Reflections on NHS Long Term Plan

Question

Response

There have been a lot of changes and developments in the way support is offered to people, for example utilising the VCS (Voluntary Community Services) to deliver wider support.  Is there anything significant that you think has caused this?

The NHS Long Term plan introduced various changes to Primary Care contracts some years ago. This included the introduction of Social Prescribing. These contracts changes ended this year, so I think it’s good to reflect on this and think what next. Will this innovative approach be rolled out to the wider NHS systems e.g. Secondary Care and will this involve widening to Adult Social Care? We (VCS) are already seeing changes from within these areas. With secondary care we have been approached to explore ways to focus on health inequalities and targeting support at specific long-term conditions. With ASC the focus is on the wider support that falls outside the Care Act criteria and the response to those wider needs. 

Before the NHS Long term plan, was there support similar to Social Prescribing Link Work?

I started with Age UK Islington just over 8 years ago. Shortly before this the ICB (then known as the CCG) had funded the Locality Navigation service: this offered support so that clients could look at alternative ways to manage their long-term health conditions and address a multitude of factors affecting people’s lives, things that were getting in the way of their general wellbeing. The service initially focused on ‘signposting’ to non-traditional providers, then ‘active signposting’ (providing help to engage with services) and now also coordinating support between a wide range of professionals.

How does the Navigation Service differ from Social Prescribing?

I think for a long-time people have confused ‘Social Prescribing’ with Social Prescribing Link Workers. The term ‘Social Prescribing’, meaning support that does not require medicine, has been around for decades. It was never called Social Prescribing but it’s what the VCS has always done.

The key differences between Primary Care Social Prescribing and Locality Navigation is in the complexity and integration of support.

PCN Social Prescribers don’t tend to support people with multiple needs or several health conditions, they tend to work with someone who has a certain level of motivation or capability, working for a shorter period say 4-6 weeks, whereas Locality Navigators tend to work with people who could be experiencing a range of issues, for example, substance misuse, facing eviction or homelessness, have quite serious financial problems, to name a few. The Navigators tend to work with people for longer, on average 8-12 weeks bit on occasions a lot longer.

It’s almost like a step up from Social Prescribing. The Locality Navigators are also part of the Integrated Network Coordination (INCs) meetings, which is a multi-disciplinary approach to supporting people who have several vulnerabilities and require a range of inputs from different professionals including GPs, Social Workers and other health professionals.

How many staff do you have in each service and how many people do they support for example say over the last year?

I oversee both the Social Prescribers and the Locality Navigators, along with other services providing different aspects of personalised care and support.

Age UK Islington currently employs 8 SPLWs, including a Team Leader, who work with Central 1 and South PCN.

We also employ 6 full time equivalent Navigators which is 5 full time and 2 part time. Two of the Navigators are also Team Leaders; the team leaders provide more specialist navigation support. The Navigators work across all of Islington and attend all eight INCs.

The numbers are relative to the level of complexity of the support needed. Last year (2023-24) the SPLWs worked with over 2,000 cases, whereas the Locality Navigators worked with over 1,200 cases.

What difference do you think these services have made, both for the people receiving the support but also for professionals who refer?

That’s a big question. The Locality Navigation service has evolved significantly from the original support offer, they offer a much more integrated approach to someone’s support needs, involving a wider range of professionals, working in a structured way; ensuring the wider complex needs of people are addressed. For professionals, the feedback we have had is very positive and appreciative. GPs often report that they feel confident that their patient was getting the right support for multiple needs. I have seen the remit of the INC engagement change: at the beginning we would take more clients to INC whereas now we take more actions from the INC. I think that’s testament to the confidence in the service offer.

For SPLW, I think this has made a huge difference to Primary Care staff, specifically GPs. It enables the GPs to focus on their remit with the reassurance that they can refer their patients for non-medical support. This has reduced the number of appointments taken up with non-medical needs. For the people themselves it’s about having access to support that can make a real difference to their lives.

What is your vision for the future of both the Locality Navigation service and the Social Prescribing Link Work service

I can see both services having very different remits. To give you an idea, I think the SPLW service will increasingly work in a different way, delivering support for people to manage their health conditions via workshops, very often in partnership with specialist services. Enabling people to self-manage their conditions by learning how to make practical changes to improve their situation is hugely empowering for the individual, helps them to develop their own support networks as well as making the best use of resources.

With the Locality Navigators I think they will become more integrated with wider support and multi-disciplinary approaches to tackling health conditions and working as part of a collective alongside statutory services teams. This will involve directly co-locating across ASC, Secondary care and other health provision services, allowing services to escalate clients.

So both looking and supporting people to address their non-medical or non-statutory needs but in very different ways.