Copyright 2019 - Clinical Commissioning Groups Association

Social Prescribing - Dr Cliff Richards M.B.E

I came from a working class background in industrial Cheshire, my father died when I was nine years of age after some years of infirmity, we had little money. I sometimes was the only child in the class required to put my hand up, flagging to everyone, about my free school meals. I decided to study medicine at University and at that time I remember I was asked by my elder brother whether that would lead to a good job or not, perhaps reflecting a family view on future aspirations.


I looked on medicine as a vocation.


Why do I mention this? I think it’s something to do with being normal. I think in my early career as a GP I did look to attempt to restore patients to normality and I see this notion being held fairly clearly by many other GPs. At a certain point this concept became limiting and I reflected upon whose normality was the norm. The normality of my early years is clearly not the normality of many and the realisation that each and every one of us is abnormal in some kind of way was very freeing. This actually allowed me to work with my patients to define and solve their problems as opposed to defining their abnormalities and educating them as to how they could be normal.


This allowed me to attempt to enter into a more honest kind of relationship among patients to facilitate their progress in life. It also helped me to have a clearer grasp on my own values particularly in my working life. When I became Chair of NHS Halton CCG establishing the right kind of values for the organisation was very important and thankfully I was surrounded by a group of like-minded people who not only were able to define the values of the organisation, but also their behaviours expressed the values of the organisation. So we had a solid base to try and do something really good for the whole population of the towns of Runcorn and Widnes, comprising the borough of Halton. Many of the people of Halton live in deprived areas. There is a sense of limited choice for many of our communities, and among some of our population, fatalism about their health future. In some areas as many as 40% of the population do not access health services in a positive, way with the possibility of much undiagnosed pathology. The wider determinants of health as outlined in the Marmot Review 2010 (Fair Society Healthy Lives) impacts on our population and the report findings have not been widely mobilised as a call to action within the NHS. The NHS is an illness service struggling under the weight of increasing demand.


At the outset of NHS Halton CCG we decided to invest in Salutogenesis, a range of options, activities and solutions to add health and positive wellbeing for our whole population. The delivery model placed GP practices as a central component. All our practices were happy to sign up to develop the Community Wellbeing Model. We commissioned Well-Being Enterprises CIC to deliver a comprehensive service including opportunities for group activities, one-to-one discussions and well-being officers in all of our practices. I felt strongly that at that time, some four or five years ago, that there was sufficient evidence to support this commissioning action; however I realise that not all were convinced by the same evidence. We have now a plethora of case studies about benefits to individual patients, many community assets have been developed, our GP practices are convinced of the benefits and happy to continue funding, and we are at present looking at the health economic benefits. The published evidence from Leeds is very encouraging about the economic benefits to health from such commissioning actions.


This has also given us a solid foundation upon which to allow large number of different kinds of conversations which has led us to work with our local Super League club Widnes Vikings, significant Art centres such as the Bluecoat and Open Eye in Liverpool, and we are building our offer to initiate social entrepreneurship with our business community. We are weaving these conversations into a cultural manifesto, exploring new possibilities in the areas of Sport, Social value, the Environment and the Arts, to add health to our population.


Since the inception of the NHS there have been Health Inequalities which seem impossible for the NHS to address. I feel a new perspective should be considered with the NHS having creative conversations with as many agencies not traditionally aligned to health, to allow a paradigm shift where individuals and communities have an NHS offer to continually achieve health gain. This should feature strongly in STP approaches for true transformation.


Content provided by Dr Cliff Richards M.B.E.

Chair NHS Halton CCG


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