Social prescribing
This section describes what social prescribing is and how social prescribing could improve physical and social wellbeing for patients.
What is social prescribing?
Social prescribing is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local non-clinical services.
Social prescribing seeks to address people’s needs in a holistic way. Social prescribing also aims to support people to take greater control of their own health and recognises that people’s health and outcomes are determined more by the wider determinants of health, such as social, economic and environmental factors, genes and behavioural factors.
Common activities within social prescribing programmes
Social prescribing schemes can involve a variety of activities, which are typically provided by voluntary and community sector organisations.
Examples include:
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arts activities
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group learning
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gardening
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befriending
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cooking classes
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healthy eating advice
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volunteering
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walking groups
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dancing
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a range of sports.
Who is social prescribing most suitable for?
Social prescribing is designed to support people with a wide range of social, emotional or practical needs, and many schemes are focused on improving mental health and physical wellbeing. Those who could benefit from social prescribing schemes include people with mild or long-term health problems (including mental health), vulnerable groups, people who are socially isolated and those who frequently attend either primary or secondary healthcare.
Does social prescribing work?
There is overwhelming quantitative and qualitative evidence that people receive an immediate boost to their wellbeing following their engagement with social prescribing, and the qualitative longitudinal evidence suggests that these benefits are sustainable.
The table below summarises the range of positive outcomes experienced by social prescribing participants as reported by social prescribing stakeholders.
Source: Making sense of social prescribing University of Westminster, UK
The Rotherham Social Prescribing Service is one of the largest and highest profile examples of social prescribing in the UK. The results of the evaluation of the Rotherham Social Prescribing Service showed that 82% of all service users experienced positive change on at least one outcome measure. Progress was made against each outcome measure and most low-scoring service users (with a baseline score of 2 or less) made progress as follows:
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Feeling positive: 35% made progress; of the users with a low baseline score 65% made progress.
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Lifestyle: 26% made progress; of the users with a low baseline score 59% made progress.
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Looking after yourself: 23% made progress; of the users with a low baseline score 57% made progress.
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Managing symptoms: 23% made progress; of the users with a low baseline score 52% made progress.
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Work, volunteering and other activities: 46% made progress; of the users with a low baseline score 57% made progress.
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Money: 28% made progress; of the users with a low baseline score 71% made progress.
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Where you live: 24% made progress; of the users with a low baseline score 68% made progress.
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Family and friends: 19% made progress; of the users with a low baseline score 63% made progress.
However, robust and systematic evidence on the effectiveness of social prescribing is very limited. Many studies are small scale, do not have a control group, focus on progress rather than outcomes or relate to individual interventions rather than the social prescribing model. Much of the evidence available is qualitative and relies on self-reported outcomes. Researchers have also highlighted the challenges of measuring the outcomes of complex interventions or making meaningful comparisons between very different schemes.
Determining the cost, resource implications and cost effectiveness of social prescribing is particularly difficult. Some studies found that positive health and wellbeing outcomes came at a higher cost than routine GP care over the period of a year, but other research has highlighted the importance of looking at cost effectiveness over a longer period, particularly as it relates to reduced health service utilisation.
Social prescribing models
There are many different models for social prescribing, but most involve a link worker or navigator who works with people to access local sources of support.
Source: Making sense of social prescribing University of Westminster, UK
Social prescribing shares the values that underpin person-centred care. Schemes have therefore evolved over time to meet the needs of the particular communities they serve. Successful schemes accept a need for organic growth and partnership between stakeholders and the people using the services. Social prescribing models have been variously described and range from simple signposting through to holistic and refer to the level of engagement the link worker has with a person.
In the report Developing a social prescribing approach for Bristol, the authors describe three types of schemes:
Social prescribing light
Examples are community or primary care-based projects that refer at-risk or vulnerable patients to a specific programme to address a specific need, such as an exercise prescription or art/learning on prescription.
Social prescribing medium
A health facilitator (link worker) sees referred patients. Using agreed assessment and other tools, the facilitator provides advice on exercise, nutrition, diet, etc. The facilitator promotes self-care and signposts to voluntary organisations or self-help groups.
Social prescribing holistic model
This is a flexible model and represents the development of a project that had previously delivered at a lower level. These projects tend to evolve flexibly over time. They are innovative and seen by local practitioners to be a catalyst for enabling health providers to think much more creatively and holistically about addressing people’s wide-ranging mental health and social care needs within a non-stigmatising and empowering approach. These projects are frequently built over a long time. They are not a quick fix or a bolt-on. They are a reasoned intervention developed in partnership.
What needs to be in place to make social prescribing work?
Most social prescribing schemes have been designed to be responsive to the needs of the local community and to use local resources, rather than a one-size-fits-all approach. Social prescribing schemes focus on the needs of the person rather than their condition or disability; therefore, a social prescribing scheme is underpinned by a strong person-centred culture and acknowledges and supports a person to achieve wellness within the context of their own ‘lived reality’.
Researchers in the UK have identified what they call the essential ingredients of a social prescribing scheme.
Funding commitment
Social prescribing schemes have been funded in different ways. Funding sources include health, local authority, community grants and trusts. The effectiveness of the scheme is dependent upon the establishment and development of relationships and between all stakeholders and these relationships take time to develop. Continuity of funding is therefore very important.
For example, the Rotherham Social Prescribing scheme is underpinned by a large and long-term financial and strategic commitment and is now a mainstream component of health provision in the area. As such, it is one of the largest and highest profile examples of social prescribing in the UK. It has received national recognition for the work being undertaken and provides an aspirational model of service delivery for other parts of the country.
Collaborative working between sectors
Social prescribing is about aligning services available to a person in different sectors and identifying the need for new services. As many groups and organisations as possible should be included within the scheme and processes that facilitate oversight, governance and communication are essential. Each stakeholder group must have a local champion.
Buy-in of referring healthcare professionals
Maintaining up-to-date information about participating services is essential, as is education and facilitation of GPs and other referring healthcare providers. Referral criteria need to be designed to meet local needs and/or local need or target group. Referral criteria needs to be worked through with all stakeholders to ensure transparency.
Communication between sectors
Communication and feedback loops between all stakeholders in the scheme are essential to allow for transparency. GP coding systems are important for tracking referrals and linking to electronic patient records. This has proved challenging in the UK; however, work is underway to include social prescribing codes to the national coding scheme and software is being developed to enable tracking between local/social/community organisations and electronic patient records.
Using skilled link workers within the social prescribing scheme
The link worker has the most important role in the social prescribing scheme. Link workers have a variety of titles, including health advisor, health navigator, connector, community care coordinator. They are usually non-clinically trained and can be based in a GP surgery, other primary care service, local community resource or a mix.
They need to have a broad range of skills and be able to work independently and proactively with people. The link worker becomes the communication hub, communicating with healthcare referrers and building up local knowledge of the groups and services in the community.
The link worker has to establish and maintain links with:
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referring professionals
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people
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local voluntary, community and social enterprise groups and services.
Person-centered service
In most social prescribing schemes, link workers visit people at home, particularly where the person is unlikely to visit the GP or link worker due to social isolation, lack of confidence or other reason. Often the link worker will accompany the person to a group for the first time or help them take the first step towards doing something new.
Learn more
What is social prescribing? The King's Fund, UK
Helen Stokes-Lampard – social prescribing and the current NHS landscape The King's Fund, UK
References
What is social prescribing? The King's Fund, UK
Making sense of social prescribing University of Westminster, UK