Community and Primary Care Research Group, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.
Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.
Health Soc Care Community. 2022 Nov;30(6):e4086-e4094. doi: 10.1111/hsc.13802. Epub 2022 Mar 30.
Emerging evidence suggests that connecting people to non-medical activities in the community (social prescribing) may relieve pressure on services by promoting autonomy and resilience, thereby improving well-being and self-management of health. This way of working has a long history in the voluntary and community sector but has only recently been widely funded by the National Health Service (NHS) in England and implemented in Primary Care Networks (PCNs). The COVID-19 global pandemic coincided with this new service. There is wide variation in how social prescribing is implemented and scant evidence comparing different delivery models. As embedded researchers within an Integrated Care System in the Southwest of England, we examined the impact of COVID on the implementation of social prescribing in different employing organisations during the period March 2020 to April 2021. Data were collected from observations and field notes recorded during virtual interactions with over 80 social prescribing practitioners and an online survey of 52 social prescribing practitioners and middle managers. We conceptualise social prescribing as a pathway comprising access, engagement and activities, facilitated by workforce and community assets and strategic partnerships. We found that these elements were all impacted by the pandemic, but to different degrees according to the way the service was contracted, whether referrals (access) and approach (engagement) were universal ('open') or targeted ('boundaried') and the extent to which practitioners' roles were protected or shifted towards immediate COVID-specific work. Social prescribers contracted in PCNs were more likely to operate an 'open' model, although boundaries were developing over time. We suggest the presence of an explicit, agreed delivery model (whether 'open' or 'boundaried') might create a more coherent approach less likely to result in practitioner role drift, whilst allowing flexibility to adjust to the pandemic and enhancing practitioner satisfaction and well-being. The potential consequences of different models are examined.
新证据表明，将人们与社区中的非医疗活动（社会处方）联系起来（社会处方）可以通过促进自主性和适应力来缓解服务压力，从而改善幸福感和自我管理健康。这种工作方式在志愿和社区部门有着悠久的历史，但直到最近才得到英格兰国民保健制度（NHS）的广泛资助，并在初级保健网络（PCN）中实施。COVID-19 全球大流行恰逢这一新服务。社会处方的实施方式存在广泛差异，比较不同交付模式的证据很少。作为英格兰西南部综合护理系统的嵌入式研究人员，我们研究了 COVID 在 2020 年 3 月至 2021 年 4 月期间不同用人单位实施社会处方过程中的影响。数据来自对 80 多名社会处方从业者的虚拟互动期间记录的观察和实地笔记，以及对 52 名社会处方从业者和中层管理人员的在线调查。我们将社会处方概念化为一个由劳动力和社区资产以及战略伙伴关系促进的途径，包括准入、参与和活动。我们发现，这些因素都受到了大流行的影响，但根据服务合同的方式、转诊（准入）和方法（参与）是否是普遍的（“开放”）还是有针对性的（“有界限的”）以及从业者的角色在多大程度上得到保护或转移到直接的 COVID 特定工作，程度不同。在 PCN 中签约的社会处方者更有可能采用“开放”模式，尽管随着时间的推移界限正在发展。我们建议存在明确、商定的交付模式（无论是“开放”还是“有界限的”）可能会创建一种更连贯的方法，不太可能导致从业者角色漂移，同时允许灵活调整以适应大流行，并提高从业者的满意度和幸福感。不同模式的潜在后果进行了检查。
