The case for social prescribing: what you can do (Part 2)

Not many people know that podiatry was involved in the first social prescribing initiative in Australia 12 years ago; they not only were treating patients but they were the conversation starters who could be the all-important conduit in a socially deprived regional area that had limited healthcare services. It was the podiatrist who talked to all the other patients; they became the all-important friendly social touch point. From there, the podiatrists would talk to the local social workers who would carry out a form of link work at the time, which is one of the key components of social prescribing today.

Throughout this inaugural initiative, the podiatrists effectively helped to create a model of care where they could talk about what wellbeing looked like for the patient. This was a major step forward, and podiatrists were certainly involved in this early in-road into social prescribing in Australia. I think that the role of podiatry can be under-appreciated in terms of easy access and meaningful conversations with patients. These are the kinds of opportunities that social prescribing hinges on.

These days, with workforce pressures being what they are, it’s important to understand that if a patient comes in to see a podiatrist, the foray into social prescribing is actually a very light touch. Obviously, the podiatrist is being paid to assess, diagnose, and treat. But the extra question a podiatrist could add to this appointment is: ‘What matters to you as a person?’ And, possibly, ‘How could life be a bit more wonderful for you?’ This is what social prescribing looks like up close; at least as a solid starting point.

Perhaps the person is isolated. Or recently widowed. While you as the podiatrist can see that the patient needs better shoes, or orthotics, or whatever it is; you may learn they might not be eating enough, which of course affects their physical health and potential to be more active and mobile. So, social prescribing might take the form of a simple conversation with the patient, along the lines of: ‘If we can connect you to somewhere else so that life can be a bit easier, or more wonderful for you, what would it be?’

I think the whole key is to of course respect the role of everyone’s scope of practice in health, but also not to feel as a healthcare provider that you are trapped in a box. There is a collective responsibility to create connections between other people.

Workforce pressures are such that health professionals can feel swamped at work and there may not be time for these kinds of conversations. Yet if such a conversation is viewed at its most simple level, through the lens of connecting a patient to opportunities to become more mobile and connected in their community; then this can help you to mobilise your patient, to become more active and present in their community.

To expand on this and switch focus to the Australian Government now; what change do we want to see to help support social prescribing at the local level?

While social prescribing focuses on local opportunities for a patient to connect to their community or activity, this requires solid infrastructure. One example of this is a need to be able to drill down into any postcode and access a resource of the kinds of social prescribing opportunities available within that community. And to make this social prescribing tool available to podiatrists, physios, GPs and so forth. We need the government to get behind this vision and its impact in a very real and measurable preventative sense; effectively to create a hyperlocal directory with national infrastructure behind it.

Medicare is also firmly in our sights within the context of preventative healthcare and other reforms. If Medicare included take more preventative items like social care plans (or as part of the multidisciplinary care teams social prescribing activities can be compensated and extended into a formal plan) then this can become the safety net to flag issues early on and escalate them.

There is also a need to align Primary Health Networks with local allied healthcare providers – whether in the public or private sector. They are there to build local health ecosystems that address unmet local health needs; to help everybody at a very local level. For social prescribing opportunities to be well-supported and efficiently-facilitated locally, the infrastructure and local networks need financial and logistical support on a national coordinated level.

Ultimately, social prescribing partly reflects the disintegration of communities over the last 70 years, but it also partly reflects a lack of investment in social welfare and other services in the same time period. It is the health system that tends to suffer the ultimate consequence, in terms of cost, because people who are disconnected and lonely, who have poor health literacy and general literacy, who live in a negative environment; these people have less capacity to do better and so they are more likely to get sick and use the system a lot.

The only way to address this is to make up for this system failure. That’s also the cheapest way to do it for the government. You can either put a fence at the top of a cliff, or an ambulance at the bottom. Which makes more sense?