Implementation and impact of a social prescribing intervention: an ethnographic exploration

Tessa Pollard; Kate Gibson; Bethan Griffith; Jayne Jeffries; Suzanne Moffatt

doi:10.3399/BJGP.2022.0638

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Synchronicity of link workers with care managers in Japan
Ryuichi Ohta

Published on: 16 July 2023
The implementation and impact of a social prescribing intervention: an ethnographic exploration
Sarah L. Piper and Emma Gardiner

Published on: 16 June 2023

Published on: (16 July 2023)
Page navigation anchor for Synchronicity of link workers with care managers in Japan
Synchronicity of link workers with care managers in Japan
Ryuichi Ohta, Family physician, Unnan City Hospital, Japan
Social prescribing has been applied in healthcare systems in the United Kingdom, focused and praised internationally. In social prescribing, link workers are supposed to work effectively by collaborating with patients and other healthcare professionals. However, Pollard et al. show the concrete challenges of linker workers in clinical settings and partial commitment to social prescribing.¹ In reality, link workers suffer from the variety of patients’ conditions and characters and poor recognition of medical professionals about link workers. Although gradually recognized in health care, they cannot effectively function in social prescribing with the financial and systems pressures. Pollard et al.’s research can synchronize with the negative results of social prescribing in health outcomes and Japan’s initial implementation of care managers for effective geriatrics care.^2,3

Time and continual revisions are essential for the implementation of new healthcare stakeholders. In Japan, the training of care managers started in the late 1990s, specifically with the introduction of the Japanese Long-Term Care Insurance System that began in 2000. This system aims to support the independence of the elderly and reduce the burden of care in families and local communities. Care managers are responsible for understanding the living conditions and wishes of people needing care, creating care plans based on them, and providing appropriate...
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Social prescribing has been applied in healthcare systems in the United Kingdom, focused and praised internationally. In social prescribing, link workers are supposed to work effectively by collaborating with patients and other healthcare professionals. However, Pollard et al. show the concrete challenges of linker workers in clinical settings and partial commitment to social prescribing.¹ In reality, link workers suffer from the variety of patients’ conditions and characters and poor recognition of medical professionals about link workers. Although gradually recognized in health care, they cannot effectively function in social prescribing with the financial and systems pressures. Pollard et al.’s research can synchronize with the negative results of social prescribing in health outcomes and Japan’s initial implementation of care managers for effective geriatrics care.^2,3

Time and continual revisions are essential for the implementation of new healthcare stakeholders. In Japan, the training of care managers started in the late 1990s, specifically with the introduction of the Japanese Long-Term Care Insurance System that began in 2000. This system aims to support the independence of the elderly and reduce the burden of care in families and local communities. Care managers are responsible for understanding the living conditions and wishes of people needing care, creating care plans based on them, and providing appropriate services. Therefore, they need to have professional knowledge of care, communication skills, and coordination abilities. This system is an essential element in dealing with Japan's aging society. However, based on our research, care managers were not recognized effectively among Japanese medical professionals and suffered from misunderstandings in healthcare.³ Continual information provision and revisions of care management of geriatrics improved the standpoints of care managers. Now, the care manager is one of the key healthcare workers in Japan. For the effective implementation of link workers in social prescribing, continual investigation of their work and the revision of social prescribing is essential for evidence-based social prescribing.

References
1. Pollard T, Gibson K, Griffith B, Jeffries J, Moffatt S. Implementation and impact of a social prescribing intervention: an ethnographic exploration. Br J Gen Pract 2023. DOI: 10.3399/BJGP.2022.0638.
2. Vidovic D, Reinhardt GY, Hammerton C. Can Social Prescribing Foster Individual and Community Well-Being? A Systematic Review of the Evidence. Int J Environ Res Public Health 2021;18(10) (In eng). DOI: 10.3390/ijerph18105276.
3. Ohta R, Ryu Y, Katsube T. Care managers in rural Japan: Challenges to interprofessional collaboration. Home Health Care Serv Q 2019;38(4):270-285. (In eng). DOI: 10.1080/01621424.2019.1673867.

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Competing Interests: None declared.
Published on: (16 June 2023)
Page navigation anchor for The implementation and impact of a social prescribing intervention: an ethnographic exploration
The implementation and impact of a social prescribing intervention: an ethnographic exploration
Sarah L. Piper, Final Year Medical Student, St. George's University of London
Other Contributors:
Emma Gardiner, Team Leader & Community Organiser, South Norwood Community Kitchen
This article raises many useful questions about social prescribing - is it a health-adjacent empowerment service or a service that can address core inequality issues? This question has geographical, race and class implications, where different groups and populations may benefit from entirely different services.

To meet needs, social prescribing services should be built with input from local voluntary action groups and potential service users. Co-designing the service requires teams to ask the local community, “what issues can your doctor/nurse/pharmacist not help you fix?” The answer to this question will likely uncover that empowerment isn’t enough to get out of many circumstances, and many areas would benefit much more from a service that understands and can support with the intricacies of securing safe housing, basic nutrition, benefits support, and employment opportunities.

Some communities are lucky to have an organisation built to meet local needs – by the local people for the local people. I have had the opportunity to work with a voluntary organization in South London, South Norwood Community Kitchen, which is able to help people meet day-to-day needs and provides a space to gather, raise issues and build a platform for change. In our area, housing instability is cited as a major issue contributing to physical and mental health challenges – for an effective social prescribing model to be built here, services and resourc...
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This article raises many useful questions about social prescribing - is it a health-adjacent empowerment service or a service that can address core inequality issues? This question has geographical, race and class implications, where different groups and populations may benefit from entirely different services.

To meet needs, social prescribing services should be built with input from local voluntary action groups and potential service users. Co-designing the service requires teams to ask the local community, “what issues can your doctor/nurse/pharmacist not help you fix?” The answer to this question will likely uncover that empowerment isn’t enough to get out of many circumstances, and many areas would benefit much more from a service that understands and can support with the intricacies of securing safe housing, basic nutrition, benefits support, and employment opportunities.

Some communities are lucky to have an organisation built to meet local needs – by the local people for the local people. I have had the opportunity to work with a voluntary organization in South London, South Norwood Community Kitchen, which is able to help people meet day-to-day needs and provides a space to gather, raise issues and build a platform for change. In our area, housing instability is cited as a major issue contributing to physical and mental health challenges – for an effective social prescribing model to be built here, services and resources must acknowledge and address this.

The article notes that some social prescribers are cold-calling people to find suitable service users – during a major cost of living crisis, I don’t believe this is due to lack of demand. Social prescribing relies on referrals from primary care teams – this process requires education for healthcare professionals around which services are available. For the future of social prescribing to be successful, social prescribing and local voluntary services should be an essential part of healthcare training, possibly in the form of mandatory placement time within community organisations.
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Competing Interests: None declared.