Social Prescribing works, now let’s prove it

Social Prescribing works, now let’s prove it

01 Jun 2023

This week there has been some negative coverage in national press about the evidence for the effectiveness of social prescribing. The Daily Mail led with the headline ‘scant evidence that social prescribing works[1]’ and the Guardian reported[2] ‘recent research raised serious doubts about its effectiveness’, both quoting a systemic review published in the BMJ.

This review completed by academics from the ‘RCSI University of Medicine and Health Sciences’ concludes; ‘There is an absence of evidence for social prescribing link workers. Policymakers should note this and support evaluation of current programmes before mainstreaming.’

Let’s look at this review to understand the true picture.

Social prescribing is a movement to address the social and environmental factors impacting on a person’s health; providing personalised support, via a Link Worker, to help people identify what matters to them, and empower them with skills, resources and local community groups to take control of their health and wellbeing. It is holistic, addressing a wide range of conditions and issues, and personalised to the needs and strengths of the individual. Since 2019, it has been specified and resourced by the NHS as part of primary care; with plans for one Link Worker for every 10,000 people.

Therefore, prior to 2019, there was very limited investment, guidance, consistency and agreement on what constitutes social prescribing, how it should be delivered and the outcomes it aims to achieve. A wide and diverse range of initiatives have used the generic term to mean non-clinical interventions to improve wellbeing, from books on prescription to walking groups. Only with the formal introduction of a definition, a model, guidance[3], Link Worker competencies, training and an outcomes measure in 2019 did social prescribing as an NHS intervention begin to exist. Even so, without formal regulation or a specific qualification for Link Workers, social prescribing is still in its infancy as an integrated part of NHS care in England.

So, what evidence is being considered in this review? Only evidence which meets the academic, clinical criteria; ‘This systematic review only included randomised trials and controlled before–after studies’. However, no randomised control studies have been conducted on social prescribing since it was included as part of NHS care. Therefore the review only included historic studies of schemes that the researchers determined as ‘social prescribing’ of which there are four in England, from 1992, 2000, 2011 and 2017.

Unsurprisingly, such studies generated little evidence of system level benefits such as impacts on primary care capacity. This ‘absence of evidence’ is wrongly being reported as evidence of ineffectiveness[4] rather than recognising no appropriate research has indeed been completed.

Research undertaken by the University of Kent on Involve’s NHS social prescribing is academically robust and independent[5]. It shows significant impact and benefits to patients and the NHS; ‘Overall, findings suggest those who engage with social prescribing report benefits across a range of psychosocial, physical and mental health outcomes.’ NHS data proves this; there was a 12% reduction in GP appointments for the cohort studied.

I would urge the National Institute for Health Research and other academic bodies to invest urgently in a randomised control trial for NHS social prescribing in England. Without this level of evidence, academics and clinicians wedded to the medical model will continue to challenge the concept and value. This disrupts effective implementation and risks the future sustainability of this important and transformative initiative which is already changing lives for the better.

[1] [2] [3] [4] [5]