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The Oldham Social Prescribing Innovation Partnership brings together partners from the Local Government, Health, Voluntary, Community, Faith and Social Enterprise sectors to help people address ‘more than medical’ need by linking them into community capacity such as support groups for depression or walking clubs.

It places social value, community development, co-production and sustainability at the heart of the partnership and then iterates the model of delivery to best support residents in need.

The partnership is delivering benefits for the health and care system (such as a 62.5% reduction in GP appointments and a 90% reduction in A&E visits) and is helping people live healthier happier lives, improve outcomes and enter employment.

Watch this short video explainer by Rebekah Sutcliffe, Strategic Director of Communities and Reform at Oldham Council (case study continues below):


Oldham has adopted a highly strategic, overarching commissioning model, led by its three inter-related Social Value themes: Thriving Communities; Co-operative Services and Inclusive Economy.

This incorporates a community partnership methodology engaging: citizens, local employers and SMEs, the VCFSE sector, anchor institutions (such as Oldham College, Oldham Leisure and Oldham Library), statutory agencies and local housing providers.

The partnership working, placed based approach was applied particularly to health and wellbeing to co-ordinate local services through a local ecosystem re-modelling. For example, Dr. Carolyn Wilkins OBE is Chief Executive of both Oldham Council and NHS Oldham CCG, integrating health and social care through “Oldham Cares”.


The Oldham Social Prescribing Innovation Partnership is a pioneering three-year and £1.25m Innovation Partnership on behalf of Oldham Cares (Oldham’s integrated care organisation) to a local consortium of voluntary and community organisations.

The partnership’s objectives are to improve the health and wellbeing for people in Oldham through ‘more than medical’ care and support, build on community capacity, reduce pressure on the health and care system and for system learning.

Social Prescribing was recognised as a core means to apply the integration of health and social care through reorganisation based on local community strengths, in particular by building on the VCFSE services and connections; listening to what matters to community members; extending provision beyond medical solutions; and focusing planning on individuals and their role in the co-design of their own support.

The Innovation Partnership procurement procedure was recognised as an ideal basis to develop a collaborative local community partnership approach to social prescribing. It combines Service Design; Social Value; Engaging Service Users; Capacity Building; Community Benefit; Consortia Building; Equal Partnership and Economic Growth.

A consortium of five locally-rooted charities was selected as Innovation Partner, with Action Together CIO as the lead consortium partner. The consortium met the requirements for reach across Oldham, multi-disciplinary expertise, engagement capacity, an established local reputation and public benefit purposes aligned with those of Oldham Cares.

The Social Prescribing Model features:

  • an integrated centralised front door for referrals
  • standardised processes across the system network
  • a co-ordinated casework tracking system, providing network wide information on referrals, casework management, case records and outcome monitoring
  • alignment of network services (Early Help,  Personal Independence Payment; Improving Access to Psychological Therapies)
  • named “local connector” social prescribing workers for each of 3 service categories and 15 residential clusters – workers meet with individuals and explore how local activities and non-medical support may improve personal health and wellbeing
  • a named Community Development Worker focusing on the further building of VCFSE and supporting the presentation of the community offer by local connectors to residents
  • promoting peer network communications and activities for patients with common conditions

After Phase 1 in Oldham West, which worked with 10 GP surgeries, supporting 284 people, full recruitment and implementation plans across all sectors in place from summer 2019.

In practice, GPs, or network participants identify a non-medical need then make a referral to the relevant local connector/social prescriber, who meets the individual to agree how their individual needs may best be met within the system; connection is made to the personally identified activities, or support; the individual is supported within the community; feedback is provided into the network system and to the original referrer.

From the outset there were quantified anticipated target reductions in GP appointments, A&E attendances and non-elective bed days.

Wider benefits include:

  • the development of a co-ordinated approach for other community development projects, supporting the general place-based integration plan
  • revealing connections between activity, mental health and poverty and gaps in provision, for example in befriending and for the middle aged
  • link to small “fast grant” programme, inviting ideas from the community
  • indicators for the strategic deployment of Oldham’s Social Action Fund to community groups, spaces and projects

Key stakeholders:

  • Oldham Council
  • Action Together as the consortium lead
  • Four other local charity consortium members
  • A wider network of community activity and support organisations
  • GPs
  • Individual local connectors/social prescribers
  • Local community members

Key statistics:

  • 1,400 community groups within the network are delivering 1.5m interventions a year
  • A referral rate of over 30 per week (three times the original business case)
  • Current overall indicators against targets: reductions in Primary Care attendances of 56%; A&E attendances of 83%; and non-elective bed days of 73%

Challenges this project sought to address:

  • inadequate integration between health and social care and barriers to the two systems being co-ordinated
  • excessive, inefficient and expensive health engagements at primary and secondary level, which could be reduced by improved care engagements
  • insufficient attention to the inter-connected, multiple needs of individuals resulting in piecemeal single engagements, preventing improvement in personal circumstances and conditions over time
  • disconnected, non-integrated care and VCSE provision
  • the primacy of traditional, transactional, short-term public service competitive contracting and the undervaluing of purpose-driven community asset mobilisation, collaboration and co-ordination


The vision for the Project was to take the conceptual principles of social prescribing and build a community partnership network, integrating and developing the potential local community capacity for a networked system delivering timely wellbeing support, before care services are needed and timely care services before medical engagements are required.

The innovation started with the Oldham Integrated Social Value and Oldham Cares health and social care integration strategies. This led to a community wealth-building, mobilisation and engagement approach, based on co-ordinating, strengthening and developing local community provision and a commissioning strategy based on building local community partnerships, networks and systems.

Use of the Innovation Partnership procedure was innovative, as there was no known previous use of the procedure to draw upon, except the near contemporaneous and equally pioneering Leicestershire County Council Children’s Services case. This involved adapting typical processes to the requirement for a design and delivery contract and a specification for community, consortium and partnership working.

The two core design innovations were: systematic approaches to providing for one to one meetings with individuals, to identify and support their personal needs; and to organising engagements by such individuals with their community support and activity networks.

A tender was published “for the provision of an Innovation Partnership to co-design and deliver a Social Prescribing Network”, for a contract duration of three years plus a possible further three years. It referenced the Thriving Communities strategy and further development of a prior pilot project in part of the borough. A negotiation process was included.

Particular tender drafting considerations were:

An emphasis on assessment by reference to capability, capacity and commitmentPlease see the Social Value Imperatives
An appropriate change control/explicit variation process, To allow for iterative, collaborative project development
A bespoke contract documentProviding for a progressive, working relationship
Bespoke Special Contract Conditions Covering collaborative roles and responsibilities; project governance; project implementation; transition and renewal; project payments; project intellectual property rights; and project specification.

The project was Highly Commended in the “Innovation of the Year – Other Organisations (than health)” “Showcasing Excellence in Public Procurement” Government Opportunities Awards 2020.

Other elements which made the project successful:

  • Putting the needs of local people at the heart of service re-organisation and provision through co-production
  • Shifting the balance of power to residents and community partners to develop the right and simplified commissioning means of directing services towards community needs
  • the active intention to transform commissioner/supplier/patient transactions and defined function boundaries into purpose-led partnership relationships

More details:

What next?

5 Fundamental Correctives for Public Service Reform

Read about the Five Correctives here or click the buttons below for descriptions of the outcomes of, process behind, underlying principles, and evidence for each corrective.

9 Key Principles for working with purpose-aligned partners

Component principles for effective partnership working. Click here.

Tools, Resources and Model Documents

Example documentation, contracts, processes and agreements you can access – or use as a checklist as you progress your partnerships. These practical models and outlines include a set of social value imperatives.

Case studies of purpose-aligned partnerships

Examples of successful public service community partnerships delivering a variety of public services. See them here.

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