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Prescribing the Resolution of Conflict in General Practice

Prescribing the Resolution of Conflict in General Practice

In the UK, around 40 community mediation organisations offer vital support to individuals grappling with conflict in their homes, workplaces, and neighbourhoods. Conflict also takes a toll on our health, often driving individuals to seek support in GP surgeries. Victoria Harris’s explores the potential of social prescribing, where GPs can refer patients to conflict resolution services. Through real-world examples like Mediation Hertfordshire’s pilot scheme, she showcases the potential of integrating conflict resolution into referral pathways.

There are around 40 community mediation organisations in the UK, which support individuals experiencing conflict at home, in the workplace or with neighbours.

Unresolved Conflict Results in GP Appointments

Conflict affects health. A GP surgery is often the first port of call when anxiety, depression or insomnia arising from conflict impacts wellbeing. The treatment for these conditions may alleviate symptoms but they do not get to the root cause. Conflict that is unresolved results in additional appointments and repeat prescriptions that arguably could be avoided through the social prescription of conflict resolution services.

A Conflict Resolution Pilot Scheme for GP Referral

The advent of social prescribing provides an opportunity for GPs to refer patients to these services for the benefit of both patients and general practice. At Mediation Hertfordshire, a community mediation organisation based in Hemel Hempstead, a pilot scheme funded by Herts Valley Clinical Commissioning Group proved this point. Ten cases were referred over a 12-month period from general practices in Watford and Three Rivers in Hertfordshire. The not for profit Mediation Service then supported patients with mediation and conflict coaching. The presenting issues spanned child contact issues, family breakdown following a bereavement, a parent in dispute with their child’s school, antisocial behaviour, a parking dispute with a neighbour and a financial dispute.

Conflict that is unresolved results in additional appointments and repeat prescriptions that arguably could be avoided through the social prescription of conflict resolution services.

A key aspect to the success of the scheme was the investment in relationships to raise awareness of the scheme and to promote a simple referral pathway. This was achieved by delivering both live and pre-recorded training over Zoom to GPs and practice nurses, social prescribing link workers, mental health support workers as well as to community support policing teams and voluntary sector agencies. At the heart of general practice, nurses have an important role to play recognising the triggers of ill health and the wide range of options available to present to patients. More broadly the practice nurse has the ability to drive cultural change towards expanding the role of social prescribing within general practice. Patients could either self-refer through Mediation Hertfordshire’s website or they could be supported in making a referral through their local surgery. At the conclusion of this project, anonymised case studies showed positive outcomes for these individuals with reference to agreed wellbeing indicators. It will likely be considered that this small sample is insufficient to influence policy, but the seeds have been sown. Greater research is called for to investigate the links between conflict and health with reference to the demands that are placed on general practice and how best these demands could be alleviated at the same time as supporting patient recovery.

Social and Economic Circumstances Determine Quality of Health

Fortunately, there is an emerging awareness of the social determinants of health identified over 30 years ago by researchers Dahlgren and Whitehead (1991). They identify the broad social and economic circumstances that, together they argue, determine the quality of health of the population. The model they use incorporates social and community networks as well as living and working conditions. Conflict can adversely impact these determinants, and yet the type of conflict arising is not necessarily one that will find itself at the door of the court. Rather it is likely to arrive at the door of a local GP surgery. Here, patients see their GP as a safe figure to confide in and to whom they can discuss their distress and the symptoms arising from being embroiled in the conflict that is adversely affecting their lives.

Commissioning Services that Make a Difference

With the changes to the health economy and the introduction of Integrated Care Systems it is timely to look at what services should be commissioned that could make a real difference. Health commissioning bodies need to recognise the value of conflict resolution to the social determinants of health and to incorporate the provision of conflict resolution services into patient pathways. Local community mediation organisations stand ready to support.

This article was first published in Practice Nursing 2022, Vol 33, No 8

Victoria Harris

Victoria Harris is the CMC Programme Manager and runs the Academic Forum as well as two Working Groups for Peer and Community Mediation. A solicitor for 15 years, Victoria moved to the voluntary sector to support mediation in the community and became CEO for Mediation Hertfordshire, during which time she innovated a contract for mediation to be socially prescribed from NHS primary care. She is the author of Transforming Community Conflict and The Cost of Community Conflict.  She is now a Trustee for Mediation Herts and was a member of the 2022 judging panel for the National Mediation Awards.

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