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Lonely but not alone

Loneliness

GPs don’t have a cure for an increasingly lonely and ageing population, but to reduce the consequences of a life devoid of contact — such as alcoholism and heart disease — they are banding together to help the vulnerable find support

Loneliness is as bad for your health as smoking 15 cigarettes a day, according to recent research. 

The researchers, from two US universities, concluded: ‘Perhaps the most important challenge posed by these findings is how to effectively utilise social relationships to reduce mortality risk.’

Separately, research by the charity Age UK has found more than one million people aged over 65 in the UK identify themselves as lonely. 

Feeling lonely is linked to a number of health issues such as cognitive decline, clinical dementia, high blood pressure and heart disease. It is a risk factor for alcohol consumption, smoking, being overweight and low physical activity. 


Time of need

This will come as no surprise to GPs, says BMA GPs committee chair Chaand Nagpaul (pictured below). 

‘Our daily experience with patients demonstrates the adverse effects of loneliness and isolation,’ he says. 

Dr Chaand Nagpaul is Chairman of the General Practitioners Committee‘Isolated patients are vulnerable, not having someone at hand to assist them in times of acute need.  

‘Many are also not aware nor enabled to take advantage of support available to them to reduce isolation,’ he says. 

The Campaign to End Loneliness, a network of organisations aimed at reducing the problem in older people, is calling for doctors to do more. One of its proposals is for greater use of ‘social prescriptions’, which often involves a referral to an activity intended to increase well-being.

One of the practices already doing this is the Bromley by Bow Health Centre in east London. The surgery shares its premises with a number of community services including some aimed at older people, to which it can refer patients.


Social prescribing

Since last year, Tower Hamlets CCG (clinical commissioning group) and the local GP network have expanded the scheme to other practices in the area, which can refer their patients via electronic form to services such as a grandparents group, exercise programmes and art classes.

Bromley by Bow GP Saul Marmot says: ‘When you’re socially isolated, your physical and mental health undoubtedly deteriorate and as you become more unwell, you become even more isolated. 

‘There are a number of things that we, as GPs, can do to stop people from sinking deeper into this trap. Through the social prescriber scheme at Bromley by Bow, people can get involved in many different programmes.

‘The art group [email protected] has been going for around 15 years in one guise or another and is essentially a social group, with making art as an excuse for a raucous get-together.’

If someone is low in mood, or identifies themselves as isolated, GPs ask screening questions to identify if people are in need of services.

He says: ‘We refer via the simple universal referral form, which is emailed to the referrals coordinator and simultaneously saved in the patient’s notes. 

‘The referrals coordinator then phones the patient to discuss and sometimes arranges to meet them. It is much nicer for the patient to know that they’ve been referred to someone who rings them, rather than being fobbed off as the GP has no time.’


Beyond direct remit

GPs often refer to relevant organisations on an informal basis. 

Helena McKeown ARM 2013BMA community care committee chair Helena McKeown (pictured right) says: ‘I think dealing with loneliness is beyond GPs’ direct remit but we should fulfil our duty by signposting the lonely to available services such as the befriending service provided by volunteers accessible through Age UK where I work, and the charity Alabaré which provides support for individuals with mental health issues voluntarily.’ 

The Campaign to End Loneliness has also suggested CCGs put more money into schemes to deal with isolation in over-65s.

Calderdale Council and Calderdale CCG have jointly invested £1m to tackle loneliness, which will fund a number of programmes due to start in autumn.

The programmes, which are still in the early stages of planning, will work with an established network of community organisations based across Calderdale. 


Social change

Dr Nagpaul believes that healthcare cannot take full responsibility for loneliness and there needs to be wider changes to society to support the growing ageing population.

He explains: ‘There also need to be changes in the social care system, developing the role of carers, as well as recognising and supporting the increasing role of voluntary agencies and increasing awareness of available support. 

‘Enacting these changes would not be an appropriate use of a CCG’s healthcare commissioning budget in isolation, which for most is already overstretched. But CCGs do have influence on local authorities via health and well-being boards where these issues should be addressed, with many of the solutions pertaining to social care.

‘The adverse consequence of loneliness will itself be a cost on health and social care budgets and therefore there is also a preventative economic reason to support isolated patients.’

Although doctors cannot deal with the burden of isolation and loneliness alone, it is clear they can be at the frontline of identifying vulnerable patients and helping them to find support. 

 Read Social Relationships and Mortality Risk: A Meta-Analytic Review