Social prescription – Why a ‘Wellbeing Script’ can start tomorrow?

We are exploring the concept of a ‘Wellbeing Script’ – how it might work, and most importantly, how it can simplify a referral pathway between clinicians, their patients, and their local Neighbourhood House – those powerhouses of social connection. This opens a world of possibility largely revolved around a referral model bringing patients from disconnection to social connection with positive health impacts. We have discovered many gems and ‘natural social prescribers’ already in our project in the Central Highlands region of Victoria. They are the forward thinkers in medicine who seamlessly practice prevention, as much as preventative and primary care in their daily consultations.

One such gem is Dr Kevin Lee, an endocrinologist and specialist physician who fell in love with Clunes many years ago and continues to practice in this vibrant little community. Dr Lee champions the importance of social and community connection and refers patients in his consultations to a range of health promoting activities not as an extra but a fully integrated part of clinical practice.

Dr. Lee believes it is “simple and day to day practice, you don’t need an extra session just to socially prescribe”. Dr. Lee can share many stories of light social prescribing benefitting his patients. One such patients he recalls presented with obesity (BMI of 37), prediabetes, rheumatoid arthritis, and was wheelchair bound. Dr. Lee noticed that they had an interest in gardening in their backyard. After engaging them with the benefits of horticultural therapy, he had essentially ‘prescribed’ them a course of increased gardening activity which not only increased their dietary fiber intake from their own produce, but over time, they “no longer needed a cane to walk, reversed [their] prediabetes to normal and [could] drive to go back to work [again]”. Her husband was also able to demonstrate his support for her by building raised vegetable boxes and platforms to garden on. In just over six months, they achieved more than 15% weight loss, from 106.9kg to 89.4kg, which is equivalent to a gastric band intervention.

Dr. Lee and Lana de Kort, Clunes Neighbourhood House Manager, have teamed up to imagine what is possible in their community. As a start they have designed and are at present delivering and intensive lifestyle modification program “Weight off my shoulders” with their community. The first program was full upon announcement, we look forward to hearing about the health and wellbeing impact in the future.

Sometimes it is nice to know we can just get on with it – try things, iterate, try again. We don’t need to wait for the perfect system for social prescribing, we can lightly prescribe right now- with the resources available in communities across Victoria, and certainly sign-post pathways for health and wellbeing.

Dr Kevin Lee

Why are we going ‘light’ on social prescribing?

We are often asked in the Wellbeing Scripts project as to why we use the term ‘light’ social prescribing rather than just social prescribing. We have been guided by Kimberlee’s (2015) analysis of a range of existing programs which identified four levels of social prescription: Signposting; and Social Prescribing Light, Medium and Holistic.

Our ‘why’ for a focus on signposting and ‘social prescribing ‘light’, sees a combination of provision of information to patients and community members, and referral between General practice and Neighbourhood Houses (potentially in both directions). Further:

  • It is human-centred in design – created by the people using the system for their context, purpose, and community need
  • It is sustainable– taps into and uses existing capacity and capability, removes us from the searching for funding treadmill
  • Is a ‘Value add’ relationship – there is great value for GPs and Houses in connecting and referring for their community
  • It further unlocks mutual benefit– at a time of great need to socially connect people
  • It is asset based – we go with the energy in the system for greatest likelihood of change and uptake
  • Is place-generated and created – fit for purpose for that community and that GP and NH relationship
  • It has potential for growth– we can learn and iterate, creating solutions that meet the actual needs and opportunities at hand 

As Nicole Battle, CEO Neighbourhood Houses Victoria, puts it “Wellbeing Scripts can be mutualistic with the Neighbourhood Houses being able to refer patients to GPs”.

Put simply we do not want to get too caught up in the enormous size of the effort and resourcing required to shift the health care system to social prescription. This takes time and resources. 

So how might we contribute to this holistic system as it emerges? We aim to demonstrate how bespoke scripts can be developed and used for everyone’s benefit, we do not see the need to wait- rather, we intend for our regions Wellbeing Script to compliment and inform.