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Future Fit Traning

Understanding social prescribing: Everything you need to know

The social prescribing model is being widely promoted to make general practice (GP) more sustainable as a way of linking patients in primary care with sources of support within the community.

What is social prescribing?

It is well established that 80%–90% of health outcomes are linked to social determinants of health, including health-related behaviours and socioeconomic and environmental factors [1]. Non-medical interventions have increasingly been proposed to help patients improve health behaviours and manage their conditions [2]. One type of intervention is known as social prescribing and is a more recent initiative developed to address social determinants of health [3]. Social prescriptions have been used for several years across European countries [4]. In England, the NHS Long Term Plan states that nearly one million people will qualify for referral to social prescribing schemes by 2023/24 [4]. Although there is no definitive definition, National Health Service (NHS) England defines social prescribing as ‘a way of linking patients in primary care with sources of support within the community the help improve their health and wellbeing [4].

The social prescribing model is being widely promoted to make general practice (GP) more sustainable as a way of linking patients in primary care with sources of support within the community [5]. It provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and well-being [5]. Schemes commonly use services provided by the voluntary and community sector and can include an extensive range of practical information and advice, community activity, physical activities, befriending and enabling services [2,5]. These activities aim to help address the psychological problems and low levels of well-being that often manifest infrequent attendees in GP [1,2,5]. By addressing these, it is often hoped that there will be a subsequent positive impact on the frequency of attendance [5,6].

 

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Is social prescribing beneficial?

While research is emerging in support of the benefits of social prescribing, to date this evidence is insufficient to provide definitive guidance on what works or what doesn’t [3]. Evaluating social prescribing schemes, however, can be challenging due to the complex and wide-ranging issues social prescribing seeks to address, wide variations in interventions, the wide range of additional influences on individual health and wellbeing, the lengthy duration for benefits to emerge, and the expense of thorough evaluation [5]. Moreover, many current evaluations are small scale, short term, poorly designed, lack standardised outcome measures, and fail to account for wider influences on health and wellbeing [5,7]. Conversely, the lack of robust evidence of effectiveness does not mean social prescribing is ineffective [7]. Qualitative studies suggest that patients are satisfied with social prescribing schemes, particularly valuing a trusting and supportive relationship with their link worker, the time and space to address social problems, and link workers’ extensive knowledge of the range of community support services available [8-11]. Patient improvements concerning mental wellbeing, specifical reductions in social isolation and loneliness, and reductions in primary and secondary care usage represent promising outcomes [8-11].

While social prescribing is likely to benefit many patients, we need to consider the scope of practice of those providing such services [12]. A variety knows these facilitators of titles, including community navigator and health trainer. Yet, “link worker” is an increasingly popular title because it references the need for a link between referring clinicians, patients, and local voluntary and community sectors [13]. Key aspects of the link worker role include: working with patients to identify meaningful goals; co-producing an action plan with the patient; enabling access to activities and sources of support in the community, and providing ongoing motivational support to help patients achieve their goals [13]. It is, however, essential to identify the level of qualification people will need to fulfil these roles.

 

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Conclusion

Additionally, we need to consider the broader social policy contexts within which social prescribing is delivered, specifically the constraints on the UK’s voluntary and community sectors imposed by a prolonged period of austerity and the impact of reductions in local authority budgets [14]. This, coupled with the growing demand for services, may make it more difficult to refer patients to community activities due to a lack of capacity or availability. Against this backdrop, balancing funding for link workers and activities requires commissioners and service designers planning. So, is social prescribing the way forward when addressing social determinants of health? There is a high level of support and recognition that it has the potential to reduce the financial burden on the NHS. Still, we must not forget that it requires funding, planning and qualified staff to deliver the outcomes that have been identified.

References

  1. Hood CM, Gennuso KP, Swain GR, et al. (2016). County health rankings: relationships between determinant factors and health outcomes. Am J Prev Med. 50:129–35.
  2. Alderwick HAJ, Gottlieb LM, Fichtenberg CM, et al. (2018) Social prescribing in the U.S. and England: emerging interventions to address patients’ social needs. Am J Prevent Med ;54:715-18
  3. Jani A, Liyanage H, Hoang U, et al. (2020). Use and impact of social prescribing: a mixed-methods feasibility study protocol. BMJ Open 10:e037681. doi:10.1136
  4. National Health Service (2019). NHS Long Term Plan: London. UK. National Health Service. https://www.longtermplan.nhs.uk/
  5. Bickerdike L, Booth A, Wilson PM, et al. (2017) Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open;7:e013384. doi:10.1136/bmjopen-2016- 013384
  6. Kimberlee, R., Ward, R., Jones, M. and Powell, J. (2014). Measuring the economic impact of the wellspring healthy living centre’s social prescribing wellbeing programme for low level mental health issues encountered by GP services. Project Report. South West Forum, UK. 2013. POV_ Final_ Report_ March_.
  7. Husk, K., Elston, J., Gradinger, F., Callaghan, L. and Asthana, S. (2019). Social prescribing: where is the evidence? Commissioned editorial.
  8. Moffatt S, Steer M, Penn L, et al. (2017) What is the impact of ‘social prescribing’? Perspectives of adults with long-term health conditions. BMJ Open;0:e015203. 367 22.
  9. Wildman JM, Moffatt S, Steer M, et al. (2019) Service-users’ perspectives of link worker social 368 prescribing: a qualitative follow-up study. BMC Public Health; In press. 369 23.
  10. Faulkner M. (2004). Supporting the psychosocial needs of patients in general practice: the role of a voluntary referral service. Patient Edu Counsel. doi:10.1016/s0738-3991(02)00247-1 371 24.
  11. South J, Higgins TJ. (2008). Can social prescribing provide the missing link? Prim Health Care Res Develop;9:310-8
  12. Health Education England (2016). Care navigation: a competency framework. Available at: Care Navigation Competency Framework_Final.pdf (hee.nhs.uk)
  13. McConnachie, A., Fitzpatrick, B., O’Donnell, K., McKenzie, M., Skivington, K., Chng, N., Smith, M., Wyke, S. and Mercer, S. (2017). The Glasgow deep end links worker programme evaluation: analysis implication of an unusual randomised study design. Trials, 18(Supplement 1), pp.28-29.
  14. National Audit Office (2018). Financial sustainability of local authorities. Available at: Financial sustainability of local authorities 2018 – National Audit Office (NAO) Report