Tim Anfilogoff, Head of Community Resilience for Herts Valleys CCG gives his reflections on Social Prescribing and Covid-19 in West Hertfordshire.

In 2014, Herts Valleys CCG, in partnership with Herts County Council, commissioned four voluntary organisations to provide six community navigators.  This service was built on HertsHelp  which is a county-wide single point of access for expert triage to 12,000 entries on the community database.   

The navigators soon showed the difference they could make ‘getting alongside’ people who needed – but would never ring – HertsHelp.  The service was expanded into the countywide Hospital and Community Navigator Service during 2018.  In 2019, the NHS Plan provided the VCS partners the chance to employ most of the new Primary Care Network Link Workers integrating them with the 20 strong navigator service.  This guaranteed business continuity, with workers supported in local teams.  This integrated approach has since proved invaluable.

In 2018-19,  10,000 clients had a service with high client and referrer satisfaction matched by powerful case-studies.  Warwick-Edinburgh short surveys showed an 11% improvement in mental wellbeing and the Campaign To End Loneliness Tool an 18% reduction in loneliness.

A pilot used an algorithm to identify people using A&E ten or more times a year for non-clinical reasons (as confirmed by their GPs).  Reaching out with social prescribing support, three High Intensity User workers helped people reduce A&E use by at least 40%.  This was our first ‘outreach’ service.

The new Primary Care Network Link Workers were inducted in December.  We heard VCS concerns about the balance between ‘travel agents’ (prescribers) and ‘holidays’ (prescriptions) and the CCG was about to invest £400k in local grants so Link Workers could help community assets develop…

And then Covid hit.

The Link Workers, like the VCS in general, swiftly turned into remote outreach workers, calling shielded and vulnerable people, offering practical and emotional support (occasionally in the early chaos delivering food parcels to desperate people themselves).  The Primary Care Network Link Worker team was expanded to include the High Intensity User navigators and six mental health link workers (being piloted with Mind) broadening capacity and skills-base and building resilience against sickness and self-isolation.  Senior navigators, District Councils and Adult Care Services shared lists to minimise people missing out or wasting resources on people already supported.  A Link Worker follow-up call for patients with suspected Covid, at day 7 and 10, took pressure off practice staff.

Having expanded HertsHelp’s capacity by 400% – emergency funding and seconding in of Carers in Herts and Mind workers – HCC leafleted every door.  On one day in April, 650 people, who had previously not known what to do – called HertsHelp for support.

We won’t waste this crisis.  Old barriers are down.  Despite huge challenges, the VCS have shown amazing flexibility and responsiveness.  Doctors are speaking directly to them to find local solutions.  Volunteers have poured into the system (10,000+ in Herts, not including 15,000 NHS Responders).  We’re analysing challenges to the sector and will spend the £400k (suspended along with business as usual) as part of recovery, using the statutory sector’s awareness of its reliance on the VCS to argue for more.  Seconding furloughed VCS workers temporarily into additional Link Worker roles is being considered.

We knew social prescribing was a key tool for integration.  The crisis framework of outreach and wellbeing-calls by Primary Care Network Link Workers can now morph into strategic use of the power of the community to attack the health inequalities highlighted and exacerbated by Covid.  In the words of Simon Stevens, we must take ‘this opportunity to lock in beneficial changes that we’ve collectively brought about in recent weeks…’  We mustn’t forget the crucial role the VCS has played in getting us through the crisis.

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