What is social prescribing?

What is social prescribing?

Social prescribing can be understood as  one of a family of approaches, sometimes  called community-centred approaches, to health and wellbeing. Community-centred approaches seek to mobilise community resources to improve people’s health and wellbeing and promote equity. Social prescribing generally refers to health and care professionals connecting people to a range of non-clinical support (such as arts, sport and exercise, nature groups, employment and housing support), usually through a social prescribing link worker. 

The term ‘social prescribing’ originated in the UK, but as it expanded globally, there became a need to create an internationally agreed definition – one that expands social prescribing beyond clinical settings. Therefore, social prescribing is defined as ‘a means for trusted individuals in clinical and community settings to identify that a person has non-medical, health-related social needs. They subsequently connect them to non-clinical support and services within the community by co-producing a social prescription – a non-medical prescription, to improve health and well-being and to strengthen community connections.’ 

People’s health and wellbeing are largely shaped by a range of social, economic and environmental factors. Social prescribing draws on the tenets of prevention to mitigate the impact of adverse socio-economic determinants of health and health inequalities. It is designed to support people with a wide range of social, emotional or practical needs in a holistic and asset-based way. Social prescribing also aims to support individuals to take greater control of their health, and in this way contributes to health creation. Some view social prescribing as a mechanism for bridging the gap between health and care and voluntary, community, social enterprise and faith (VCSEF) organisations.

Social prescribing is not new. Ideas on social prescribing in England have been around for a long time. It can be traced back to the 1920s with the Peckham Experiment, and later to the establishment of the Bromley by Bow Centre in 1984. For many years, though, social prescribing existed in isolated pockets and remained largely unnoticed by national NHS bodies. Many different schemes connected GPs with community groups to support people’s mental health and wellbeing, and the NHS GP exercise referral scheme was introduced in the 1990s. Over time, recognition of the benefits of social prescribing led to its integration into health and care policy and the NHS, which we discuss in later sections.  

How is social prescribing funded and organised?

There are three key elements to social prescribing: who it is for, how a referral or prescription is made, and what it entails. 

Who is social prescribing for?

Social prescribing is for anyone, but it has been found to be particularly helpful for people with mental health conditions (mild or long term), those who are socially isolated or have complex needs, and those who frequently attend either primary or secondary health care. In addition, some social prescribing schemes are developed to fill gaps in services and support people with specific health needs – for example, proactive social prescribing, where link workers identify population groups who are a priority for primary care networks (PCNs) (such as services for older people with dementia), or at-risk groups (such as people experiencing homelessness or children and young people). Proactive social prescribing is a more targeted way to use link workers. We review the evidence for this in later sections.

How social prescribing happens in England: link worker model

Different models of social prescribing are used across England. One of the most common models is the link worker model (other terms such as community connector, navigator and health adviser are also used). Link workers are usually funded through the NHS and may be based in PCNs or embedded in voluntary sector organisations. Some are also funded by local authorities, charities and integrated care boards. 

 Referrals to link workers can be made through a variety of routes, such as general practice, social services, fire services, the police, job centres, and other voluntary and community services. Once a referral has been made, the link worker spends time with the individual to understand what matters to them and to co-create a personalised plan based on their needs. They then help the person to access local community support to address those needs.  

 What sort of activities are delivered?

The kinds of support that link workers can connect people to can be grouped into four areas, each covering a myriad of activities and services:  

• arts, culture and heritage, such as music, art groups and museum projects 

• physical activity 

• education and welfare support, such as employment support, financial advice and fuel poverty support (for example, National Energy Action’s work, which brings together the energy, housing and health sectors) 

• natural environment, such as gardening and nature walks. 

The activities are typically provided by VCSEF organisations, which are recognised as significant contributors to community health.  

Over the years, the scale of social prescribing has grown, with increasingly diverse funding sources, local activities and services that people can be connected to. An evaluation of the national roll-out of social prescribing in primary care between 2019 and 2023 shows a steady growth of referrals from GPs. However, the scope has also increased as well. At different times, national policies have focused on developing social prescribing for particular groups or health conditions – for example, the cross-government Green Social Prescribing national programme built on the goals of the 2019 NHS Long Term Plan. Another example is the government-funded Active travel social prescribing pilots in 11 local authorities outside of London.

Does social prescribing work?

Since social prescribing became a national movement and integrated into health and care policy, key questions have been raised about who benefits from it, which models are effective, and how the evidence generated at a local level can be scaled across wider regions. 

A growing number of case studies showing benefits to individuals

There is a growing body of evidence that social prescribing can lead to a range of positive health and wellbeing outcomes for individuals. Many studies (both qualitative and systematic reviews) show an increase in individuals’ self-esteem and an improvement in their mental and physical health, as well as people feeling more empowered to take responsibility for their health and wellbeing. Some reviews show particularly positive outcomes for people living with long-term conditions. 

On a larger scale, evaluation in 2019 by the British Red Cross community connectors national programme, which aimed to tackle social isolation and loneliness, found that overall the service had led to more significant improvements in loneliness and wellbeing for people under 60 years than those over 60. However, the same study also showed that the improvements were not universal; some groups benefited much more than others, and different people experienced different types of benefit based on life circumstances. 

In a more recent evaluation, researchers at Manchester University used general practice patient surveys from 2018 to 2023 to examine whether the roll-out of link workers through PCNs improved population health. They found that link workers had a positive impact on the experience and outcomes of those patients living with mental ill health or long-term conditions. The results also showed that an increase in social prescribing had a positive effect at a population level. However, they did not find evidence when it came to the impact on people experiencing loneliness and social isolation. Another example is the national evaluation of the Preventing and Tackling Mental Ill Health through Green Social Prescribing Project, which found that more than half of people who participated were from the most socio-economically deprived areas. It also showed statistically significant improvements to wellbeing, and a social return on investment by government.  

Evaluations with regards to the benefits of social prescribing for children and young people are discussed in a later section. 

An evidence base that needs development 

Although evidence on social prescribing (much of it positive) continues to accumulate, there remain gaps in the evidence base when it comes to patient health outcomes, including why and under what circumstances social prescribing can be optimally delivered, the value of link workers, and the cost benefits to the health and care system. 

Despite a national roll-out of social prescribing in primary care, and an increase in investment and number of schemes, there are still questions regarding its value to health and care and the benefits to patient health outcomes. Some researchers have questioned whether it is too early to judge the value of social prescribing. This is because the national roll-out, as part of the NHS comprehensive model of personalised care, coincided with changes to health and care systems (e.g the creation of integrated care systems), and the Covid-19 pandemic (many link workers who were funded through the NHS only started their role just before or after the pandemic). These events disrupted the embedding and development of link workers in primary care. 

For other researchers, there are continual longstanding issues that need to be addressed when it comes to building the evidence for social prescribing.  

First, many of the studies are small in scale and based on localised areas and schemes, making it difficult to compare across wider areas and provide definitive guidance as to what works. However, there have been attempts to improve the evidence base for the impact of social prescribing on a larger scale, such as the government-funded Green Social Prescribing Project and the Manchester University study. 

The National Academy for Social Prescribing (NASP) has also done extensive work to build the evidence base, including looking at the effectiveness of social prescribing, the impact on health service use and costs, the economic impact of social prescribing, and outcome measures. NASP is also working in partnership with University College London (UCL) to establish a National Centre for Social Prescribing Data and Analysis, with the aim of building the evidence for social prescribing and co-designing a long-term national data and analysis strategy. NASP and UCL are currently working on a project to quantify activity benefits, as well as new research on wellbeing outcomes and return on investment.  

Second, some evaluations have focused on how the schemes work and their progress rather than outcomes. In instances where outcomes are measured, there have been challenges related to variations in defining the outcomes, the criteria used to measure them, differentials in outcomes assessed, and the quality of data collected. To address these challenges, in 2020 NHS England worked with other stakeholders to develop a common outcomes framework for social prescribing to help ensure a consistent evidence base across England.  

Third, there have been criticisms about the reliance on mostly qualitative methods, including the use of self-reporting outcomes, with just a few controlled trials. This results in a lack of control groups that would better demonstrate the benefits of social prescribing in a systematic way. However, the use of control groups and randomised controlled trials to measure the benefits of social prescribing are not appropriate in all circumstances, as social prescribing can be as much about the process as a defined outcome. There can also be issues relating to the diversity of models, initiatives and the people involved, as well as contextual factors, which are difficult to control.  

There is growing evidence for the cost benefits of social prescribing to health and care – for example, NASP’s rapid review of the economic impact of social prescribing shows its social and economic benefits. Another NASP report on the impact of social prescribing on health service use and costs of nine local health systems showed reductions in GP appointments and urgent care use, especially for frequent service users.  

The current available evidence offers good reason to think that social prescribing can deliver health and wellbeing benefits for many people, including evidence for economic value. More large-scale research and data are needed to build robust evidence – and this may require a longer-term approach.  

Social prescribing and health inequalities: lessons for design and implementation 

There are increasing health inequalities in the UK, and social prescribing is often depicted as an avenue to help tackle them. Yet evidence on how social prescribing contributes to tackling health inequalities is mixed. Current evidence shows significant progress when it comes to accessibility – for example, a study from UCL showed that higher proportions of people from ethnic minorities and deprived backgrounds were supported by social prescribing compared to their population. Data from the Oxford Social Prescribing Observatory and the English Longitudinal Study of Ageing shows similar results. 

Some reviews show the potential of social prescribing for reducing health inequalities at a local level – for example, for people with socio-psychological needs from lower socio-economic backgrounds, and helping them to manage long-term conditions. A review of opportunities and challenges when it came to addressing the unmet needs of people living with long-term conditions showed that there were benefits to the individuals, especially where they had strong relationships with their link workers. 

Although there are examples of how social prescribing can help tackle some health inequalities, crucial challenges still need to be addressed. Some researchers note that there is work to be done to tackle some of the persistent inequalities in access for people living in rural areas. Others argue that the complexity of health inequalities, the methods of research, and geographical differences make it difficult to reliably judge how, and in what circumstances, social prescribing can deliver benefits. For others, there is a dependency on anecdotal qualitative evidence on the benefits of social prescribing to individuals and groups.  

In contrast, some researchers have argued that unless sufficient attention is paid to design and implementation, social prescribing initiatives can exacerbate health inequalities in access and support. Some of these inequalities can be a result of geographical differences in the number of link workers, with some PCNs in areas with high health and social care needs struggling to recruit link workers; a study comparing geographical inequalities and provision of link workers found that areas that required support had fewer link workers. The study was only focused on link workers funded by the Additional Roles Reimbursement Scheme (ARRS). 

The ability of social prescribing to address the social determinants of health and reduce health inequalities at a wider level has been challenged more critically. There is less robust evidence regarding social prescribing directly reducing health inequalities at population level. However, there are attempts to create frameworks and approaches in order to collate and demonstrate the broader impact of social prescribing on health inequalities, such as the aforementioned National Centre for Social Prescribing Data and Analysis.  

When it comes to ethnic and racial health inequalities, organisations such as the Race Equality Foundation have argued for the consistent and rigorous collection of ethnicity data to help better understand the outcomes of social prescribing on targeted groups.  

Overall, the complexity of health inequalities, and of social prescribing models and schemes, requires nuanced approaches to tackling health inequalities and demonstrating the impact of social prescribing. 

The policy development of social prescribing 

Various national policies have shaped the integration of social prescribing in primary care. The momentum for change was also accelerated by the creation of the Social Prescribing Network, which helped make the case for social prescribing as a coherent movement in England. The NHS’s 2014 Five year forward view helped lay the groundwork for social prescribing by emphasising prevention and recognising the essential role of the voluntary and community sector. Building on this, the General practice forward view in 2016 further acknowledged the contribution of the wider workforce in complementing GP services and providing community-based support, including social prescribing. 

The 2019 NHS Long Term Plan made a significant shift towards a new model of care. Comprising six programmes, including personalised care planning and personal health budgets, the model aimed to tackle fragmentation of care and enable people to take greater control of their health and care, particularly those with more complex needs. Social prescribing was a key component of the programmes. The integration of social prescribing in the Long Term Plan made England one of the first countries to integrate psychosocial activities alongside biomedical approaches, and the National Academy for Social Prescribing was established in its wake to raise the profile of social prescribing, build the evidence base, and share learning and good practice.  

More recently, the government’s 10 Year Health Plan for England endorses social prescribing as central to its aims of prevention and shifting care into the community. 

Other government departments have shown an interest in the potential of non-clinical interventions. A government report from 2023 on the progress of the strategy to tackle loneliness showed the benefits of social prescribing in tackling loneliness, and argued for more sharing of good practice, improved staff training on loneliness, and evaluation of schemes using recommended loneliness measures. The recent Keep Britain Working report highlights social prescribing as a mechanism to deliver workplace health provision to support employees to return to or stay in work.

How has social prescribing progressed since its integration in national policy?  

Social prescribing in primary care 

The increasing challenges in demographics – an ageing population, complexity of health needs, and pressures on the health and care system – have helped drive national policy changes and the adoption of social prescribing as part of broader health and care reform.  

Since its integration in health and care policy and practice, social prescribing in primary care in England has been growing. The 2019 NHS Long Term Plan marked a step change in ambition by incorporating social prescribing into its comprehensive model of personalised care. For GPs, the plan confirmed the formation of PCNs. Part of their responsibility was to expand their multidisciplinary workforce, including the recruitment of social prescribing link workers. The plan has led to a roll-out of link workers in primary care across England, funded through the Additional Roles Reimbursement Scheme (ARRS). In 2019, a five-year contract framework for general practices came into effect that allowed every PCN with a population of 30,000 or more to be reimbursed for the costs of employing a link worker (one full-time equivalent; more for PCNs with populations of more than 100,000). In 2022, it became a formal mandate for every PCN to provide social prescribing as part of its services. Even though the contract expired in 2024, it is still mandated in the Network Contract Directed Enhanced Service (DES) for PCNs for 2025/26. 

The NHS Long Term Plan also committed to funding up to 1,000 new social prescribing link workers by 2020/21, with a goal that at least 900,000 people would be referred to social prescribing by 2023/24. This target was far exceeded. In 2023, the NHS Long Term Workforce Plan projected a need for 9,000 link workers by 2036/37. As of 2023/24, there were approximately 3,600 link workers in England employed through NHS funding and mainly delivering social prescribing with adults. However, the number of link workers could be higher as social prescribing in England is now being provided by some local authorities, hospitals, and other local and regional organisations. By 2023/24, more than 1 million people had been referred to social prescribing. 

Below are some examples of social prescribing developments outside of primary care, which are not funded through ARRS but from other sources.

Social prescribing in secondary care  

The shift towards more personalised and integrated care – especially between primary and secondary care – creates an opportunity to broaden the reach of social prescribing. This is further enhanced by the NHS 10 Year Health Plan, which emphasises neighbourhood-based health, a shift from hospital-centric care to community, and preventive approaches. 

Although social prescribing is less commonly seen in secondary care, integrated care systems are gradually introducing social prescribing into adult secondary and community services with the aim of better integrating primary, secondary and community care. In 2018, the charity Family Action published a practical guide on Social Prescribing in Secondary Care. The report highlights the benefits of social prescribing for connecting care between primary and secondary care – for example, link workers can deliver social prescribing in hospital, and following discharge, they continue to work with the patients across primary and community care.  

Recent examples of social prescribing in secondary care include Barts Heart Centre’s social prescribing service within its cardiovascular prevention team, delivered in partnership with the Bromley by Bow Centre. Although the service is in its first year, an evaluation of the project showed that there were more male patients accessing their service than female patients, who often make up a significant number of patients accessing social prescribing in primary care. Other secondary care services are also trialling different models of social prescribing – for example, social prescribing for people leaving intensive care units. 

Social prescribing for children and young people 

Although most social prescribing services are adult oriented, there is a shift towards providing more social prescribing services for children and young people. Evidence shows an increasing number of children and young people in England experiencing poor mental health, with demand for mental health services outpacing capacity. Children and young people’s organisations, such as the National Children’s Bureau and Barnardo’s, consider social prescribing to be part of the solution when it comes to supporting young people’s physical and mental health and wellbeing needs.  

Social prescribing schemes for children and young people are broadly similar to those for adults. Link workers are embedded in local communities and work with statutory organisations, education and other VCSE organisations to ensure that children and young people are referred to the right services. Age-appropriate settings are central to ensuring access to and effective delivery of social prescribing. For example, in Greater Manchester, the Hyde PCN’s Healthy Hyde programme works in schools to support children and young people’s physical and mental health. Preliminary studies have shown the benefits to young people of embedding social prescribing in educational settings.  

Other pioneering social prescribing schemes developed for children and young people in health and care include a pilot at the Great North Children's Hospital, which is delivering social prescribing care for young people with a neurodisability accessing hospital care, and their families.  

Evidence for the effectiveness of social prescribing among children and young people is increasing, with studies show benefits to their mental and physical health and wellbeing, and social development. For example, emerging evidence from Barnardo’s (one of the largest voluntary sector providers of social prescribing for children and young people in England) shows some of these benefits, especially for those who live in disadvantaged areas. The National Children’s Bureau used examples from HeadStart, a UK wide social prescribing programme funded by The National Lottery Community Fund, to understand how social prescribing interventions can support children and young people experiencing poor mental health and social deprivation. The National Children’s Bureau found that the young people who consistently engaged with the programme developed their social and emotional skills and improved their mental health, confidence and resilience.  

UK-wide and international developments in social prescribing 

Social prescribing has been gaining momentum, with more countries adopting it in different forms. The model of social prescribing to provide holistic personalised care, and the learning from the English context, has seen varied implementation worldwide – mainly in middle to high- income countries.  

The delivery models vary. Some countries have social prescribing based in health and care. Others employ social prescribing roles outside of health and care – for example, community and social services in Wales and the Netherlands. A report entitled Social prescribing around the world, co-authored by the International Social Prescribing Collaborative (ISPC) founded and supported by NASP, provides a world map of social prescribing across different health and care systems. Below are some of the developments in the UK.  

Scotland

From the late 2000s to 2010, Scottish health policies such as the Better Health, Better Care Action Plan, the Equally Well Review and the Commission on the future delivery of public services highlighted the importance of person-centred care and helped build momentum for social prescribing as part of public health transformation. This saw the development of a national Community Link Workers programme, funded by the Scottish government, in which link workers were integrated into primary care and based in GP surgeries. The government also funded the creation of a national Community Link Worker Network. Another national network – the Scottish Social Prescribing Network (SSPN) – was created in 2020, bringing together different sector partners. Social prescribing is also one of the mechanisms for achieving the Scottish government’s vision for its Population Health Framework. The framework aims to create a whole-system approach to improving population health, delivering health equity, and embedding prevention in health and care. Part of that work is to develop a national social prescribing framework.  

Wales

Social prescribing is delivered through various organisations outside of health and care, such as third sector organisations, local authorities, and housing and education groups. Social prescribing has been developing in Wales, gaining national attention with the publication of the Social prescribing in Wales report and the establishment of the Wales Social Prescribing Research Network in 2018. National policies such as the Social Services and Well-being (Wales) Act, the Well-being of Future Generations (Wales) Act and A healthier Wales: long term plan for health and social care have acted as catalysts for social prescribing, while the National framework for social prescribing, established in 2023, facilitated a coherent high-quality approach to social prescribing nationally. The framework also highlights the country’s social prescribing model, commissioning and outcomes framework. 

Northern Ireland

Social prescribing is locally led and provided by a network of community organisations. There are a range of funders for social prescribing in Northern Ireland, including The National Lottery Community Fund, the Department of Agriculture, Environment and Rural Affairs, and local commissioning. The link worker model is used to support people who are referred from primary care services and community organisations. Currently, there is no standardised national social prescribing framework.  

Towards the future of social prescribing

Social prescribing is not a panacea for reducing demand on health and care services or tackling health inequalities. However, the government’s 10 Year Health Plan for England offers opportunities to develop social prescribing models that are genuinely community led – shifting power and resources into communities where the wider determinants of health actually play out. It is also a chance to invest in community infrastructure and the voluntary and community sector. The sustainability of social prescribing long term is tied to these investments – primarily small charities receiving referrals.  

The neighbourhood health guidelines published by NHS England in early 2025 ensure that link workers are included in neighbourhood multidisciplinary teams to support integrated working across sectors as part of neighbourhood health. Scaling of community health and wellbeing workers is a chance to develop social prescribing further. 

There is a drive towards using population health data to improve the health and wellbeing of specific groups. There is also the intention for integrated care boards to become stronger and more strategic commissioners for population health and reducing health inequalities. These offer opportunities for social prescribing as part of the core social infrastructure that supports people with their health and independence. They also contribute to building a stronger and more complete evidence base. 

The development of digital technologies will continue to help shape how care is delivered with the goal of improving health outcomes. Looking ahead, developments in digital technologies provide an opportunity to think about how social prescribing services can be enhanced through digital tools. Currently, some social prescribing services are piloting apps to help support individuals in need – for example, in East Staffordshire. In addition to NHS-supported systems, various private companies are developing digital platforms that are being widely used by VCSE organisations and other sectors beyond primary care. These platforms offer data that makes it easier to assess social prescribing models, highlight disparities in access, and inform outcomes analysis. 

But there are challenges, too, including whether a shift to digital first could remove some of the power of social prescribing in terms of human connection, and how well people will be able to distinguish reliable, evidence-based apps from unsafe ones.

The 10 Year Health Plan and its focus on harnessing digital technologies, including use of the NHS App – which the government sees as acting as a digital social prescriber – is a mechanism for thinking through effective ways of using digital tools in social prescribing. Despite its promise, digital social prescribing faces barriers such as digital exclusion, lack of infrastructure, and limited evidence on long-term impact. Additionally, the use of apps misses the human connection and the ‘what matters to you conversation’ that a link worker has with the individual in need.

Current and future structural changes – for example, the dissolution of NHS England and its merger into the Department of Health and Social Care – could disrupt the national leadership, voice and strategic support for social prescribing. The work of NASP and its role in creating and disseminating evidence and championing social prescribing remains important for ongoing stability. The earlier dissolution of Public Health England also removed a cadre of leaders committed to wider community approaches to health, of which social prescribing is part. Although social prescribing is embedded in the GP DES contract and in neighbourhood health guidelines, there could be unintended consequences of other policies. For example, there is no guarantee that the central funding for link workers (available through the ARRS scheme) will last forever and whether priority for those posts will be maintained, which is especially concerning for those areas with high socio-economic need. This could call into question the sustainability of social prescribing as it is currently delivered, as well as achieving health outcomes for people. 

As social prescribing continues to grow, extending beyond primary care in the NHS and globally, it is important that it is done in a way that pays careful attention to learning and evidence building. Practice and policy kick-started in England has gained momentum across the rest of the UK and internationally. As with all good ideas, imitation and development are the sincerest form of flattery. England now needs to learn as much from others as from its own experience.