Grant Awarded: £14,997

Phase Completed: Research and Development

The Cardiff South West cluster operates 11 GP practices across a population of 66,410 patients. Some areas in the South West cluster experience high deprivation levels with 60% of the cluster population living in some of the most deprived areas in Wales. Over the next decade, the population of older people and those living with chronic conditions is likely to increase.

Tempo (formerly known as Spice) is a community development organisation that developed Time Credits - an alternative currency that works on a simple hour-for-hour basis: for every hour volunteered to a community activity a Time Credit is earned. These can then be spent on a diverse range of activities.

Cardiff South West GP Cluster and Tempo worked together to explore how offering Time Credits for people with low-level depression and anxiety could generate savings by leading to a reduction in the amount of medication prescribed.

Social Prescribing (SP) is a way to link patients with other non-medicalised sources of community support such as gardening, leisure, arts and well-being groups and is increasingly being used to address conditions such as low-level depression and anxiety.

The Time Credit Social Prescribing Pilot tested how time credits could be combined with social prescribing to bring additional benefit to patients.

The pilot ran in three practices in Cardiff. Two social prescribers were employed to consult with eligible patients to whom they prescribed time credits upfront. By reversing the process of ‘earning’ a time credit, patients have immediate access to a wide range of activities that they are interested in, potentially accessing activities that would help to alleviate the symptoms associated with depression and anxiety.

78 participants accessed the social prescriber and of these, 21 were frequent attenders (defined as 15 appointments or more over the last 12 months), representing the heaviest users of health care services. Further analysis of the social prescriber notes suggested that these patients had very complex psychosocial needs that benefited from the 1:1 support provided by the social prescriber. For this group of patients, the economic evaluation shows a reduction in GP appointments and prescriptions resulting in a cost saving for the GP practices.

49 time credit prescriptions were issued during the trial period. By the end of the trial, seven patients had spent their Time Credits in the Tempo network and none had progressed to volunteering to earn further Time Credits.

It is important to highlight that the combined cancellation and no-show rate is in-line with other social prescribing projects, leading Cardiff South West GP Cluster and Tempo to conclude that more long-term investigation is needed to fully comprehend the effects of social prescribing.

• Loan funding isn’t always the most appropriate way to finance health innovations - analysis of the benefits of the social prescribing work by Tempo and Cardiff West GP Cluster showed a small amount of cashable savings generated, with greater levels of social return on investment reported. This did not present a clear rationale to implement the work at scale funded by a loan, but other funding arrangements might prove more suitable.
• Engagement with Time Credits during the research and development phase was low, although, these findings were comparable to those of other Time Credit projects in their first months of trading. A longer-term piece of research could be designed to take this into account.
• Personal Data can (rightfully) be difficult to access in the health sector and taking steps to ensure that any necessary patient data is available for analysis will help to prevent barriers later in the process.

This case study is also available in Welsh.