To mark Social Prescribing Day 2023, Professor Tony Avery OBE, GP and National Clinical Director for Prescribing at NHS England, writes for The College of Medicine on the system approaches needed to optimise medicines to better care for people living with pain…

While medicines provide an excellent range of tools for clinicians to give life-changing and life-saving care and treatments, taking medication unnecessarily has adverse effects for patients, wastes valuable NHS resources and damages the environment.

Overprescribing is a key issue in the NHS that I am keen to tackle in my role as National Clinical Director for Prescribing, working alongside colleagues at the College of Medicine and the Beyond Pills Campaign. It’s crucial to ensure that patients are supported to safely reduce or stop medication that is no longer providing benefit.

At NHS England we are focusing on the impact of medicines associated with dependence or withdrawal symptoms. Taking these medicines, if they are prescribed inappropriately or for longer than necessary, can harm patients’ physical and mental health. Patients may become dependent on the medicine and experience withdrawal symptoms.

They may also need to take additional medicines to manage side effects. In some cases, evidence-based, non-medical alternatives can be the safer and more effective option and social prescribing can also help people manage the psychological and social impact of living with pain and other health conditions commonly associated with overprescribing.

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As part of an overall NHS medicines optimisation strategy, we’ve published a new framework for local health and care providers which aims to support health and care systems to reduce inappropriate prescribing of medicines associated with dependence and/or withdrawal symptoms, like opioids, z-drugs, benzodiazepines and antidepressants, where they may no longer be the most clinically appropriate treatment for patients.

The framework encourages integrated care boards (ICBs) to design and develop new and innovative system-wide approaches working in partnership with people with lived experience, local government, and the voluntary, community and social enterprise sector. This approach, grounded in shared decision-making, may involve developing new services, but these don’t have to be expensive and, by treating
people with pain and other chronic conditions in the community, there is less impact on NHS resources and better outcomes for individuals.

It’s clear that we can innovate with new approaches to improve patient outcomes and deliver value for money. On my recent visit to Gloucestershire, I was inspired by the creative ways in which people with lived experience, colleagues in healthcare and the voluntary sector have come together across the health and care system to bring about transformative change in the lives of people living with pain.

I heard about the fantastic work that Dr Cathy Stannard, Clinical Lead for Pain Transformation, and her colleagues have done at NHS Gloucestershire ICB. Here health and care professionals have been helped to develop their knowledge and skills of health coaching and motivational interviewing; thus, gaining confidence and and greater job satisfaction from helping people experiencing long-term pain.

GPs had been encouraged to limit their prescribing of strong analgesics but were keen to be able to offer something instead, and this is where the expansion of social prescribing has been very helpful. Gloucestershire has a thriving voluntary sector and there are around 5,500 voluntary and community groups. The county has around 80 social prescribing link workers who work with the people referred to them to focus on what matters most to those people and what might help the most.

This may range from art and other creative health group activities, classes aimed directly at improving mental health, practical programmes like The Producers (similar to Mens’ Sheds), and direct support for anything that is causing problems in life (such as finance or housing problems). I spoke to many people who had been helped to live better with the impact of their pain and engagement in meaningful activities was an important part of this.

I visited the GL11 Community Hub where they take over a thousand referrals from local GPs per year, for their ‘From Patient to Person’ service, with 600 receiving counselling, 300 health coaching, and 300 receiving benefits/housing advice. The Community Hub has 450 volunteers representing around 5% of households in the overall local community.

What’s so impressive is that NHS Gloucestershire ICB has transformed its whole system, working collaboratively with many providers and clinicians, enabling people with lived experience to co-design services, and mapping the services that are already in place to enable better access and address health inequalities.

This shows what health and care communities can do when working together as teams in an holistic way and is a great example to other ICBs throughout the country, many of which are already looking at better ways to support people with long-term pain and other chronic conditions that optimise the appropriate use of medicines.