Project: Midlothian Green Health Prescribing
A new way of working together to promote the benefits of green health
Green Health Prescribing (also known as Green Social Prescribing) is an evidence-based approach that supports people to engage in nature-based activities and interventions which offer solutions to improve physical and mental health outcomes.
Green Health Prescribing is not a new idea, in fact, individual healthcare practitioners and partner organisations across the Lothians have been involved in this work to varying degrees for some time.
Evolving from Green Health Prescribing Report a one-year Green Health Prescribing test of change project was initiated in Midlothian, aimed at looking at ways in which it can be embedded in local level health systems.
The purpose of this project was to:
- Embed a sustainable prescribing model within primary healthcare settings
- Ensure that the work is targeted toward people who can most benefit from green health activity.
An evaluation of this project was completed by Matter of Focus in December 2022, outlining positive outcomes and highlighting factors that were critical to the success of the project so that learning can be taken forward when embedding green health prescribing in other areas.
Developing a model for Green Health Prescribing in Midlothian
From opportunities for everyday contact with nature, to nature-based interventions that support a person to work towards a defined outcome, evidence states that a Green Health Prescribing approach can contribute towards the following outcomes:
- Improved physical health
- Improved mental health
- Reduced social isolation and improved community cohesion
- Reduced risk of Covid transmission compared with indoor activities
Within Midlothian, there is a wealth of informal green opportunities including parks and other places to walk in nature. There are also existing services and resources among community and voluntary groups to support green prescribing. This made Midlothian a logical next step when looking at how to develop a model for green health prescribing in Lothian, offering an opportunity to build on what existed already and work collaboratively with providers across the region to define what a more strategic, joined up approach could look like in practice.
NHS Lothian Charity provided £20,000 grant funding for the delivery of the project. A Public Health Project Manager co-ordinated and managed the project alongside NHS Lothian Charity’s Green Health Programme Manager. It was also supported by a wide range of staff and organisations across different roles and sectors, who provided their time, knowledge, and connections to make this possible:
- Lothian Health and Social Care Partnership staff, including General Practitioners, Practice Nurses, Pharmacists, Physiotherapists, Mental Health Nurses and Wellbeing Practitioners.
- Local Authority colleagues from Aging Well part of Midlothian Council Sport and Leisure Services.
- Third sector organisations, voluntary and community groups working in a green health providing role, including Health in Mind, Mayfield and Easthouses Development Trust, and Cyrenians’ Midlothian Community Garden.
Staff across the different organisations were keen to explore new ways of working and learning from others. Green health activity providers came with their own evidence of the benefits of spending time outdoors, with many healthcare prescribers also being aware of these benefits in their own lives.
The group met monthly with informal activities taking place in between meetings. This regular dialogue was hugely important as it allowed both the sharing of good practice and lessons learned, as well as ensuring prescribers had a good understanding of the wide range of options available and how this could contribute to improved outcomes for people.
Ian Mackenzie, Green Health Programme Manager at NHS Lothian Charity, said:
“During the pandemic people started to rediscover the benefits of being outdoors, for both mental and physical health, finding positive solutions in nature and how it could have a positive impact on their lives.
“We have known about the health benefits of nature for a long time, and worked with NHS Lothian to develop the first health board led Green Health Strategy, capturing the opportunities that exist for mainstreaming green health activities across the system, and building models of care that embed green health activities across a diverse range of healthcare professionals.
“We identified that, as well as actions outlining what needed to happen for projects to be successful, there also had to be a shared understanding of how things should happen. We call these our ‘Golden threads’; enthusiasm amongst communities and stakeholders for this work, imaginative ideas, and a desire to connect and work in partnership. Without these, I believe projects have less chance of being successful.
“Another important factor for successful delivery is having good conversations. In the context of this project, that meant making green health prescriptions a more natural part of conversations between patients and healthcare professionals. It also extended to the wider project team; it was important that we were having good conversations too, outlining a new way of working together with flexibility and opportunities to go beyond our normal roles to spread awareness of the benefits of green health prescribing widely in primary care settings.
“The final reason for its success is that it fitted naturally with the professional values and practices of those who have engaged in it.”
Feedback and Evaluation
As this was a one-year test of change project, the short time frame means that it this project is still in the beginnings of much of its impact on the system. Nevertheless, this has not been a barrier to its success. It is clear from the learning gathered so far that there is a lot of potential for further development of this approach in Midlothian and beyond.
The short time frame also means that the evaluation contains less specific information about the numbers and profiles of participants, but, in spite of this, the project is still able to demonstrate a big difference to outcomes for people who accessed a green prescription.
People who engaged with green health providers have reported improvements in their overall wellbeing as a result of getting involved with the activities, including improved sleep, self-esteem and confidence. Through their engagement with activity providers, they have also gained outdoor skills and new experiences as well as accessing community networks. Others have been able to identify feeling less anxious and less isolated.
From a project team point of view, prescribers and providers have formed a multidisciplinary network that will help to build and sustain momentum going forward.
Participant feedback collected by green health provider.
“When I was walking in, I got a churning in my stomach – I didn’t know if it was anxiety or excitement but I feel really relaxed now. My shoulders have dropped. I feel good”
Key Success Factors
As well as the feedback above, the following were identified as key factors in the success of the project:
Establishing a network of stakeholders
- A group of engaged stakeholders including primary care professionals and third sector organisations formed the Midlothian Green Health Prescribing Group to take this project forward. Led by the Project Manager, they set out a work plan and shared vision for the project and tailored the existing outcome map to better fit the context of Midlothian.
- Collaboration with those who had a strong sense of being ‘bought in’ to the benefits of this opportunity and that this was the right thing to be doing.
- Extending the group to a wider range of healthcare professionals to build capacity for engaging in a more structured way.
Two green health prescription routes
- Two different routes were developed to fit a range of patient needs.
- Offering the right level of support that was needed; signposting or a wellbeing service referral.
- Led by patient choice and control
- Having good conversations to explore options and find the right thing for the right patient
A multidisciplinary approach
- This joined up approach has enabled sharing of best practice, further development and a wider and more diverse audience engaging with their projects.
- An holistic approach to care isn’t new for many of the practitioners but the ability to signpost and share information has been great/ wider range of knowledge of what is available.
- Working across sectors with a range of professionals in a supportive and constructive working process.
- Support to keep going that extra mile.
- Develop new working practices and spread the benefits.
A visible green health presence in GP surgeries
- ‘Greening’ the GP waiting rooms with posters, leaflets and further information.
- Plant tables where staff and patients can help themselves and share ideas and opportunities
Further developments in green health prescribing are already underway to build on the work to date. This includes expanding the range of initiatives provided such as cycling activities and green space development, as well as expanding the awareness of this model to further professionals and GP practices. There is a clear appetite amongst those already involved in the project to continue and build on their success so far.
- NHS Lothian
- Midlothian Health and Social Care Partnership
- Ageing Well
- Health in Mind
- Mayfield and Easthouses Development Trust
- Cyrenians Midlothian Community Garden.
- Matter of Focus – Project Evaluation report