A new NHS pilot in Gloucestershire gives 12 GP practices the ability to prescribe Forest Green Rovers football tickets to patients with mild to moderate depression. It’s part of a movement towards replacing a purely medical model – think: what antidepressants should we prescribe? – to a social and community model of care. Initiatives like this are easy to mock for being insufficient to address the huge strains faced by the NHS. And, for better or worse, may lead to an increase in people seeking care for depression in the hope of free football tickets. But this sort of thing has been supported by the health secretary, Wes Streeting, as part of his efforts to change the NHS from a sickness treatment system to a preventive health service.
The rationale is that GPs are overwhelmed, with patients showing up with issues such as back and neck pain, depression and anxiety, or just overall fatigue, headaches and feeling unwell. The medical approach is to prescribe medications – in fact, the NHS in 2023-24 prescribed more than 89m antidepressant courses (for an estimated 8.7 million identified patients who received at least one drug) – at great cost to both individuals, given the side-effects, and to the budget of the health service.
And yes, there is a strong pharmaceutical lobby pushing magic bullets and drugs on to individuals. Can’t sleep? Take a melatonin pill. Anxious? Take Xanax. Obese? Try a GLP-1 agonist such as Ozempic or Wegovy. In pain? How about oxycodone (which carries the risk of opioid dependency). Perhaps we have been overmedicalising how we treat common conditions that people go to see a GP about. Which is where the idea of social prescribing comes in – that is, referring patients not for specialised care or medication, but instead linking illness to community resources found in exercise, nature, community, music – or even football matches.
There’s no need to hammer on about prevention – I think it’s universally agreed that prevention is better than cure. But it’s easier said than done (as I’ve written about extensively). To develop the implementation of schemes, pilots have been launched with promising results. NHS England refers to a 2017 University of Westminster evidence summary which estimated 28% fewer GP consultations and 24% fewer A&E visits for people in a social-prescribing scheme. This is not just in the UK, but part of a growing global policy approach whether in Denmark, Canada or Malaysia.
For example, the Danish health authority funded a pilot scheme called Kulturvitaminer (culture vitamins), which offered those unemployed or on state sick leave and suffering from stress, anxiety or depression, support over 10 weeks to be part of cultural activities such as a singing group, a guided reading club, or a drama class. Data from the trial found that participants were happier, more motivated and felt better physically.
Yet, we can’t just talk about joining a new walking group, cooking club or art class without considering the larger stresses of modern life that often cause these chronic health issues. Inequality has increased in the UK – driven by Brexit, the pandemic and record inflation: just look at the simultaneously growing numbers of billionaires and food banks. Housing is increasingly unaffordable, while salaries stagnate. Life is indeed harder, especially for young people unsure about their economic futures and quality of life.
In almost every health metric, the poorest communities are also the sickest. As the divide grows between the top 1% and the rest of the population, an increasing number of people are pushed into hardship, including many in traditionally middle-class occupations such as teaching and nursing, whose incomes do not support the same standard of living as that of the previous generation working in the same jobs. Prevention is also about ensuring stable and affordable housing, a living wage and social support. The biggest health challenges aren’t medical, but social, economic and political.
At least social prescribing is a step forward in recognising that health issues are often the result of underlying isolation, precarity and stress, and in offering a route into individuals feeling more integrated and supported. In giving free football tickets, perhaps it’s giving a moment of joy and support to someone – who a GP has identified as feeling isolated, disconnected and depressed – who otherwise might not have been able to afford or even dream of that kind of experience. The football ticket pilot won’t fix the NHS or Britain’s underlying economic troubles, but it’s a step in the right direction of seeing health as something built in communities and not in hospitals or clinics.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
