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“I think wellbeing grabbed my attention, which I think is really exciting”, General Practitioner.

A global pandemic that keeps on evolving, the closure of Neighbourhood Houses from being the open centres that they are, and an unbelievably stretched primary care sector hasn’t stopped this two-year project in laying the foundations for a bright wellbeing future.

To recap: The Wellbeing Scripts Building Project is led by the Central Highlands Association of Neighbourhood Houses based in Ballarat covering 14 houses across the central highland’s region of Victoria. The project was funded by the Commonwealth Governments Men’s and Women’s Health Chronic Disease Prevention Program for a two-year period 2020 to 2022.

The purpose of the project was to prototype and test a ‘light’ social prescribing approach between General Practitioners (GPs)/Health Practitioners and Neighbourhood Houses (NH). In a nutshell, this was about awareness raising of NHs and the valuable range of services and programs they offer for everyone in the community and creating an awareness for GPs of these services, and developing a simple referral mechanism/s. This is ‘light’ social prescribing, the signposting of places of referral.

We employed a human-centred design methodology, genuinely open to the question of ‘how might we’ design a process that’s agile, and easy to use in connecting these two very significant services in our communities. We conducted dialogue interviews, initiation workshops, prototyping workshops, and a whole group consolidation session which brought the communities of Bacchus Marsh, Ballarat, Creswick, and Clunes together to share their prototypes and experiences in March this year.

“Previously it was more of a chat … now it’s perhaps more let’s try to find something you could do? And so, it’s perhaps just moved a bit more of a step forward”, General Practitioner.

Our intent was to design, then then test these ideas in practice.

Neighbourhood Houses remained closed most of 2021, our most critical year for implementation. This meant that the range of socially connecting services and programs were not provided, those we had hope would be ‘referred’ to by GPs. Instead, we used the project time to develop a range of tools to assist GPs in referring to Neighbourhood Houses, available on www.chanh.org.au/wellbeingscripts. These include:

• short introductory film resources;
• localised referral templates for general practices to download and apply to their practice; and,
• a clinic poster with a QR code for health practioners.

Now what? We have recently undertaken some dialogue interviews with GP participants, dialogue interview in style to check-in on project learning, insights now on social prescribing and what the Wellbeing Scripts project might look like in the future.

“So, I think that that was sort of really useful in terms of doing the workshopping and the really sort of thinking through how you know how to access and understanding the neighbourhood house, yeah definitely just increased my awareness of that I was able to take back to the practice and we used the posters”, General Practitioner.

“The neighbourhood house has activities refer them to, but it’s about how do you actually really support people to socialize them into groups, learn how to join groups”, General Practitioner.

Now that NHs are open and offering comprehensive calendars of activities in each community this is the opportunity to refresh and boost the project by encouraging the use of the tools and templates for referral and to track this process of referral. This is the opportunity we missed due to COVID. One way to do this is our 2-minute video which guides health practitioners through ‘how to’ download and adapt a Wellbeing Script for their practice. Simple, practical, and ready for use.

What’s next? We are super excited that the Western Primary Health Network has funded a phase 2 for Wellbeing Scripts. This project is running through to September 2022 with the aim of further in-depth interviews and distilling the insights to shape a “Wellbeing Script: Framework for the Future”.  This phase introduces a second cohort of GPs, practice nurses, and psychologists into shaping how a Wellbeing Script could suit their practice, and how the scaling of a Wellbeing Script approach would work for general practice uptake.  

We are often asked in the Wellbeing Scripts project as to why we use the term ‘light’ social prescribing rather than just social prescribing. We have been guided by Kimberlee’s (2015) analysis of a range of existing programs which identified four levels of social prescription: Signposting; and Social Prescribing Light, Medium and Holistic.

Our ‘why’ for a focus on signposting and ‘social prescribing ‘light’, sees a combination of provision of information to patients and community members, and referral between General practice and Neighbourhood Houses (potentially in both directions). Further:

• It is human-centred in design – created by the people using the system for their context, purpose, and community need
• It is sustainable – taps into and uses existing capacity and capability, does not require us to spend all our time seeking funding, then more funding
• Is a ‘Value add’ relationship– there is great value for GPs and Houses in connecting and referring for their community
• It further unlocks mutual benefit – at a time of great need to socially connect people
• It is asset based – we go with the energy in the system for greatest likelihood of change and uptake
• Is place-generated and created – fit for purpose for that community and that GP and NH relationship
• It has potential for growth – we can learn and iterate, creating solutions that meet the actual needs and opportunities at hand 

As Nicole Battle, CEO Neighbourhood Houses Victoria, puts it “Wellbeing Scripts can be mutualistic with the Neighbourhood Houses being able to refer patients to GPs”. 

Put simply we do not want to get too caught up in the enormous size of the effort and resourcing required to shift the health care system to social prescription. This takes time and resources. So how might we contribute to this holistic system as it emerges? We aim to demonstrate how bespoke scripts can be developed and used for everyone’s benefit, we do not see the need to wait- rather, we intend for our regions Wellbeing Script to compliment and inform.

In our work we are exploring the concept of a ‘Wellbeing Script’ and what it might be, how it might work, and most importantly, how it can simplify and ease a referral pathway between clinicians, their patients, and their local Neighbourhood House- those powerhouses of social connection. This opens a world of possibility largely revolved around a referral model bringing patients from disconnection to social connection with positive health impacts. We have discovered many gems and ‘natural social prescribers’ already in our project in the Central Highlands region of Victoria. They are the forward thinkers in General Practice and medicine who seamlessly practice prevention, as much as preventative and primary care in their daily consultations.

One such gem is Dr Kevin Lee, an endocrinologist and specialist physician who fell in love with Clunes many years ago and continues to practice in this vibrant little community. Dr Lee champions the importance of social and community connection and refers patients in his consultations to a range of health promoting activities not as an extra but a fully integrated part of clinical practice.

Dr. Lee believes it is “simple and day to day practice, you don’t need an extra session just to socially prescribe”. Dr. Lee can share many stories of light social prescribing benefitting his patients. One such patients he recalls presented with obesity (BMI of 37), prediabetes, rheumatoid arthritis, and was wheelchair bound. Dr. Lee noticed that they had an interest in gardening in their backyard.  After engaging them with the benefits of horticultural therapy, he had essentially ‘prescribed’ them a course of increased gardening activity which not only increased their dietary fiber intake from their own produce, but over time, they “no longer needed a cane to walk, reversed [their] prediabetes to normal and [could] drive to go back to work [again]”. Her husband was also able to demonstrate his support for her by building raised vegetable boxes and platforms to garden on.  In just over six months, they achieved more than 15% weight loss, from 106.9kg to 89.4kg, which is equivalent to a gastric band intervention.

Dr. Lee and Lana de Kort, Clunes Neighbourhood House Manager, have teamed up to imagine what is possible in their community. As a start they have designed and are at present delivering and intensive lifestyle modification program “Weight off my shoulders” with their community. The first program was full upon announcement, we look forward to hearing about the health and wellbeing impact in the future.

Sometimes it is nice to know we can just get on with it – try things, iterate, try again. We don’t need to wait for the perfect system for social prescribing, we can lightly prescribe right now- with the resources available in communities across Victoria, and certainly sign-post pathways for health and wellbeing.