A GP distributing football tickets? It may seem silly, but “social prescription” could be a giant jump for the NHS | Devi Sridhar
A The new NHS pilot in the Gloucestershire gives 12 GP practices the ability to prescribe Forest Green Rovers football tickets to patients with mild to moderate depression. This is part of a movement towards the replacement of a purely medical model – think: what antidepressants should we prescribe? – a model of social and community care. Initiatives like this are easy to make fun of being insufficient to fight against the enormous strains with which the NHS is confronted. And, for the better or for the worst, can lead to an increase in people looking for depression care in the hope of free football tickets. But this kind of thing was supported by the Secretary of Health, Wes Street, as part of his efforts to change the NHS of an disease treatment system to a preventive health service.
The justification is that general practitioners are overwhelmed, with patients with problems such as back and neck pain, depression and anxiety, or simply global fatigue, headache and patients. The medical approach consists in prescribing medication – in fact, the NHS in 2023-24 prescribed more than 89 million antidepressants (for around 8.7 million identified patients who have received at least one medication) – at a high price for both individuals, taking into account the side effects and the budget of the health service.
And yes, there is a strong pharmaceutical hall that pushes magic bullets and drugs to individuals. Can’t sleep? Take a melatonin pill. Anxious? Take Xanax. Obese? Try a GLP-1 agonist like Ozempic or Wegovy. In pain? How about oxycodone (which involves the risk of dependence on opioids). Perhaps we were too medicalized how we deal with the common conditions that people will see a general practitioner. This is where the idea of social prescription comes into play – that is to say by referring to patients not for specialized care or drugs, but rather linking disease to community resources found in exercise, nature, community, music – or even football matches.
It is not necessary to hammer on prevention – I think it is universally agreed that prevention is better than healing. But it’s easier to say than to do (as I wrote in depth). To develop the implementation of diagrams, the pilots were launched with promising results. The NHS in England refers to a summary of evidence of the University of Westminster 2017 which estimated 28% in less GP consultations and 24% fewer visits to people in a social prescription program. It is not only in the United Kingdom, but is part of a growing global policy approach, whether in Denmark, Canada or Malaysia.
For example, the Danish Health Authority financed a pilot program called Kulturvitaminer (vitamins culture), which offered the unemployed or on state sick leave and suffering from stress, anxiety or depression, support for 10 weeks to be part of cultural activities such as a singing group, a guided reading club or a theater class. The test data revealed that the participants were happier, more motivated and felt better physically.
However, we cannot just talk about joining a new walking group, a cooking club or an art lesson without considering the more important stress of modern life which often cause these chronic health problems. Inequality has increased in the United Kingdom – driven by Brexit, pandemic and record inflation: it is enough to look at the growing number of billionaires and food banks. The accommodation is increasingly unaffordable, while wages stagnate. Life is indeed more difficult, especially for young people who are not sure of their economic future and their quality of life.
In almost all health metrics, the poorest communities are also the most sick. As the gap develops between the highest 1% and the rest of the population, an increasing number of people are pushed in difficulties, including many in traditionally middle class professions such as teaching and nursing, whose income does not support the same standard of living as that of the previous generation working in the same jobs. Prevention also consists in ensuring stable and affordable housing, decent salary and social support. The biggest health challenges are not medical, but social, economic and political.
At least social prescription is a step forward to recognize that health problems are often the result of isolation, precariousness and underlying stress, and by offering a path to individuals feeling more integrated and supported. By giving free football tickets, it may give a moment of joy and support to someone – that a general practitioner has identified as isolated, disconnected and depressed – which may not have been able to afford or even dream of this kind of experience. The football ticket driver will not repair the NHS or the underlying economic problems of Great Britain, but it is a step in the right direction to see health as something built in communities and not in hospitals or clinics.
