A new review by NHS England has found that 10% of prescriptions dispensed are either inappropriate for patients’ circumstances and wishes or could be replaced with alternative treatments.

Overprescribing is a serious problem in healthcare systems across the globe. About 1 in 5 hospital admissions among over-65s are due to the harmful effects of medication.

Following the review, ministers are pledging to prevent unnecessary medicine prescriptions. The paper called for practical and cultural changes to make sure patients get the most appropriate treatment for their needs.

Increasing the use of social prescribing is one. Social prescribing is the referral of patients into non-clinical routes. With the help of a link worker, a patient can dig deeper into 'what matters to me'. Identifying alternative solutions to one's needs can reduce the propensity to prescribe medicines.

What causes overprescribing?

Overprescribing refers to giving people medicines they do not need or want. This may mean the potential harm outweighs the benefit of the medication. Possible scenarios of overprescribing are as follows:

• A better alternative may be available but is not prescribed
• A certain medicine is appropriate for a condition but not an individual
• A condition changes and the initial prescription is no longer working
• A patient no longer requires the medicine but continues to receive prescriptions
  

These situations fall under two overarching causes for overprescribing: systemic and cultural. Overprescribing is rarely a consequence of incorrect diagnoses. It is more so the result of shortcomings in our healthcare system and culture.

Systemic factors:

• single-condition clinical guidelines
• a lack of alternatives
• deprescribing not built into the prescribing process
• a lack of access to extensive patient records
• inadequate digital infrastructure
• time pressure
  

Cultural factors:

• a healthcare culture that favours medicines
• a paternalistic tendency to treat the 'illness' and not the 'patient'

As Health and Social Care Secretary Sajid Javid notes:

"With 15% of people taking 5 or more medicines a day, in some cases to deal with the side effects of another medicine, more needs to be done to listen to patients and help clinical teams tackle overprescribing."

What role does social prescribing have to play?

A key factor to tackle within prescribing culture is equality, i.e. creating an equal partnership between clinicians and patients. This includes:

• shared decision-making about starting or stopping a medicine;
• better incorporating technology;
• effective review of prescriptions;
• considering alternatives that may be more appropriate.
  

Scaling up social prescribing can be a significant move in this realm. A wide range of causes from social to environmental can influence one's health. GPs and healthcare professionals often lack the time and expertise to address these. These factors then become unmet needs, where prescriptions treat the symptoms but not the causes of a condition.

Patients may instead benefit from other forms of support that tackle these root causes. Even in a case where a GP does suggest alternatives like a change in diet or increase in exercise, these are often just suggestions. Patients are not followed up with systematic guidance and support. In fact, 40% of GPs say they would refer patients if they had more accessible information on alternative services.

This is where social prescribing can be the game-changer. Social prescribing is a means to address inequality in healthcare culture. With the help of a link worker, patients have the necessary time to talk through key issues and needs. They also have the agency to co-develop a plan to meet their wellbeing goals.

Link workers bring in a comprehensive knowledge of local community services that may be suitable for clients. This means patients can access practical options aside from medicines to improve their health.

High-quality integration of technology will also further streamline the social prescribing process. For instance, tech-for-good start-up, Joy, provides an integrated marketplace of community services. Link workers can filter the needs and demographics of clients to target the most appropriate services. With instant referrals and automated updates, link workers can keep track of clients' progress.

Joy's in-built insights function also provides public health analytics. This discerns the efficacy of preventative measures, identifies health inequalities and locates gaps in service provision. Such quantitative data on social prescribing is currently lacking. Only with substantial evidence can appropriate alternatives to prescriptions be put in place. This would have the potential to tackle overprescribing as a whole in the long term.

As the government-commissioned review suggests, we need an openness to challenge our present healthcare system and culture to tackle overprescribing. By subverting healthcare's paternalistic model and harnessing the power of community, social prescribing is one way to do so.