Shared leadership is crucial to integrating and maximising social prescribing in neighbourhood health

Wednesday 19 March was social prescribing day – a time to celebrate the impact of social prescribing on the health and wellbeing of people and communities.

Social prescribing involves a health care professional referring patients to non-clinical services in the community to support their health and wellbeing. It bridges local health systems, communities and support services. Since being included as part of the NHS Long Term Plan in 2019, social prescribing has made significant progress: 3,500 link workers have been recruited as part of primary care teams, and by March 2024 around three million people in England had been supported, helping to reduce demand on health care services.

There is increasing evidence about the benefits of social prescribing at local levels- including its positive impact on long-term conditions. In addition to connecting people to community services, there is a recognition that link workers have knowledge and experience in co-designing services with local people. This means they understand gaps in community resources, assets and where funding can be targeted.

The government’s new neighbourhood health approach is central to achieving its three shifts (analogue to digital, hospital to community, and prevention focused). Part of the government’s neighbourhood health services guidelines on prevention and shifting care into the community include connecting people to community-led health services, of which social prescribing is a part. While there are questions about how neighbourhood health will be implemented effectively, it does provide an opportunity for social prescribing to be integrated into more parts of the health and care system, maximising the skills and knowledge that social prescribers bring to the partnerships and galvanising direct investment in community capacity.

The current neighbourhood health guidance emphasises health and care when discussing joint senior leadership. If neighbourhood health is to address health in a wider sense, eg, to include social determinants of health, it is crucial that a shared leadership approach is considered at a senior level between health and social care, community-led health services, and experts by experience. A shared leadership approach enables power sharing, decision-making and allocation of funding that reflects local needs.

But there are challenges that must be overcome first.

Across different parts of the same systems, relationships between system leaders, commissioners and social prescribing teams are patchy and there are instances of social prescribers struggling to engage with their local commissioners and senior NHS leaders. For example, social prescribers working on pilots undertaken by Hastings Voluntary Action and Reaching People in Leicester on older people experiencing financial hardship experienced difficulties engaging with senior NHS leads. This ultimately affects the ability of social prescribers to contribute meaningfully to shared decision-making in neighbourhood health at a senior level. And as some NHS senior leadership structures once more undergo significant change, it is likely this could get worse.

Moreover, health care systems have traditionally operated within hierarchical structures – where decision-making authority is concentrated at the top and flows down. These structures and ways of working can create a disconnect between senior leaders and middle managers, frontline staff, social prescribing teams, the voluntary sector and local communities. Hierarchies also create challenges to shared leadership, particularly in complex multi-disciplinary and community-driven areas such as social prescribing and integrated care.

So what can commissioners and system leaders do to enable shared leadership?

To embed social prescribing and maximise what it has to offer neighbourhood health, system leaders and financial decision-makers must recognise that hierarchical structures often create power imbalances with communities and community-led services. Instead, they need to design and establish shared leadership frameworks that enable collaborative decision-making and sustainable funding models, drawing on the community needs and strengths of those with lived experience and the expertise within community-led services.

This starts with health and care senior leaders having a business-as-usual approach where they create time to meaningfully engage and co-design with their local communities. Listening to community experiences of social prescribing will help them understand what social prescribing interventions work, why they work, and what they can do to support them. The same principles of listening and engagement must also apply to working with and understanding the contributions, expertise and knowledge social prescribers bring that can enable shared decision-making.

The engagement and relational work must be done at all levels of organisations and systems; this has the benefit of ensuring that relationships and connections are not held only by individuals in particular roles. This will be particularly important during the current restructures at national and system level; changes to institutional structures should not mean the loss of skills, knowledge and relationships that have been built.

By investing in relationships, governance and funding structures that promote shared leadership, senior leaders can co-create the conditions for integrated care and neighbourhood health to become a truly transformative, person-centred model of care.