Teresa Meekings, CNHC registered for three different disciplines, writes about the complementary therapy service she has piloted which is funded by Kensington and Chelsea CCG ...
The complementary therapy service which I started to develop in April 2016 forms one element of a social prescribing offer which, in turn sits within a larger Self Care programme. It is funded by West London CCG and aimed at delivering a more holistic approach to the health of older people with long-term conditions. The social prescribing offer is managed by the local voluntary sector support organisation, Kensington and Chelsea Social Council (KCSC) and includes around 9 community groups who offer a range of non-medical services, including massage therapy.
My complementary therapy service developed and was built into the social prescribing offer, partly because of my earlier work. In December 2015 I was approached by Olivia from KCSC, who knew that I provided a reflexology service for carers in a neighbouring borough. Olivia told me that her organisation was working with West London CCG to set up a social prescribing service pilot. She then introduced me to a local ‘disability organisation’ which would be one of several delivery partners and had its own small massage service.
I had been using MYCaW to measure impact for a couple of years, so I had good evidence of the difference that complementary therapies could deliver and of the quality of service. There were clear advantages to a partnership on both sides, so I was subcontracted to deliver treatments from the disability organisation’s centre. Originally it was thought there would only be six clients per-year. Each client would be allowed to have six-hour long treatments. Clients needed to be over 65 and have two or more medical conditions to be referred. This however, created a problem. Most clients had mobility problems and could not get to the centre. As a solution, we negotiated to add home-based treatments to the offer.
The service took off slowly at first. I would sometimes see just three new clients a month. Even so, that was more than had been originally predicted. As GPs and social prescribing link workers became more familiar with the social prescribing system and the positive feedback from our clients, that changed. By December 2016 referral rates had doubled and continued rising for both centre and home-based referrals – so much so, that additional delivery sites were added for centre based referrals.
It was obvious that more was needed. Direct discussion with the CCG commissioner led to another extension to the offer. This time, myself and my small team were contracted to deliver 30-minute onsite massage and reflexology sessions at two ‘integrated care centres’. Alongside this, to provide long term sustainability, I set up a social enterprise - Community Massage London CIC.
We are now almost four years into the programme and have built an even stronger evidence base. We use patient activation measures (PAM) to monitor the progress of most clients. This looks at the knowledge, skills and confidence a person uses to manage their own health and care. PAM scores have the advantage of making it possible to put a cash value on service impact. Independent research, by Envoy Partnership, covering just under 300 clients referred in one year has shown our complementary therapy work creates a value to the local health-care system and patients at nearly three and a half time the cost of the therapies. In addition, we know from before/after treatment changes in Warwick Edinburgh Mental Wellbeing scores and from case studies that that we have a positive impact on mental wellbeing. We also continue to use MYCaW for other CCG funded work, because it is both uncomplicated and focusses on the outcomes that are important to clients themselves.
It has been an exciting time. Being involved in social prescribing means we can see the benefit of our work daily. It has created the opportunity to put together a great team and made it possible to take on extra work and support the CCG in other ways.
There were several things which came together to make this possible. Through working with unpaid carers, I was in touch with the way that health and social care services were developing locally and had good connections with the local community sector. I already used MYCaW along with qualitative feedback to measure the impact of reflexology and massage, so I had evidence I could build into a business case. West London CCG, for its part, was willing to invest in social prescribing, knowing that it would lead to longer term efficiency and quality improvements. The CCG chair was an active member of the College of Medicine and the CCG commissioner was open to ideas and innovation. Perhaps most important I was comfortable working in partnership with a range of organisations.
What was accomplished was ground-breaking. Reflexology and Massage therapy has struggled to find a mainstream role in the NHS and build an evidence base. Social Prescribing was also quite new and unproven. That is changing now. Social prescribing schemes are being developed widely across the NHS.
Every Primary Care Network (a grouping of 30-50,000 patients) will have a social prescribing link-worker funded by NHS England. Those Primary Care networks may be managed across a whole CCG or Council to create a social prescribing system, but they will still need to form links with their local voluntary and community sector to put together a social prescribing offer. Long term, the intention is that savings this creates will be invested in the front-line offer, but currently that is up to individual CCG’s.
If you are interested in getting involved in social prescribing, some research will be needed to understand what is being developed locally.
- You will need to understand whether front-line service delivery will be funded, and it is worthwhile getting involved.
- There may already be something in place with an organisation like my own looking for additional therapists.
- If there is not, identify a potential champion in the CCG, Primary Care Networks, or voluntary sector.
- Consider partnering with a local voluntary sector organisation to add value to what they could offer.
- If you have already set up an asset locked social enterprise, you might be able to get directly involved.
- Be ready to evidence the value of what you deliver, whether through case studies or formal measures.
- Most of all, get your foot in the door and be prepared to start small if that is what it takes. You can be confident that your results will lead to growth.
For more information on the evaluation of outcomes research: