Social Prescribing – Effective Mechanisms for Social Prescribing

Social Prescribing – an overview

Social Prescribing entails linking individuals from primary care (often their GP) to social interventions, with the potential to improve health and wellbeing. This pathway expands available options to clinicians whose patients have complex social and medical needs, by connecting them to community resources, information and social activities, as well a range of statutory and non-statutory agencies.

Potentially, social prescriptions can enable healthcare professionals to respond more effectively to a range of non-clinical needs and connect patients with professionals who are able to provide longer consultations and more detailed knowledge of local social activities.

The range of activities is diverse and can include gardening programmes, books on prescription, exercise on referral, referral for debt counselling, or housing advice. The range is such that the mechanisms of action are also diverse and can be activated through being with people, cognitive stimulation, or identity generation. In this way, social prescriptions are potentially applicable for treating a broad range of conditions or their prevention.

The practice of social prescribing is growing in popularity, but delivery is also disparate, variable and complex. A variety of referral models exist, ranging from signposting by primary care practitioners through to iterative activity choices, facilitated by link workers who can meet at length with patients and collate available activities to suit need and lifestyle, as well as provide a point of ongoing contact. There are myriad ways in which this process can be disrupted; for example if staff are not aware or unsupportive of the idea, or patients are unable to initiate their particular social prescription, it is impossible to maximise the potential of the service, ensure appropriate use, and avoid wasting resources.

There is then a risk of social prescribing services being developed without evidence about what should be offered or the processes that are required to support them. A disconnect between health and other services might result in patients not getting a social prescription appropriate to their needs. Our research programme seeks to generate robust evidence about what works, for whom, and in what ways.

Background

The use of non-drug, non-health-service interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. The interventions typically involve accessing activities run by third sector or community agencies and may be described as non-medical referral, community referral or social prescribing. A wide range of activities and agencies have been considered, including art therapy, walking groups, reading groups, green/nature activities and volunteering. For such interventions to be effective, patients need to be “transferred” from the primary care setting into the community and maintain their participation in the activities there. It is not currently known what approaches are being used to enable people to reach community services that may benefit their health and well-being and the effectiveness of these efforts is unclear.

Work is being conducted in parallel to this review by Dan Bloomfield, Sara Warber, Lora Fleming et al. in developing a feasibility study for a nature-based social prescribing intervention, the review will inform this work.

Research question

We plan to undertake a realist review to unpack the uncertainties relating to methods of social prescription referral. Realist approaches try to understand “what works, for whom, in what circumstances, and why” and draw on evidence from a wider range of sources than traditional systematic reviews.

This project results from a question prioritised in the 2014 round:

• Would Green prescriptions improve patient wellbeing, quality of life and reduce GP visits by patients with complex health problems or mild to moderate depression?

Project aims/objectives

The review will have two phases in approaching the objectives listed below; (a) will identify programme theories in the literature and (b) will use targeted searches to seek suitable evidence to refine these theories.

• What are the main factors or mechanisms that are thought (both scientifically and experientially) to explain the success or failure of social prescribing?
• Are there methods of referral that are particularly useful and appropriate for different groups of people (we are particularly interested in those with mild to moderate depression)?
• Which approaches to referral are likely to be appropriate, or inappropriate, within NHS primary care settings?
• What is best practice for people with mild to moderate depression to receive nature interventions? (By this, we mean any intervention which occurs in the natural environment where, for example, greater benefits have been shown to accrue compared to similar activities indoors.)

This review was led by the Evidence Synthesis Team.