Around one in five general practitioner (GP) visits are for non-medical problems, such as loneliness or financial difficulty. However, these non-medical problems are known to have a big impact on patients’ health and well-being.
GPs are aware of this and want to take a more holistic approach to care, but often are not sure how to do it. This has led to the development of 'social prescribing', where GPs 'prescribe' social activities or support for people with the help of a link worker.
The link worker is someone who knows a community well, is an excellent listener and is skilled in supporting people to make changes. They meet with people referred for social prescribing, talk about what matters to them and make a personal plan – the 'social prescription'.
This might include joining community groups, support to return to work or education, accessing mental health supports or lifestyle changes, like doing more exercise. The link worker then helps people to join groups or just keeps in touch and encourages people to do the things on their prescription. The length and type of link worker support are tailored to the needs of each person.
These social prescribing (also called 'community support') programmes are being rolled out in many countries, including the UK, Ireland, Australia and the US. Policymakers hope that social prescribing can not only deliver improved health and well-being, but can reduce health inequalities and save money by diverting people to more appropriate care in the community. My colleagues and I set out to see what evidence there was for this and found mixed results – although we acknowledge that proving the effectiveness of these types of programmes is difficult. Our results are published in BMJ Open.
We searched all the medical studies, websites and reports from social prescribing projects. We were looking for studies that compared a group of people who met a social prescribing link worker to a group that didn’t, (known as controlled trials – a high standard of clinical trial) and synthesised the evidence in a 'systematic review'.
We summarised all the studies, in particular, to see if they had measured quality of life or mental health, and if they had included people from disadvantaged areas or with several health conditions, as often social prescribing programmes focus on these groups.
We found eight studies in total. Three were published in the US and five were published in the UK.
The length of time people could meet the link worker varied. Most of the studies were quite short (less than six months) and people only met the link worker a couple of times. Because there was so much variation in the studies, it was hard to find consistent evidence that link workers made a difference to patients’ quality of life, mental health, social contacts, physical activity or primary healthcare use.
Three US and one Scottish study included people from disadvantaged areas, who also had more than one health condition. Two of the US studies had longer and more intensive programmes where the link workers met people weekly for six months and worked closely within the healthcare system. These two studies found that people reported higher quality care and there were also cost savings because of fewer days in hospital.
The third US study found a reduction in emergency department attendance, but an increase in primary care visits. The Scottish study found that people who met the link worker three or more times had improvements in quality of life, mental health and exercise.
Overall, evaluating social-prescribing link workers in this way would appear to show limited benefits, but this only gives a partial picture. Social prescribing is designed to be different depending on the needs of the person and the resources in the local area, so determining if it works or doesn’t work on a larger scale is difficult. This evaluation approach is also very health-focused and social prescribing is likely to have wider benefits for communities and society.
What our findings do suggest is that longer, more intense support from link workers working closely with healthcare providers probably benefits people with complex needs, such as those who live in disadvantaged areas and with several health conditions.
At the moment, there are very few link workers per head of population. In Ireland, for example, a national social prescribing system is being introduced that will have one link worker for every 50,000 people. To see changes in health inequalities and cost savings, our review suggests that there needs to be a focus on intense support for a smaller number of people or an expansion of the availability of link workers. Either way, it is important to keep learning about how social prescribing works best so the potential benefits can be realised.
- Bridget Kiely Clinical Research Fellow, RCSI University of Medicine and Health Sciences
- Susan Smith, Professor of General Practice, Trinity College Dublin
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