Beyond Pills – kill over prescribing

‘Social prescribing’ – prescribing excercise, dance, writing classes, diets, yoga, singing with a choir, gardening or almost anything else that the patient fancies – instead of another drug prescription has been the buzz treatment on the NHS for several years now. And when  you look at the facts around prescription medicines you can understand why. Did you know that:

• 10% of prescribed drugs (approximately 110 million items) are not only unnecessary but may cause harm
• Adverse drug reactions account for 10-20% of hospital in-patient admissions
• At least 15% of the population (8.4 million of us) take more than 5 separate medicines daily, often using one drug to treat side effects of another
• Dispensing in primary care doubled from 10 prescription items per head per year in 1996 to 20 in 2016

The financial argument

According to the NHS Business Services Authority, in 2019 the cost of the prescriptions dispensed in the community in England was  £9.08 billion. This was an increase of 2.81% on 2018. So if we assume that the cost has continued to go up by just under 3% a year since then, that means that the cost of over prescribing of drugs last year was around a £1 billion – certainly enough to fully meet the pay demands of the nurses and quite a few others.

Social prescribing is not free. Evidence suggests that it works best when there is good support from the prescribers and good contacts are maintained with both the patient and the group providing the activity. None the less, the costs of so doing are a great deal lower than the drug alternative. So, on financial grounds it would seem to be a  desirable option.

But, clinically, does it work?

The jury seems to be out on its efficacy.

Anecdotal evidence of its benefits abound. Brighton GP Laura Marshall-Andrews, author of What Seems to be the Problem?, has seen multiple prescribing reduce by 10% since adopting social prescribing. She reports that chronic illnesses and conditions that cause pain and mental health problems such as anxiety respond well to social prescribing. Meanwhile Southport GP Dr David Unwin has seen his surgery’s spend on diabetes drugs plummet by £68,000 a year since ‘prescribing’ a low-carb diet to patients at risk of or with Type 2 diabetes.  And they are only two of many. But hard evidence is difficult to collect.

This is not altogether surprising because of the nature of social prescribing. The number of alternative activities that could be included are so many and so varied that collecting evidence of success will be extremely difficult. It would also appear that the success of social prescribing is very dependent on the support that the patient receives and a successful link between prescriber and prescribee.

‘A good thing’

But whatever the evidence in support of social prescrbing may be, any reduction in excess prescribing of drugs seems worth pursuing. So the Beyond the Pills Campaign has to be a ‘good thing’ – even if it does no more than raise awareness of the horrendous damage that our addiction to prescribed drugs is doing.

And even if it is difficult to assess the benefit of each specific prescribed activity, the very act of taking agency and a more positive and active role in their own health care can have remarkably beneficial effects on the patient’s mental health. They feel empowered, invigorated and in control and often, as a consequence, their physical symptoms improve, sometimes  dramatically.

To find out more about the Beyond Pills campaign and the many activities which fall within the social prescribing remit, check in to the College of Medicine and Integrated Health site here.