Pathways to green prescribing in Midlothian

For public health nurse, Tracy McLeod, going green is all about helping people to live well and have a good quality of life. And this is the essence of a project being pioneered in Midlothian, where Tracy is the Population Health Project Manager.

The positive impact of greenspace and green health activities on health and wellbeing is being increasingly recognised. The COVID-19 pandemic has also shone a spotlight on the subject, with outdoor activities and nature being an important consideration for people affected by lockdown and social isolation.

But even before the pandemic, NHS Lothian Charity understood the importance of greenspace on physical and mental health and wellbeing. This was the reason behind the development of their Green Health Programme. Through this programme, the Charity works in partnership with NHS Lothian to make the most of the NHS estate and community greenspaces as health assets.

Pilot Project

Tracy, who works for NHS Lothian Public Health Directorate, has been translating plans into practical application, piloting a Green Health Prescribing project with a steering group of health and social care, council and third sector colleagues.

By the start of 2022, the group had four prescribers and four providers on board and is now scaling-up to offer green health opportunities across the Midlothian area.

From a public health perspective, the Green Health Prescribing Project is about the promotion of health and wellbeing, and addressing health inequalities (for people who may find accessing the outdoors difficult due to complex health and social circumstances),” says Tracy. “We know that if people spend more time being active outdoors, they will have better health and wellbeing.”

In fact, green space is often described as the ‘natural health service’.

Green Health Prescriptions

The steering group has identified primary care key prescribers – GPs, practice nurses, physiotherapists, pharmacists and mental health nurses – and, with them, has developed green health prescriptions.

Similar to other medical prescriptions, green health prescriptions are issued at healthcare facilities, which can be emailed, or picked up at reception.

Key to this is having a good conversation with the person, focusing on what matters to them and on their personal outcomes for their own health and wellbeing, tailored to their specific needs,” Tracy explains.

Prescriptions to connect people to nature, and to each other in an outdoor setting, are varied.

They could range from suggesting a stroll in the park, to pointing the patient in the direction of local walking and gardening groups, to a referral to a formal therapeutic programme. The wellbeing service based in each GP practice will support those who experience more health inequalities with ‘warm handovers’, or visits, making it easier for people to engage.

As well as green spaces, activities can take place in blue spaces, which might be anything from wild swimming to another water-based pastime.

Patients could be involved with more walking, netball or football, for example,” says Tracy. “There are also gardening opportunities, outdoor cooking, mindfulness, an opportunity to spend time in open spaces, walks and cycle paths in Midlothian. This increases general knowledge about the outdoors, improving confidence and gaining skills. It could be one-on-one, or in group activity.”

Roll-out

And while Tracy and her team are working to roll out the Green Health Prescribing project in Midlothian, it is anticipated that the concept will eventually be expanded across the country.

The project is all about prevention,” says Tracy. “I am hoping more people will keep well within their communities and need less medicine and less engagement with health and social care services.”