In 2022 discussions began between Community Link Workers (CLWs) and RSPB Edinburgh about opportunities for partnership working and to develop further the Nature Prescription that was successfully piloted by RSPB Scotland and NHS Lothian and NHS Shetland previously. A Nature Prescription (NP) is designed to give a patient the opportunity to connect with nature and their local green or wild space, and in so doing to improve their mental and physical health. A great deal of research evidence demonstrates the effectiveness of increased access to nature with improved wellbeing. Reduced social isolation can also be achieved in cases where the patient is open to connecting with others for shared green activity.
In discussions with Frances Simpson of RSPB, it was agreed that the CLW role was well-placed to build on the original NP model (in the original model, a GP offers a patient a NP through a leaflet and nature activity calendar and then the onus is on the patient to engage with nature from there). Frances’ input was essential in getting things progressed further in our partnership with RSPB.
Generally, a CLW role involves supporting a patient to develop achievable practical goals and to understand local resources to help with this. Our role also crucially involves accompanying someone to ‘get over the line’ with attending a service or meeting a service provider – the classic CLW ‘chum in’ that often makes the difference for a patient truly engaging with a service or not. So a CLW can potentially develop the Nature Prescription opportunities more fully with a patient by providing this 1-2-1 structure for getting started and also providing feedback on progress. This structure (and the all-important ‘chum in’ option) was missing from the previous NP pilot.
PCHP and CLW Network support for the Nature Prescription partnership work
My TSO organisation Pilton Community Health Project (PCHP) also played an important role in enabling me to have sufficient time and support set aside to develop this partnership. PCHP communicated early on with the CLW Network in Edinburgh about this and introduced Frances from RSPB to the CLW Network. The Network in turn were supportive for us to explore opportunities for developing the Nature Prescription service for our patients and practices.
Based in the heart of North Edinburgh, PCHP has been serving local people and their families since 1984. Pilton Community Health Project works alongside local people to improve their own health and wellbeing and in turn create a happier, more resilient community. Our drive to listen, then create local wellbeing initiatives such as Taking Steps to Better Health are supported through our partnerships with organisations who work alongside people with a strengths-based approach and share knowledge and resources to achieve a collaborative advantage. As a CLW-employing organisation, PCHP welcomed the opportunity to partner with RSPB to strengthen and develop our own nature prescription work and that of the CLWs.
Our GP Practices are ready to ‘go green’
My two GP practices, Bangholm Medical Centre and Eyre Medical Practice, have both been extremely supportive and encouraging about developing the Nature Prescription for their patients and look forward to seeing the results of this service in the months and hopefully years ahead. We initially developed a Wellbeing Walking group that serves both practices and this has been successfully running since June 2022, providing a welcoming and informal walking group for all ages. Emily Ronaldson from Edinburgh and Lothians Greenspace Trust expertly runs this walking group (as well as others in Edinburgh) and those who attend this group report feeling very positive and energised every time. As someone who occasionally attends myself (when I introduce new patients to the group), I find this to be a lovely and positive group that reduces social isolation and improves connections to green space, particularly on the cycle paths where many birds can be seen and heard at this time of year. On the very first outing of the group Emily pointed out a Tawny owl to participants during a walk through Warriston Cemetery – a rare treat for bird lovers to see in a suburban setting! The GP practices view the NP service as an extension of this positive practice-level connection to green wellbeing.
Nature Wellbeing Training Days delivered to CLWs by RSPB Edinburgh
The CLWs in North Edinburgh had an opportunity to attend a training day (the South CLWs recently did so too) to equip CLWs with the confidence and skills to offer the Nature Prescription to our patients. Katie O’Neill and Ida Fabrizio – two very experienced and skilled trainer-facilitators from RSPB – provided an inspiring, enjoyable and practically helpful training experience for us. The day was about, firstly, enabling CLWs to learn new ways to find our own individual connections with nature and to experience how this enhances wellbeing and mental health. We achieved this by being outside together experimenting with different activities to help us feel more mindfully present with nature. Some of these skills we can now share with patients. The second half of the day was a workshop session indoors identifying opportunities as well as barriers, in how we can offer a NP to interested patients. Having discussed barriers we then explored possible solutions, learning practical ways to try to include these into our existing role and busy workloads.
Every CLW in attendance reported leaving the training day energized and refreshed with new skills for personal wellbeing, as well as feeling much more confident about how to introduce the NP to our patients and give them the best opportunity to benefit from it.
Nature Prescription and CLW role in future
One of the practical solutions we identified in the workshop was for CLWs to have the option of creating a ‘green slot’ in our diaries. This would enable us to more easily accommodate space for a new patient who could really benefit from our support to connect with a green space near to them to begin their Nature Prescription. After this initial meeting, it is then over to the patient to develop this further depending on what goals they want to achieve. The Nature Prescription demonstrates the value of the CLW role within GP practices and of enabling patients to become more aware of and then to connect to community resources, in this case with wild spaces and green activities in their community.
The CLW role can provide an opportunity for a diverse range of patients (many of whom experience a nature-deficit in their daily lives and may be struggling with mental health) to connect with nature, in a way that a purely signposting approach would not always be able to achieve. The Nature Prescription is now a rolling agenda item for our monthly North meetings and CLWs across Edinburgh will continue to share information and learning around how we can best offer this to patients in the future.
Danny McShane is a Community Link Worker in North Edinburgh.