Client Processes
We explored the range of processes that different organisations adopt to work with their clients, participants and people they interact with. This helps give an oversight of best practice for community organisations when considering their own internal processes.
By ‘client processes’ we mean structured activities, steps, or tasks that are designed to achieve specific goals or outcomes, this could include client management, communications, decision making, progression and support processes.
Client Processes used within Social Prescribing in Bolton
Co -written with Bolton Social Prescribers Natalie Jones and Jacky McFadden from Bolton GP Fed and Marvin Constantine, Health Improvement Practitioners (HIPS) Service Manager at Bolton NHSFT Integrated Community Services Division.
Social Prescribing happens across 9 primary Care Networks (PCN) in Bolton with 20 Social Prescribers employed by the GP Fed, plus 1 hospital based, and 2 Health Improvement Practitioners (HIPS) managed by NHSFT as well as 1 social prescriber based at Bolton Hub with Bolton CVS.
More than 25% of GP appointments are non-medical issues that patients present with i.e., isolation, stress, financial difficulties, home and environmental issues etc… Social prescribing has been developed to support patients with their non-medical issues and are based in PCN areas and GP surgeries.
Bolton’s 3 biggest issues currently are housing difficulties, finance, and isolation (2023/4)
Needs may differ across geographical areas. Patients in Farnworth and Kearsley often have complex issues around housing and finances. Elderly patients in Turton may have needs around isolation so may benefit from the Staying Well Service and Age UK.
What is Social Prescribing?
Social prescribing is an approach that connects people to activities, groups, and services in their community to meet these practical, social, and emotional needs that affect their health and wellbeing, the wider determinants of health. Examples of patient issues include addiction, abuse, grief, panic attacks, rape, redundancy, bullying, loneliness, unable to leave the house, bereavement.
Social prescribers offer:
Tailored support through listening and responding, empathy, encouragement, praise and emotional intelligence.
No time constraints i.e., one visit or many depending on the needs of the patient.
What matters to me approach – my options now; “What I can do, not what I can’t do”
Support to patients with complex needs.
Work around barriers to an agreed plan or options.
Social Prescribing can include:
Agreed support to attend appointments, groups and activities including transport, ring and ride etc…
Reviews can be telephone and in person for as long as needed.
Allocated time to keep up to date and research activities and services in their PCN local areas.
This approach helps the patient build confidence and take charge, empowering autonomy and self-efficacy.
Awareness that it is a trial-and-error process and may include failed and sometimes retraumatising situations i.e., grief counselling when a patient is not ready or an unforeseen clash with a retraumatising person or situation.
What supports Social Prescribing processes?
Good relationships with the Local Authority, statutory and voluntary services is key to being able to offer patients what they may need i.e., housing support, befriending services, social groups etc…
Keeping up to date with this information can be tricky as things are constantly changing. Social Prescribers have allocated time within their role to refresh local knowledge of community activities and assets.
The Public Health website https://letskeepboltonmoving.co.uk/ now being used by Social Prescribers to capture Bolton’s assets and VCSE organisations are encouraged to sign up and post their activities. The site is public and open to all.
How Social Prescribers Work (Trauma Aware/ Sensitive)
Social prescribers work from a person-centred, strength and asset-based approach with patients and much like VCSE organisations in the TI Bolton audit recognise trauma and sometimes complex trauma in their patients and have developed sensitive ways of working that is not formalised as a Trauma Informed approach. Trauma Informed training has not yet been rolled out (2023).
Training and Learning
There is no pre-requisite formal training necessary to become a Social Prescriber, lived experience is accepted and once in post core NHS England training and refreshers are given. HIP Training Modules (recommended by social prescribers)
https://socialworkpodcast.blogspot.com/2009/10/prochaska-and-diclementes-stages-of.html
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7468-8
https://www.habitweekly.com/models-frameworks/the-com-b-model
https://www.rsph.org.uk/qualification/level-3-certificate-in-health-and-wellbeing-improvement.html
Social Prescribers have access to the FutureNHS platform: https://future.nhs.uk/
Connect with peers across health and care.
Share professional knowledge.
Learn from over 3500 workspace communities.
Safe and secure platform with trusted support.
Bolton Wide Social Prescribing Forum and GM Social Prescribing Forum
The forums invite organisations and community grou to monthly meetings. VCSE organisations can attend to find out about social prescribing and promote their work.
Social prescribers share knowledge, case studies and support but sometimes its a struggle to access the forum and gain support. Barriers to access include can allocating time and ensuring its the right environment to meet needs and prioritising own knowledge.
Clinical Supervision and Unstructured Support
Some social prescribers access clinical supervision, but this is not consistent. Instead, some staff set up informal support mechanisms including:
WhatsApp groups
Staff informally supporting each other within a PCN area.
Case study development helps reflective practice.
Informal 1-2-1’s with trusted friends.
NESTAC
NESTAC is a charitable community organisation aimed at supporting refugees, asylum seekers and other immigrants from the new emerging communities, with a focus on those from African origin living in the North West of England.
NESTAC shared their approach to client processes with us, They:
Offer vital peer mentor support at GP/ Police visits
Are involved with The Lotus Hub (5 Minoritized Communities Pilot) which is a cross sector collaboration overcoming barriers caused by competition between organisations for participants/ funding/ spacesOutline the need for 24hour support for out of hours situations ie. After work/ drinking – not just a phone-line. They recognise the value of Bolton Listening Lounge.
Suggest quarterly GM Charities Fair with common interest to get to know other organisations for collaboration and support.
Stand Up Sisters
Stand Up Sisters was set up in October 2018 as a women’s empowerment and arts organisation led by and for women with lived experience of mental health issues, substance misuse and sexual/domestic violence. Since then, they have worked with over 620 women including those who have lived experience of mental health issues, substance misuse and sexual/domestic violence homelessness, hate crime, a history of offending, and sex work. The organisation is based in and works with participants who live in the Greater Manchester Metropolitan Borough with a current focus on Bolton and Rochdale. They support women to fulfil their hopes, dreams and ambitions through finding their creative voices and therefore their voice in society.
Stand Up Sisters shared their approach to client processes with us, They:
Use a person centred approach in engaging with other organisations i.e. a named person or known person would be involved in the care process.
Support with referrals -they can be done together with a phone call and form filling support.
Have volunteer and peer support for welfare rights tribunals, mental health services and other appointments.
Write letters of support for job centre
Understand word of mouth can be more effective than leaflets i.e. recommendations within the groups
Connect to crisis support through GMMH Hotline 24hour emergency (outside hours i.e. after 7pm)
Stand Up Sisters will be providing training for the Listening Lounge staff at Mhist (an out of hours service which will be running in Bolton) commissioned by NHS Bolton (previously at 1 Point).
Fortalice
Fortalice are a Bolton based charity providing frontline services for people who are, or have been, affected by domestic abuse and violence.
Their support includes refuge accommodation, local community services, education and accredited training for professionals. Choice and agency of the person is foremost.
Fortalice shared their approach to client processes with us, They:
Make calls for someone if needed or requested to organisations you are working closely with and have good relationships with.
Develops and provides many outreach services within their own portfolio (20 projects) so can manage the process themselves.
Recognise relationships with other organisations is key to signposting.
