourhood with a population of 50,000 people). The annual cost of this across England, including fees for local administration (linked to knowledge of the sector), would be less than £60m.
Principle 3: Recognise VCFSE as Link Worker Host Organisations as the preferred model.
Anecdotal evidence is that VCFSE organisations that host link workers share their knowledge and understanding of the local sector with their link workers. Where this does not happen, there is either a very long (with little delivery) learning curve or a piecemeal approach to sector inclusion. Clearly, there needs to be a review of the benefits of PCNs using VCFSE host Organisations with a view to making VCFSE hosting the preferred approach. Outside of a narrow definition of social prescribing, this builds a different culture of PCN-VCFSE partnership working which is essential.
Principle 4: Adequate reimbursement for VCFSE host organisations of a minimum of £10k per Link Worker.
VCFSE host organisations are allowed a maximum of c.£2.5k for hosting a Link Worker at present. This contributes to the costs of hosting but falls short of the reality and is a disincentive to joined-up working. The hosting fee for local VCFSE organisations should be topped up to £10k per link worker so that organisations receive a more adequate contribution for their time, commitment, networks, expertise and frankly, their costs. Host organisations need this in order to invest their time and relationships into social prescribing.
Principle 5: Recognise the importance of a strong local VCFSE ecosystem in legislation and guidance as part of a good local Social Prescribing system.
(i) Where there is an effective local VCFSE infrastructure organisation (with volunteer brokerage) linked to the social prescribing system, the impact on GPs, the local Health and Social Care system, and communities, multiplies many times over. While we are not suggesting that DHSC picks up the cost of this, this needs to be championed and investment secured locally.
(ii) Integrated Care Partnerships (ICPs) as they take over from CCGs must be asked to recognise this as part of understanding their ‘Place’ and developing an effective partnership with the VCFSE sector. This approach should be endorsed and guidance developed as part of the Health and Care Bill. Our own draft ICP-VCFSE checklist is a fundamental building block for understanding the maturity of local integrated working.
Principle 6: Support the local health and social care system by investing in Social Care Link Workers.
National DHSC investment should not just be to release demand and improve outcomes for primary care. Our social care is equally under extreme pressure. Link workers, hosted by local VCFSE agencies, should be part of an effective local social prescribing system and funded alongside primary care link workers by DHSC.
Principle 7: All Government departments commit to building on local Social Prescribing Systems.
Many government departments are committed to building thematic models of social prescribing (Arts on prescription, Green Prescribing, etc). National public sector agencies and government departments should commit to ‘building onto’ local SP systems. eg DWP, Department for Business, Innovation and Skills (BIS), Arts Council, DEFRA, etc, rather than creating their own siloed systems for social prescribing. Ultimately, we need a workforce and a system that can link into a full range of opportunities, including, for example, skills training.
Principle 8: Primary Care Networks (PCNs) commit to building on local VCFSE systems, networks and assets.
This should be a central and fundamental part of PCN’s work in a healthy neighbourhood and as part of developing an integrated, with VCFSE sector, health neighbourhood approach. This approach, and commitment, should be broader than just social prescribing and how Link Workers work. Social Prescribing is one element of how PCNs are being asked to develop and operate, but this commitment should be embedded across the PCN’s operating and engagement model. Social Prescribing should be the first step in building locally integrated (with communities and their local VCFSE sector) health and care systems with an effective community development support system.
Principle 9: Allow for an additional, potential VCFSE allocation for each of the Primary Care Reimbursement Scheme roles.
In order to support the implementation of Principle 8, this potential additional allocation should be available to make it easier to build in VCFSE hosting as a viable option. The current level of reimbursement is a disincentive to joined-up working with the VCFSE sector and inadvertently promotes isolated PCN working.
Conclusion
If implemented these principles would provide the groundwork for a genuinely integrated health and care system that draws on the strengths of 300,000 plus grassroots VCFSE groups and communities. We believe that such an integrated model of working, based on the Salford work on using a place-based VCFSE grants programme, can generate £17 for every £1 invested.
Based on our own rough costings, we estimate that implementing these nine principles (SP9) would cost the DHSC £109.2m per annum.
Cost estimate for implementing SP9
Calculation
Annual Total Cost (£ million)
Principle 1
No additional cost but a significant contribution to the local health economy if opened up
£0
Principle 2
Based on a 56.223m population and a 12% local administration fee for integrating the investment locally and identifying local strategic purpose match and a £2m national quality and cost assurance process managed by NASP
£65m
Principle 3
Evaluation of benefits of a VCFSE Host organisation, £100k max.
£0.1m
Principle 4
Uplift of £7.5k per link worker, with c. 1200 Link workers
£9m
Principle 5
Research into the impact of an effective local VCFSE infrastructure agency in a local integrated health and social care system, £100k
£0.1m
Principle 6
152 Local Authorities with Social Care responsibility, with 2 link workers at c.£50k each
£15m
Principle 7
No additional cost. This should also reduce duplication and cross-Departmental costs in total.
£0m
Principle 8
No additional cost. This should also reduce duplication and costs in total, and create a better system.
£0m
Principle 9
Host fee of £10k available for additional roles. It is estimated there will be 22,000 in total. Working on 20,000 (non-Link Worker) and a 10% take-up rate = 2,000 x 10k
£20m
TOTAL
£109.2m