"We're total idiots," says John, 68, gesturing to the rest of the small group peering optimistically into the Tyne on a gloomy autumn morning. "We fish in all weathers. We stand here in the snow." But he adds: "It's more about meeting up than catching fish."
Other members of the Newcastle fishing group agree. It is a chance, they say, to break free of the emotional isolation of keeping their feelings under wraps.
"I never thought I would suffer from depression," says Paul, 59, who was unable to carry on in his job after a brain tumour and a heart bypass. "It just crept up on me. I lost a lot of friends when I was trying to tell people. They didn't want to know. You can't talk to your family, really. [People think] a man doesn't cry. It's a comfort to talk to someone who's already had it. These people here have opened me back up, to be honest."
Friendships have been moulded as the group vie to catch the most "flatties" (flounders), whiting and cod; and the fishers regularly meet up for a coffee at other times of the week. The group's current members found it through a variety of routes, from word of mouth to a stall at a local fete. But with the expansion of a scheme for Newcastle GPs to offer "social prescribing" – an approach that seeks to improve health by tackling patients' social and physical wellbeing – members may increasingly come via a referral from primary care.
New research released on Tuesday by the innovation charity Nesta and the Innovation Unit suggests GPs across the country are increasingly keen on the "more than medicine" approach of social prescribing, which typically includes activities from dance classes to knitting groups and cookery clubs. Among 1,000 doctors surveyed, four out of five thought social prescriptions should be available from their surgeries, in particular exercise groups, help with healthy eating and groups providing emotional support. Yet patient experience suggests the opportunities to benefit are limited. Nesta questioned 2,000 members of the public, with just 9% saying they had received a social prescription. More than half (55%) said they would like their GP to offer them.
Halima Khan leads Nesta's People Powered Health programme, which has funded six areas in England to design and deliver innovative services for people living with long-term health conditions, including a formal social prescribing system in the Newcastle West clinical commissioning group (CCG). Khan believes social prescribing has the potential to transform healthcare. "It creates a new script for the consultation that enables both clinical and social elements to be taken into account," she says. "If you're just treating clinical origins then you're not getting to the root of the problem."
John, who suffered from severe depression for years, wishes a GP could have been more creative in helping him. "They do the normal, give you a few tablets and say come back in a month," he says. "[They ask] 'do you self harm?' When you say no, that's it – that's all they're bothered about, whether you're going to do damage to yourself or others."
While some doctors may refer patients directly to groups or activities, the huge number of options on offer from the community and voluntary sectors means it is often more efficient to refer to intermediary services, such as Healthworks Newcastle, which works with people with mental health problems and which set up the fishing group a year ago.
Link workers, such as health trainers or peer mentors, can offer the support patients may need to make challenging behaviour changes – right down to going on the bus with them to a new group if necessary.
In Newcastle West, where the 15-month Nesta project ended in March, the next phase is funded by the Social Enterprise Investment Fund. One of only a few social impact bonds (SIBs) being developed in the health field, it aims to scale up the existing work to enable up to 5,000 patients a year to access social prescribing – while reducing the cost of supporting them. The bond works by paying back investors when demonstrable savings are made from fewer visits to A&E or GPs, and less medication. Though the number of patients going through the formal system so far has been fairly small – around 100 – and it will take time before savings are identified, GP Guy Pilkington, the chair of the CCG, says the approach is crucial.
"The health service is facing what appears to be ever-increasing fiscal holes between what we get and what we have to do. If we don't get better at empowering people to look after themselves, using low-cost, high-impact interventions, we're going to really struggle in the near future to fund a comprehensive health service," he says.
One member of the fishing group, so-called "young" John, is unequivocal about the group's impact. "If I wasn't doing this," the 30-year-old says, "I'd be dead. It's the only thing that's helping me really."