Danielle’s story: Pre-contact groundwork and preparation
Danielle is a social prescribing link worker in a PCN with previous experience of social prescribing in the voluntary sector. They share their experience of routine pre-contact stages and some insight and tips on how to prepare to support a client with dementia who has been referred to them.
Danielle believes that there is some due diligence groundwork that a social prescriber should undertake to be better prepared and make the most of their (limited) time with their client with dementia. When a referral is received, Danielle often feels that the information provided lacks details:
“In the referral, it tells me who’s made the referral, their contact details and usually a little bit about the situation. It is very dry, doesn’t tell me where the person is accepting of it, whether he wants to talk, whether they are going to come out, what their prognosis is, if there’s anything else”.
Therefore, Danielle finds that some further digging is required to obtain clients’ information.
Having experience of working within PCNs and charities, Danielle recognises that having access to clients’ records within PCNs is advantageous at the point of referral, as it allows the social prescriber to gather reliable and accurate background information on clients:
“PCN versus charity referral, the most important difference is that through a PCN I can see people’s medical records. So, before I meet them, I have a much clearer idea of what exactly their diagnosis is, and I know whether they’ve got consent for relatives to speak for them, whereas working in the voluntary organisation you don’t have access to any of that and you’re very reliant on what people tell you, which is not always the whole truth”.
Before taking on a client, Danielle finds it very helpful to discuss with their own team who is the most appropriate person to support that client, based on the background information available:
“We consider expertise within your team. The way it happens is the GP will send the referral through. Our team get together, and we’ll look at the referrals and we see who’s better suited for that client based on our different background and expertise”.
Because of the very large number of referrals, Danielle’s team have also implemented a traffic light system based on matter of urgency:
“When we get the referral, they get added onto our waiting list, which is quite long just due to the number of referrals that we receive. We prioritise referrals in a matter of urgency. So, say if something comes up which is quite urgent, we will try to prioritise that and contact them within a few days to obviously address the issue as quick as we can. Say urgency would be homeless, no food, no gas and electric. Then, we have high priority which it may be struggling financially and sometimes we get referrals for people with dementia, and they haven’t got attendance. So, we tend to put them on high priority just because how long the process takes to claim. And then we have moderate, which would be people that are maybe just interested in social groups or activities”.
Once the social prescriber is ready to open the referral based on matter of urgency and expertise within the team, they would undertake some preliminary research. Danielle finds this helpful to get a sense of what potential resources are available in the community:
“That normally starts online, to find the charities that are involved or the statutory services that might be able to support with this case”.
It is also good practice with clients with dementia to start communication in paper format:
“We would send a letter first, so they’ve got a letter to see who we are, why we’re ringing and when we intend to ring. If we have their permission to contact a family member, then we would be contacting the family member as well. But I think if they’ve got something in writing, they can pop that in the calendar. If not, we would hope that a family member might pick that letter”.
When making first contact, it may come up that the caregiver or family member wishes to be involved in the support of the person they care for. Or it may become evident that the client with dementia would struggle to engage if unsupported. In that case, Danielle suggests considering submitting a request to change the name on the from the client with dementia to the caregiver. But this needs careful consideration:
“I have been known to go back and say to the GP – would it be easier if you put the referral in the carer’s name? Because you’re then kind of scooping both up with one go. It’s to make things much easier, dealing with the couple, if that’s appropriate. It’s not always appropriate. If there’s no communication issues, you go straight to the patient with the dementia. Maybe it’s an early diagnosis and they’re functioning very well”.
Finally, when making first contact, it is important to remember that clinical notes may reflect GPs’ views of clients’ needs, and that there may be discrepancies with clients’ views. Needs may also change between referral and first contact. Therefore, Danielle suggests, double checking with the clients themselves reason for referral as soon as possible:
“Even when I read the notes on the GP, I like to let the patient lead the conversation because what they said during that consultation with the doctor might change. They might need something else”.
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