In the first Level 3 Qualification in Social Prescribing course in the UK, three learners submitted an assignment during the micro-commissioning unit in the form of a blog.
Ahead of primary care networks receiving funding to increase social prescribing provision, three link workers explore how micro-commissioning is working in three separate STP regions in Yorkshire and Humber, alongside how it benefits patients and how it guides link worker roles.
* Pictured above: Sarah Rust Social Prescribing Advisor Bassetlaw CVS and Social Prescribing Qualification Tutor, Dan Hopewell.
Micro-commissioning for Social Prescribing in West Yorkshire STP
Background
20% of patients present at GP appointments with non-medical needs(2). These patients are ideal for link workers to support with socio-economic issues. Link workers need a thriving VCSE sector to ensure there are options for patients and capacity for referrals to be accepted. One way of supporting the VCSE sector is through micro-commissioning.
Micro-Commissioning
Micro-commissioning is the process of identifying and addressing needs at an individual level through creating additional activities in local communities. Link workers and Social Prescribing services can micro-commission the ‘social prescription, creating activities that offer patients ways in which to improve health and wellbeing locally. Micro-commissioning and small-grants funding allows the VCSE sector to grow capacity and establish new provisions to fill gaps to meet needs.
Benefits
Individuals
Micro-commissioning of non-medical options ensures that GP’s/Link Workers can offer choice and flexibility to patients. Personalised care and support plans can allow individuals to be an active participant in their own journey, leading to greater empowerment, promoting ownership and encouraging commitment.
Being involved in prescribed activities presents individuals with opportunities to build social capital. Building a larger and stronger support network has been proven to reduce the risk of death in adults by half(3). Individuals may also find themselves presented with the opportunity to volunteer or secure employment.
Community
If the health and wellbeing of individuals within communities improves the whole community could feel the benefit. A more cohesive community forms and continues to build on relationships and networks, resulting in improved wellbeing of the whole community, leading to sustainability.
Another aspect of community sustainability to recognise’ is the growth achieved from micro-commissioned activities collaborating with assets within the communities to lead activities.
Service Delivery
With funding entering the VCSE sector through micro-commissioning, capacity increases. With increased capacity services are able to deal with demand, ensuring that referrals from PCN’s can be accepted and waiting times reduced.
Micro-commissioning also improves choice, with multiple services offering similar options, it provides an opportunity for services to learn from each other to ensure best practice, driving quality and improving efficiency. Offering a patient more choice within their own communities reduces access barriers, such as transport affordability and helps to tackle the wider determinants of health. Improved choice also ensures that PCN staff have options when it comes to selecting the right services for patients. Referring to a tailored service can lead to improved outcomes; in turn reducing patients need for GP appointments, helping to reduce demand on general practice.
Applying to service delivery
Micro-commissioning gives PCN’s the opportunity to work in collaboration with patients and across sectors. Patients, link workers and VCSE providers’ working in collaboration through communication and local data intelligence ensures identified needs have the potential to be met with new micro-commissioned activities.
Collaboration also occurs between link workers and the VCSE sector when community development exists in the link worker role, they have the skills to support groups to apply for micro-commissioning.
Partnership working between PCN’s and the VCSE sector, via representatives sitting on each other’s various boards, VCSE services are well placed to support general practice to meet targets and reduce financial and capacity pressures.
The VCSE sector tends to focus on prevention(4); often GP’s have exhausted clinical options to support patients before referring to Social Prescribing services. Micro-commissioning can lead to innovation, with general practice accessing new ways to treat patients. Linking patients with these options requires GP’s to be aware of link workers and link workers need to have good local knowledge of the VCSE sector.
Process of Micro-Commissioning
- Funding sourced
- Needs identified – patients, JSNA, Local priorities
- Map existing services
- Create application – Decide how difficult this is to complete depending on desired number of applications.
- Resource support to apply – for constitutions/policies/guidance
- Write FAQ’s
- Organise resources to manage process – time, venues, panel members
- Establish agreed scoring system and priorities
- Advertise/promote
- Plan dates for closing, reviews, panels, inviting applicants to interview
- Inform successful applicants and provide agreed funding
- Agree feedback and evaluation dates
- Gather/evaluate outcomes – cost analysis
Services Involved with Micro-Commission (example):
- Social Prescribing service – gain insight into individual needs and barriers to accessing support.
- VCSE Infrastructure Organisation – Able to portray member’s needs and disseminate information to its members. Able to support services to apply/meet requirements to apply.
- Public Health Intelligence/Commissioning teams/CCG – Able to support with local data and guide on local priorities.
- Lay members – act as independent members, ensuring non-bias decisions.
- Services created and applying include: gardening groups, care providers, mental health groups and benefits support services.
References:
England N. NHS England » Army of workers to support family doctors [Internet]. England.nhs.uk. 2019 [cited 18 June 2019]. Available from: https://www.england.nhs.uk/2019/01/army-of-workers-to-support-family-doctors/
Torjesen I. Social Prescribing could help alleviate pressure on GPs. BMJ. 2016;352(1436).
Berkman L, Syme S. Social Networks, host resistance and mortality: A nine-year follow up study of Alameda County residents. American Journal of Epidemiology. 1979;109(2):186-204.
Unlocking the value of VCSE organisations for improving population health and wellbeing: The commissioner’s role. London: https://www.healthylondon.org/wp-content/uploads/2017/10/Unlocking-the-value-of-VCSE-organisations-for-improving-population-health-and-wellbeing.pdf
Localised Commissioning (Essex). London: Commissioning Support Programme; 2019. www3.lancashire.gov.uk/corporate/web/viewdoc.asp?id=53912
Localised Commissioning (Essex). London: Commissioning Support Programme; 2019. www3.lancashire.gov.uk/corporate/web/viewdoc.asp?id=53912
Micro-commissioning for Social Prescribing in South Yorkshire & Bassetlaw STP
Micro-Commissioning – what’s it all about?
Working collaboratively with people so that we understand their needs and wishes can enable them to find the support services that they want and ensure services are designed around individual need within the community. This enables the Social Prescription for each individual.
Micro-Commissioning and the benefits:
Social Prescribing is all about a finding a tailor-made solution to the need of the individual. Working with people, to gently encourage engagement with local activities and groups in the community, alongside services which may be of support and help. A person-centred approach is taken which allows complete flexibility and control of the individual to map out their own future positive outcomes. Individuals are encouraged and supported to be active in their own recovery. This is not just about passive attendance, but fully engaging and participating. As individuals grow in confidence, some becoming volunteers themselves discovering a purpose and fulfilment as well as benefitting the community at large.
Having a wide variety of groups available locally is essential to enable service efficiency and effectivity. This comes with its own challenges. Many groups have no access to funds or find the process of applying for funds to be complex and exclusive to larger organisations. Restrictions are often applied to expressions of interest in terms of governance and policy for groups, which means smaller community champion led groups often fail to meet the criteria of local funding pots.
Often local commissioners have pots of funding that are available to bid for, which strategically target areas of need that commissioners wish to focus on. This could be regarding reduced unplanned admissions into hospital for older people, GP attendances or tackling social isolation. These pots of funding could be managed by Social Prescribing services in conjunction with commissioners to meet the needs of the local population.
Social Prescribing services are in an increasingly strong position to manage these funds and orchestrate the expression of interest to those needing it most within the community, without there being any conflict of interest. Social Prescribing services do not provide services themselves; they use what is available within the local community to meet needs. When a need that is not met is highlighted, it can be used to form the basis of criteria of a funding bid to bridge that gap for the local commissioners’ requirements, individuals or those of the community. Being aware of community assets that are not being utilised to their full potential is also an opportunity ripe for development. This is where the Link workers local knowledge is of huge advantage.
Setting the criteria for a funding pot is essential. Knowing the local health inequalities, the gaps in service delivery, the needs of local people and the needs of community are crucial. It not only meets the need but prevents duplication of services within a locality. We have a responsibility to those who wish to bid. Guidance and support need to be offered to those who feel they are unable to undergo the bidding process.
The format must be as inclusive as possible to enable a wide variety of groups and services access to much needed funds. Social Prescribing services can provide help and ensure governance for groups as well as provide quality assurance. It not only forms strong collaborative working relationships, but it strengthens the local 3rd sector and individuals, empowering them to achieve more together.
Having a collaborative work ethic and being on the ground to introduce the patients to groups enables the link workers to get to know local organisations and be known. Link workers are in prime position to inform groups of funding opportunities, of quality and improvement as well as encouraging them to measure the success that is often not captured by many groups in terms of the work the impact is achieving within their communities. Evidence is vital when completing funding applications and Social Prescribing services can support data collection.
In order to succeed we need to grow and sustain the 3rd sector to become the rich and valuable asset it is swiftly becoming by providing support and encouragement to some of our most vulnerable and needy individuals. This sector deserves and desires recognition, encouragement and financial backing to enable sustainability and development of the incredible achievements and results they make to individuals, services and the community at large.
Micro-commissioning for Social Prescribing in Humber STP
East Ridings of Yorkshire Integrated Social Prescribing Service consists of three distinct roles:
- Link Worker (Practice Worker/Assessor) Acts as the link between the referrer and the connector, responsible for assessing the individuals and coproducing an action plan.
- Community Connector (Navigator/Community Link Worker) Proactively supports the individual to access appropriate services that help them in achieving their action plan and supports Builders to identify assets and gaps.
- Asset Builder (Activator) Maps, identifies gaps and helps communities to build assets that support local delivery of community services/assets
Within the East Riding of Yorkshire Social Prescribing service micro-commissioning is based around the work and collaborative working of the stakeholders within the partnership. Micro-commissioning is delivered to meet the identified needs of a given locality to offer the social prescription which the services are commissioned to deliver based on the research form the joint strategic needs assessment.
Micro-commissioning, if used correctly, can have positive impacts on individuals. If the right provider is commissioned to deliver a service, they need to have clear objectives and targets. Good commissioning is person centred and focuses on outcomes with a positive approach form the provider. A good service allows flexibility and inclusion whilst being willing to adapt to meet the needs of the community. With the commissioner given clear outcomes this allows any local partnership to work between partners to help achieve and work together to see the best outcomes. Choosing the right organisation to commissioning on a programme is key and it must be chosen correctly and by allowing it to be focused on individual needs helps create inclusion when deciding on who will commission a service.
The delivery of a service can be defined by how service can apply to be micro-commissioned. In a competitive field it is vital that the quality of the service remains high whilst at the right cost to the service. Having a competitive market can drive the price down, but it is important that the quality of delivering does not get compromised in the meantime. This effect could drive quality in a both a positive and negative way. Knowing the needs of a community can prove effective to smaller organisations as they often can focus down on the locality’s specific needs. However, smaller organisations may struggle compared to larger ones if the application process is overly bureaucratic and complicated.
The community are key in micro-commissioning and this is where a local provider could have a greater impact and effect than an outside provided. By including local people, local assets and local needs analysis this can help achieve targeted support for the community. By using Social Prescribing services to facilitate partnership working it allows community organisations to use their skills. By identifying an activity for certain areas, it avoids duplication, meaning one partner can focus slowly on their given area rather than having two competing groups for the same need. To avoid this happening having a clear leadership and project manager in place will help build engagement within the community. For Social Prescribing to provide the Social Prescription, we need to offer a package that is accessible and will be open to flexibility in the application process ensuring it is still a bespoke offer. Building relationships between both statutory and voluntary sectors will also allow for greater connections and assets to be realised in the community.
It is important to do an appropriate needs analysis using the available data, such as Joint Strategic Needs Assessments (JSNA) and or locality needs assessments to ensure that no similar service is already taking place. The East Ridings of Yorkshire CCG has sub contacted sections of the Social Prescribing programme within the East Riding of Yorkshire. This allows specialists such has HEYMIND to utilise their community development skill set as well as SMILE Foundation to help voluntary sector groups build within communities.
Identifying your need and gathering evidence is important when starting the process of micro-commissioning. This will help potential on scoring who is awarded the grant. As some services are smaller and don’t have capacity to put as much time and effort in it is worthwhile mentioning that if they should be unsuccessful first time around, they can re-apply modifying their application with the feedback given.
Following an organisation’s policies and procedures may be beneficial. Having a monitoring and agreed way around working and keeping records of progress made should also be included in micro-commissioning. This allows the commissioner to see how they operate, how they review the work carried out and what evaluation tool they will use. Acting on monitoring and measuring progress is a part of the model in the East Riding of Yorkshire. Clear targets are given for the services successful in the micro-commissioning process, which forms reviews and allows actions which lead to an improvement in the services provided.
Many thanks to Rebecca Dunford, Live Well Advisor of Live Well Wakefield, Dominique Rhodes, Asset Builder of East Ridings of Yorkshire Council & Sarah Rust, Social Prescribing Advisor of Bassetlaw CVS for their support with this blog.
