Weathering the storm: A qualitative study of social prescribing in urban and rural Scotland during the COVID-19 pandemic.

Alison Fixsen,Simon Barrett,Michal Shimonovich

doi:10.1177/20503121211029187

Abstract

Objectives:The non-clinical approach known as social prescribing aims to tackle multi-morbidity, reduce general practitioner (GP) workload and promote wellbeing by directing patients to community services. Usual in-person modes of delivery of social prescribing have been virtually impossible under social distancing rules. This study qualitatively examined and compared the responses of three social prescribing schemes in Scotland to the COVID-19 pandemic.Methods:We interviewed a theoretical sample of 23 stakeholders in urban and rural social prescribing schemes at the start of COVID-19 pandemic. Follow-up interviews with a representative sample were conducted around 10 months later. Interviewees included social prescribing coordinators (SPCs) GPs, managers, researchers and representatives of third sector organizations. Interview transcripts were analysed in stages and an inductive approach to coding was supported by NVivo.Results:Findings revealed a complex social prescribing landscape in Scotland with schemes funded, structured and delivering services in diverse ways. Across all schemes, working effectively during the pandemic and shifting to online delivery had been challenging and demanding; however, their priorities in response to the pandemic had differed. With GP time and services stretched to limits, GP practice-attached ‘Link Workers’ had taken on counselling and advocacy roles, sometimes for serious mental health cases. Community-based SPCs had mostly assumed a health education role, and those on the Western Isles of Scotland a digital support role. In both rural or urban areas, combatting loneliness and isolation – especially given social distancing – remained a pivotal aspect of the SPC role.Conclusion:This study highlights significant challenges and shifts in focus in social prescribing in response to the pandemic. The use of multiple digital technologies has assumed a central role in social prescribing, and this situation seems likely to remain. With statutory and non-statutory services stretched to their limits, there is a danger of SPCs assuming new tasks without adequate training or support.

Highlights

The non-clinical methodology known as social prescribing presents a number of advantages in these challenging times
Landscapes in which social prescribing schemes in Scotland operate. We considered it important to understand the conditions under which social prescribing in urban and rural Scotland had been operating during COVID-19 and how resultant changes might inform the future of social prescribing
Two key questions are explored: how have the conditions created by the pandemic reshaped and repurposed social prescribing and how have they impacted on the role and responsibilities of the social prescribing coordinators (SPCs) in urban and rural schemes?

Summary

Introduction

The non-clinical methodology known as social prescribing presents a number of advantages in these challenging times. This article explores the experiences of professional stakeholders of social prescribing in both urban and rural areas of Scotland during the first year of the pandemic It highlights the complexities and inconsistencies of social prescribing and the challenges the pandemic has presented to different schemes, including remote delivery and home working, and taking up additional responsibilities where statutory and non-statutory services are stretched to their limits. What for convenience we refer to as SPCs are, in practice, known by a range of titles such as link worker, social prescribing advisor, community navigator and community connector.[21,22] Another area of difference concerned background and training. The ability to get to know service users and their needs, read body language and non-verbal clues, and sometimes physically assist them or accompany them to sessions, was seen by all SPCs as necessary for effective support: Our social prescribers, so it’s not about sign posting people. . . . the social prescriber will sit down with a patient and they’ll sit and chat about, right, what is important to you, what is it you want to do to improve your health and well-being. (Jane, SPRING manager)

Objectives

Methods

Results

Discussion

Conclusion