Exploring the potential for social prescribing in pre-hospital emergency and urgent care: A qualitative study.

Jason Scott,Gayle Fidler,Emily Heavey,Daniel Monk,Darren Flynn

doi:10.1111/hsc.13337

Abstract

There is a sustained increase in demand for emergency and urgent care services in England. The NHS Long Term Plan aims to reduce the burden on emergency hospital services through changing how pre-hospital care operates, including increased delivery of urgent care. Given the recognised potential of social prescribing to address wider determinants of health and reduce costs in other settings, this study aimed to understand the role that social prescribing can play in pre-hospital emergency and urgent care from the perspectives of staff. Semi-structured interviews (n=15) and a focus group (n=3) were conducted with clinical staff (n=14) and non-clinical health advisors (n=4) from an English Ambulance Service covering emergency (999) and non-emergency (111) calls. Data were analysed using a pre-defined framework: awareness of social prescribing; potential cohorts suitable for social prescribing; and determinants of social prescribing. Awareness and knowledge of social prescribing was limited, though when social prescribing was explained to participants they almost universally recognised its benefits for their role. Social prescribing was considered to be most beneficial to those calling for reasons relating to mental health, loneliness or social isolation, in particular older people and frequent users of 999 and 111 services. Determinants of social prescribing were identified across the micro (patient and staff acceptability of social prescribing), meso (triage and referral pathways) and macro (commissioning and funding) levels of analysis. This is the first empirical study to explore social prescribing in pre-hospital emergency and urgent care services, which suggests that it has potential to improve quality of care at the point of people accessing these services. There is a pressing need to address the micro, macro and meso level determinants identified within this study, in order to support staff within pre-hospital emergency and urgent care services to socially prescribe.

Highlights

There has been a sustained increase in demand for emergency (999) and urgent care (111) telephone services in England, culminating in a recent increase in 999 calls of 5.9% between 2018/19 and 2019/20 (NHS England, 2020b), and an increase of 15.2% in 111 calls between the same time periods (NHS England, 2020c)
In response to increasing demand for emergency and urgent care, The NHS Long Term Plan (LTP) (National Health Service, 2019) was published in January 2019, setting out how new service models will be introduced in England to give patients ‘more options, better support, and properly joined-up care at the right time in the optimal setting’ (p.6)
This study aims to develop a better understanding of the role that social prescribing can play in pre-hospital emergency and urgent care services, in order to deliver care to relevant patient cohorts

Summary

Introduction

There has been a sustained increase in demand for emergency (999) and urgent care (111) telephone services in England, culminating in a recent increase in 999 calls of 5.9% between 2018/19 and 2019/20 (NHS England, 2020b), and an increase of 15.2% in 111 calls between the same time periods (NHS England, 2020c). These mirror increased pressure on the wider health system, including emergency departments (Ham, 2015) and primary care (The King's Fund, 2016), access to which is interlinked with emergency department usage (Cowling et al, 2013).

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