Social prescribing and sustainable pharmaceutical use
Both the UK Government and the NHS recognise the need for a greater focus on health promotion and disease prevention, as well as the need to better manage and address the social determinants of health. This upstream focus has not only been shown to support healthier lifestyles, but also typically requires fewer healthcare resources (including reduced pharmaceutical usage), meaning economic savings for the NHS and reduced negative environmental impact. Social prescribing is a major route through which the UK Integrated Care Systems (partnerships between local NHS Trusts, local government and other partners) hope to achieve this.
The Pharma Pollution Hub is interested in finding out more about how social prescribing could be helping to reduce the environmental impacts of pharmaceuticals, since promoting better health and wellbeing is a key leverage point to reduce reliance on pharmaceuticals in our UK healthcare pharmaceutical system. To start this conversation, we hosted a short online panel event with four fantastic guests at the University of Exeter’s European Centre for Environment and Human Health. We asked them how could social prescribing support sustainable pharmaceutical usage in Cornwall. Here, we summarise their thoughts…
Defining social prescribing and sustainable pharmaceutical usage
Social prescribing is described by the National Academy for Social Prescribing as the practice of connecting people to activities, groups and support that improve their health and wellbeing. Its aim is to address the wider social factors that impact health, such as loneliness, debt, or stress due to financial pressures or poor housing. These needs often cannot be met by doctors and medicine alone.
Typically, a healthcare professional (usually in primary care) refers a patient to a Social Prescribing Link Worker, who works with them to co-create a personalised care and support plan to help the person take control of their health and wellbeing. The link worker will help to identify appropriate resources and, or activities to address their individual needs. Activities could include joining a befriending group or community garden for an isolated person, connecting someone with financial stress to a debt managing service, nature connection classes for someone with low levels of depression, or referring someone with dementia to a dementia choir. It is estimated that at least half of the concerns brought to link workers involve practical support, for instance overcoming problems with inappropriate housing, managing finances, filling in benefits forms, etc.
There is no established definition of sustainable pharmaceutical usage, but the United Nations defines sustainability as “meeting the needs of the present without compromising the ability of future generations to meet their own needs”. We therefore suggested that sustainable pharmaceutical usage could be defined as “profiting from the human health and economic benefits that pharmaceuticals provide, without compromising long-term environmental, human or economic health”.
Welcome panellists! Please introduce yourselves and your work
Sarah Stacey, Co-Founder: College of Medicine Beyond Pills Campaign, now Secretariat Member: Beyond Pills All Party Parliamentary Group.
The Beyond Pills Campaign was set up to address over-prescribing in primary care and support non-medical alternatives such as social prescribing. It was initiated by the College of Medicine in June 2022, following the publication of the Government's National Overprescribing Review. In December 2023, the Beyond Pills All Party Parliamentary Group was launched with the goal of moving UK healthcare beyond on an over reliance on pills through an integrated approach combining social prescribing, lifestyle medicine and psychosocial interventions with safe deprescribing and a reduction in unnecessary and inappropriate prescriptions. This APPG will campaign for de-medicalised and community-centred responses to emotional distress, for funding and local services to prevent and reduce dependence on prescribed drugs, communicate with policymakers and promote changes in training and education for relevant health professionals.
Kevin Feaviour, Director of the Cornwall-based Imagine If Partnership.
Imagine If is a social enterprise that focuses on promoting individual and community development for greater health, wellbeing and happiness. Their aim is to create communities of support that generate health for their members, such as through social prescribing services and community health hubs. They take a personalised approach, helping people to co-create a pathway to take control of, and manage, their own health.
Manda Brookman, Cornwall Primary Care Climate Resilience Manager, Cornwall and South West Health and Climate Resilience Network.
The Cornwall and South West Health and Climate Resilience Network is made up of progressively-minded clinicians, community practitioners and health professionals, whose mission is to build climate and ecological resilience by joining the dots between human and planetary health. They seek to enable our health systems to move from sickness treatment to a health creation model. The network also runs the Cornwall Greener Practice Network, which provides practical support and information for primary care services to become more sustainable. It’s based in Cornwall and run by Volunteer Cornwall, supported by Greener NHS and the Cornwall and Isles of Scilly ICB. It loudly promotes the permission to act!
Julze Alejandre, Doctoral Researcher funded by the Scottish Government, Hydro Nation Scholar profile.
Julze’s research specialises in developing a sustainable prescribing strategy using implementation science methods and behaviour change theories. His current work focuses on combining nature-based social prescribing and eco-directed and sustainable prescribing of pharmaceuticals, to develop a Scottish Blue-Green Prescribing Programme for Mental Health. His work aims to help Scotland deliver net zero health by reducing pharmaceutical pollution in water environments through the sustainable use of Scotland’s aquatic resources.
Question: how could social prescribing support sustainable pharmaceutical usage, and what are the challenges in achieving this?
Sarah: The 2021 National overprescribing review report found that at least 10% of the current volume of medicines may be overprescribed and inappropriate, unnecessary and could do harm, including premature death. Social prescribing is part of an integrated approach to help reduce drug use in primary care. It empowers people to participate actively in their own health and care as an addition, or in some cases, an alternative to drugs. For example, research has shown statistically significant improvements in psychological wellbeing, reductions in loneliness and isolation, from social prescribing, which can lead to fewer drugs being used.
Kevin: An example of our work that can reduce medication use is Pain Cafés. These are places where people living with chronic pain can come together, in a facilitated setting, to share their lived experiences, support each other, get access to resources and learn new skills. The aim is for participants to feel they have purpose and control of their health, to help them maintain their motivation, autonomy and dignity. Our approach is a ‘socialpsychobio’ (turning around the biopsychosoical model) form of pain management and social prescribing. We bring people together, help them relax and feel they are part of something, have a good experience, then move into the psychological mindset of using ‘skills not pills’ programme. The social element and peer support has become a key feature of the cafes, shifting from social prescribing to sustained social support. Feedback from Pain Cafés, so far, has shown that 60% of participants have decreased their medication use, 40% have stayed on the same medication and not increased their use. In addition, 50% said they see their GP less.
Manda: To meet net zero targets to reduce carbon emissions of the NHS, one area identified for change is the footprint of pharmaceuticals. The use of medicines makes up 25% of the NHS’s overall carbon footprint and 60% of primary care. While pharmaceuticals have many lifesaving benefits there is now wide evidence of an overreliance on their prescription (by clinicians) and use (by patients). Social prescribing could reduce that and reduce the carbon and pollution impact of unnecessary pharmaceuticals – contributing to both human and planetary health at the same time. Social determinants of health include issues such as quality of housing and diet, access to green spaces, air quality etc, which are structural problems. We know these are caused by economic and political decisions, but the impact of these structural problems lands on the shoulders of the NHS who have to respond with a “health system” solution – essentially a proxy for the missed opportunity to design out sickness in the first place via better structural decisions. Social prescribing is therefore a route away from this double bind of poor human health and damaging planetary impact, by offering an alternative model for health creation. It could transform patients into contributors, as rather than being a passive recipient of medication, they become active participants in their, and their community’s, health creation, e.g. via helping to build and maintain shared community assets, like community gardens, which others can also use. However, current business models in the pharmaceutical and healthcare sectors, which are based on the number of prescriptions made to trigger payments, and the habitual use and prescription of pharmaceuticals, are substantial barriers to change. Other challenges include all the additional pressures the NHS faces, such as funding and staffing levels, which limit the time to think about doing things differently.
Julze: Increasing healthcare demand in Scotland, due to increased prevalence of disease, is negatively impacting both the environment and the sustainability of healthcare services. For example, the increase in mental health demand has seen increasing use of antidepressants, with an increase in healthcare costs, and the increasing occurrence of psychiatric drugs found in aquatic environments. Pharmaceutical residues are known to affect water quality, drive antimicrobial resistance, and affect the health of wildlife through impacting their behaviour, reproduction and development of aquatic organisms. My research shows that blue-green prescribing is a potential solution in Scotland, where the ‘blue’ refers to getting patients engaged in outdoor water-based activities, like kayaking or swimming, alongside other social prescribing activities. The ‘green’ refers to both engagement in outdoor land-based activities, as well as eco-informed and sustainable prescribing, where pharmaceuticals with less of an environmental impact are prescribed, based on data from environmental risk and hazard assessments. Critical challenges in the effective roll-out of blue-green prescribing are the awareness of the environmental impact of current practices, the understanding and acceptance of social prescribing, and feasibility.
And a quick final question: how could research drive action here?
The panel discussed the need for better leadership in delivering the large-scale change that is needed for a greater focus on health creation and disease prevention. In terms of social prescribing, the panel raised the need for more evidence of the environmental impacts of social prescribing interventions, to accompany the increasing body of data that already exists on the positive clinical, social and economic benefits of social prescribing. This would encourage and support the much-needed greater investment into social prescribing infrastructure. One of the main routes by which research could help to achieve this could be through case study sites, which could examine social prescribing practices and opportunities in a given location, and collect reliable, long-term data on the health, economic and environmental impacts of this.
In addition to improving our evidence base, there is also an issue of the existing and increasing body of evidence not being considered by current systems. There may be a data deficit but just as importantly there is a leadership deficit. We need to identify and support those who could use existing and substantial evidence to forge a different path to enable others to follow.
Many thanks and next steps!
We are hugely grateful to the speakers for sharing their amazing experiences and expertise. We felt that this was a great start to this important conversation, and we learnt that there are substantial practical challenges in rolling this out effectively, but that social prescribing offers enormous potential for more sustainable pharmaceutical usage. One of the Pharma Pollution Hub’s aims is to use research to drive action, and our next step will be to follow up on the research ideas identified here.