Healthier lives and a healthier NHS: the role of social prescribing

At a time when the NHS is under extreme fiscal pressure, interventions need to show every ounce of effectiveness if they are to deliver real ‘bang for the buck’. The evidence is mounting that social prescribing is an effective way to help people with a diverse range of issues – from social isolation and housing or financial problems to changing lifestyle behaviours and improving health.

Social prescribing is, by its nature, a diverse set of complex interventions that help prevent disease and support people’s health and wellbeing. As such, it doesn’t lend itself easily to rigorous controlled trial settings, but there is strong and growing evidence of its impact on patient outcomes, people’s mental health and wellbeing, and on the wider NHS too.

As a GP of 37 years, I have been involved in researching and using forms of social prescribing since 1991. I first came across this approach seeing community link workers in action in India, as a medical student in 1979. I realised then how important it is for people to receive support and information from their own community members, who understood them, and their lives, better than anyone.

That experience shaped my later work, starting in the 1990s with a randomised control trial of culturally appropriate diabetes health education, delivered by community-based link workers in Nottingham and Manchester, and culminating in delivering it to a diverse range of minority ethnic communities in Cardiff.

It has been very positive to see the spread of social prescribing in England over the last few decades – from small-scale local initiatives, to becoming part of national health policy under the previous Labour and Conservative governments, leading to a national rollout following the 2019 NHS Long Term Plan. There are now more than 3,300 link workers in post in primary care teams and millions of patients referred to them by GPs.

As a concept, social prescribing is sometimes misunderstood as being light touch. In fact, it should be at the heart of our efforts when it comes to health and wellbeing promotion. Although continuity of care means GPs know and understand their patients and the communities in which they live, they rarely have the time to explore the wider social factors affecting a patient’s health and wellbeing in 10-15 minute consultations. They may also not be fully aware of what support is available outside the NHS.

This is where link workers can add real value. They have more time to get to know patients and to understand what matters to them, as well as a detailed knowledge of the groups and services in that area. For example, they might help someone who’s become isolated after a bereavement to take the first steps towards socialising again. They might enable someone with respiratory problems to get the mould removed from their walls. Or they might work with someone at risk of diabetes to become more active in a way that suits them – through walking groups, chair-based exercises or dance.

Sometimes the results are dramatic, with people previously at risk of suicide finding a community that gives them a sense of purpose and belonging. More often, social prescribing is about enabling smaller but sustainable changes, encouraging healthy behaviours, helping people to improve their living environments and enabling people to become more connected to their community.

However, rising demand for link workers, without the funding to recruit and support enough of them, can limit the time they have to build relationships with community groups and the voluntary sector. This can make it harder for them to keep track of what services are available and where people can be referred. And at the same time, when GP practices use Additional Roles Reimbursement Scheme (ARRS) funding to bring in more clinical staff to meet service pressures, it can leave less room to recruit and support link workers. That can make it harder to sustain the community relationships that effective social prescribing depends on.

The English model is the most developed in the world, and it has inspired many others: more than 35 other countries have now rolled out social prescribing programmes, adapted for different contexts. Increasingly, we can learn from what’s happening in other countries – for example, from Singapore, where patients discharged from hospital can be referred to a link worker who supports them and helps prevent re-admission.

Pioneering secondary care schemes in England, like the programme in the heart attack pathway at Barts Heart Centre, show the potential for a similar approach in England. There is also work in hand to develop a new type of social prescriber, linked to GP surgeries, who can help people on long-term sick leave return to work, as part of a team of occupational therapists and work counsellors.

But we also need to recognise the challenges facing the English model. The 10 Year Health Plan rightly committed to the shift from sickness to prevention, which is essential if we want to prevent the NHS from being overwhelmed by the rising tide of illness. However, given the huge pressures on the system, we need policies and mechanisms in place to make this shift to prevention a reality. That means building on and supporting the development and success of the link worker rollout. We need to keep growing the social prescribing workforce, as a key part of the neighbourhood health service, and we need to make sure that link workers are well trained, valued and supported.

Social prescribing also relies on a strong and sustainably funded voluntary sector. Link workers are successfully reaching people in socially deprived areas, but it is crucial that they can connect people to a thriving network of local groups, activities and services in each area. The National Academy for Social Prescribing and others have recommended innovative models for pooling investment, while giving communities more power over what is delivered.

For social prescribing to be truly effective, though, all parts of the system need to work well together – from primary care and link worker capacity to a strong voluntary and community sector. It also means supporting more community-led approaches, rather than relying solely on top-down models.

Social prescribing is not a panacea, and no one claims that it can fix all the wider problems in society that affect people’s health. For me, as a GP, social prescribing has brought valuable additional tools to my management toolbox for patients, particularly for those issues that are social rather than biomedical in origin, but which present in my consulting room as medical problems. By building bridges between the NHS and communities, and by recognising the range of pressures patients face, it can and should play a key role in the future of our health system.