Has social prescribing come of age?

On 6 November 2018 the King’s Fund, a health and social care think tank in the UK, hosted Social Prescribing: Coming of Age. Social prescribing is a way of supporting people’s health and wellbeing through non-clinical interventions, from yoga through to dance classes and gardening. In recent years, it has gained increasing traction in the UK. This is set to increase significantly following the publication of the recent UK government strategy on tackling loneliness, which commits to achieving universal access to social prescribing by 2023.

The conference looked at how social prescribing has come of age in the UK and what comes next. We argue that whilst there is a positive reception, social prescribing must be underpinned by evidence to ensure it is a sustainable and useful tool. Here are our three take away points.

The King’s Fund conference brought together over 400 representatives from the public sector, academia, the NHS and voluntary organisations. Among attendees, consensus seemed almost universal on the potential of using social prescribing to address patient recovery, health inequalities, silos between general practice and community care, and easing demand on NHS services. According to James Anderson, Director of Personalised Care at NHS England, 68,977 referrals to social prescribing were made in the UK in 2017-2018. Half of Clinical Commissioning Groups, which organise the delivery of NHS services in England, are investing in social prescribing services.

Presentations from GPs highlighted the added value social prescribing can bring to patients. They also emphasised the need for an expansion of services to secondary care, simple reporting, and more sustainable funding. Service users shared stories of how they felt validated and empowered, and were keen to support social prescribing. The UK Secretary of State for Health and Social Care, Matt Hancock, highlighted in his conference speech a strong belief in the link between wellbeing and the arts. There he announced new initiatives to connect local libraries to primary care and social care services, as implemented in Norfolk, and to use music to assist people with dementia, as pioneered by Playlist for Life.

Mayor of London Sadiq Khan is also a supporter, as are other MPs across the country. Further plans presented at the conference included: to incorporate social prescribing through greater support to link workers, increased welfare and legal advice, a move towards digital platforms, and more evaluation. Medical students, under the NHS England Social Prescribing Student Champion Scheme, even suggest marking 14 March 2019 on calendars for the first National Social Prescribing Day.

Accreditation and coordination for professionals leading on social prescribing activities is key to an effective national roll out by 2023. NHS England is developing a Common Outcomes Framework for socially prescribed interventions, while the Social Prescribing Network are connecting professionals and creating a shared community of practice. However, research suggests that in some cases social prescriptions are not evidence based. This means that the impact of a socially prescribed activity on health and wellbeing is not known. Without knowing a prescription's expected impact, it is hard to evaluate the effectiveness of the social prescribing link mechanism. This is because the impact of the existence of a link mechanism cannot be separated from the impact of a prescribed activity. Only the combined impact of the link mechanism and social prescription can be evaluated and improved.  Better links could lead to better outcomes overall. This makes the case for implementing clear training and practice guidelines.

At present, the UK government’s cross-departmental strategy to tackle loneliness calls for regional steering groups, best practice guidance and improved online resources. The UK Secretary of State for Health and Social Care, Matt Hancock, stated in his conference speech that there will soon be a National Academy for Social Prescribing. These activities may address gaps in guidance. One such gap is that the National Institute for Health and Care Excellence (NICE) has no guidelines on social prescribing. We argue that there is a need for an accredited framework or guidelines, which will facilitate training of staff and support implementation for social prescribing programmes. This will then build understanding on evidence based practices around social prescribing.

The evidence base for social prescribing is expanding, but proving an impact is key to it being a sustainable policy tool. Recent evidence reviews, across several themes, highlight the challenge of clearly showing that social prescribing leads to positive and replicable results (listed below). Discussions at Social Prescribing: Coming of Age highlighted that building consensus on outcomes tracking and data sharing remains an iterative process. There is also ongoing debate over the balance between focusing on quantitative data collection (especially through randomised controlled trials) and longer-term, qualitative stories of impact on patients’ lives. 

Social prescribing evidence reviews: 

• Bickerdike et al (2017) - Social prescribing: less rhetoric and more reality. A systematic review of the evidence. 
• Gottlieb et al (2017) - A Systematic Review of Interventions on Patients’ Social and Economic Needs. 
• Pescheny et al (2018)- Facilitators and barriers of implementing and delivering social prescribing services: a systematic review.
• Polley et al (2017) - A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications. 
• Rempel et al (2017) - Preparing the prescription: a review of the aim and measurement of social referral programmes.
• Wilson and Booth (2015) - Evidence to inform the commissioning of social prescribing.

Based on current policies, it is fair to expect that the evidence base for social prescribing will improve and supporters will continue to campaign. However, challenges to funding could put at risk the voluntary, community and social enterprise-led activities that support social prescriptions. Social prescribing cannot be decoupled from austerity measures or a lack of response to calls to better fund public health interventions. Nor can it be separated from the lack of evidence on the cost-effectiveness of social prescribing. This evidence could improve understanding of how to maximise the value of available funding for social prescribing. It can ensure social prescribing is a sustainable and impactful way to support peoples’ wellbeing.  Without better information, it is harder to assume that social prescribing has a sustainable future.  

Discussions and presentations at Social Prescribing: Coming of Age outlined clear aims to improve how people access support and care in the UK. Achieving universal access to social prescribing in the UK by 2023 will involve at least some innovation in areas where social prescribing is new. There are already efforts, either in planning or underway, that will support this innovation. We support accredited guidance and improved evidence on cost-effectiveness, as well as impact, to ensure that expansions are sustainable and that expected benefits are clear. This will allow social prescribing to truly come of age, as a reliable tool to improve health and wellbeing for the people who support, provide and receive social prescriptions.