Social prescribing – who does it work for and why?

In a time when people are living longer, but with more complex healthcare needs, GPs are increasingly using social prescribing to help manage conditions.

The practice involves prescribing non-medical, community or social activities via a link worker – and the current UK Secretary of State for Health and Social Care, Matt Hancock, has stated that social prescribing is a priority and will be available in every GP practice by 2024.

But researchers agree there is not enough evidence on what works, for whom and why. Now a new study by the Universities of Plymouth and Exeter has started to shed light on the subject.

The research, published in the journal Health and Social Care in the Community, highlights the fact that social prescribing is not a single intervention but a series of relationships, all of which need to function. It also highlights the vital role of a link worker in ensuring that the social prescribing process has the best chance of success.

The research took the form of a realist review: identifying existing studies and developing ‘if-then’ statements to ascertain how social prescribing models are expected to work, then clarifying these mechanisms with broader evidence.

Lead author Dr Kerryn Husk, Senior Research Fellow at the University of Plymouth and supported by PenARC – the National Institute for Health Research (NIHR) Applied Research Collaboration South West Peninsula – said:

“Given the significant popularity of social prescribing we need more evidence on what works. It’s not a case of ‘one size fits all’ or even ‘x intervention will work for y person’, it’s a case of examining the process as a whole and ensuring that everyone is aware of the key components to give an intervention the best chance of success."

“I think the most important finding from our review was that the role of the link worker is really important to stop the process from being disrupted. If their involvement or engagement with the patient is diminished, it affects the success of the whole."
“There is more work to be done in finding evidence for the success of social prescribing, especially as many more GPs in England are starting to utilise it within their work."
“It’s a long and complex road that is vital to understand if the health service wants to work towards patient-centred care, but it’s a subject we’re definitely keen on pursuing as part of our work in the Community and Primary Care Research Group at the University of Plymouth.”

The full study, entitled What approaches to social prescribing work, for whom, and in what circumstances? A realist review, is available to view now in the journal Health and Social Care in the Community (doi: 10.1111/hsc.12839).

Recently completed projects

  • Avoidable Acute Admissions​ (NIHR) - this NIHR HS&DR funded project is investigating how clinician expertise and decision making in four hospitals in South West England can contribute to safely reducing acute admissions​.
  • Engager 1 (NIHR) - developing a model for engagement and demonstrating feasibility of a trial for prison leavers.
  • COCOA - investigating access to and continuity of health care for offenders.
  • EARS (NIHR-HTA) - A pilot RCT to assess the methods and procedures for evaluating the clinical effectiveness and cost-effectiveness of an Exercise Assisted Reduction then Stop (EARS) counselling support delivered by health trainers, among disadvantaged smokers in Devonport and Stonehouse.
  • BAcPAc - (MRC - National Prevention Research Initiative - 4 funded) - Parallel-group feasibility randomised controlled trial comparing a Psychological Well-being Practitioner supported self-help intervention combining behavioural activation and physical activity promotion (BAcPAc) with behavioural activation alone for adults receiving treatment for depression in IAPT Services in Plymouth and East / Mid Devon​.
  • South West Improving Access to Psychological Therapies (SHA) - investigating the implementation of the national IAPT programme.
  • Community Health Networks (NIHR) - understanding how networks contribute to recovery for people with severe mental illness.
  • e-coachER - investigating the effects of adding web-based coaching to an exercise referral scheme.
  • Person-Centred Coordinated Care (PCCC) - care that is guided by and organised effectively around the needs and preferences of the individual.
  • STRENGTHEN - Improving health for those under community supervision, with the support of a Health Trainer.
  • Trial of physical Activity and Reduction of Smoking (TARS) a national study to test the effectiveness of new support to help smokers who want to reduce but not quit.
  • PHASED: A systematic review of physical activity for alcohol and substance use disorders.