Social prescribing describes the process by which health-care seekers are provided non-medical interventions that seek to treat their health-care query. Social prescribing is the formalised process by which primary care physicians either directly or indirectly link primary care patients with non-medical interventions which aim to reduce the burden of health-care concerns. Primary care physicians can refer patients to a variety of activities, such as art classes for wellbeing, knitting, singing, or walking groups. To address health-care needs across the spectrum of society, health-care systems must be efficient in providing individuals with the most appropriate care.
Social determinants such as poverty, isolation, and ethnicity play roles in determining health-care outcomes. Studies have shown the role that various social interventions have on wellbeing and subsequent health-care use. For instance, singing interventions can play positive roles in post-natal depression and museum attendance is associated with positive outcomes in those with dementia. Crucially these interventions are used to support conditions which might be medication resistant or to support and enhance outcomes in medical interventions. Determining patients likely to benefit from social prescriptions are therefore the responsibility of primary care physicians. Typically, aging individuals or those with long-term mental, complex, or multiple medical conditions would benefit from social prescription interventions. The term social prescription is most widely used in the UK, but this process occurs globally under less formal terms. In the USA, social prescription is referred to under the umbrella term ‘social determinants of health care’ whereas WHO have over the last decade commissioned reviews into the role that social interventions can play in improving health-care outcomes.
In the UK, social prescription is considered a key component of the National Health Service (NHS) as part of its aims for the 2023–24, namely the Universal Personalised Care project (UPC). UPC aims to allow individuals to have more personalised access to health-care resources to address medical, mental, and social aspects of their health. In practice, general practitioners (GPs) identify individuals who might benefit from social prescription at the point of primary care interaction and work alongside specialised social prescribing link workers who directly link patients with appropriate social interventions.
Whilst there are data to link social interventions with improved health-care outcomes in individuals, real world case studies on the role these initiatives can have at a societal level and the potential economic benefits are scarce. The Rotherham social prescribing pilot conducted over 2 years, between April 2012 and March 2014, looked at the potential effects of a social prescription intervention in a metropolitan borough with a population of over 100 000 people. The Rotherham pilot funded 24 community organisations to provided 31 consistent and reliable social prescribing services. 1607 patients were referred to the services of which the most common services were information and advice, community activity, physical activities, befriending and enabling (mentoring). In terms of demographics, over 87% of the participants were older than 60 years and 61% of the participants were female. The pilot looked at wellbeing, economic burden, and health-care use as outcomes. After 3–4 months, 83% of patients had experienced improved wellbeing as determined by a number of validated outcome measures. Inpatient admission reduced by as much as 21%, accident and emergency attendances decreased by as much as 20% and outpatient appointments reduced by as much as 21%. As a result, the investigators estimated cost reductions to the NHS of £552 000, representing a return of £0•50 for every £1 spent over the 2 years of the pilot. The investigators further projected that the return on investment would increase every year the project remained in operation due to a reduction in the burden of long-term illnesses. This real-world pilot showed the potential that social prescribing can play in improving the health of a population with positive economic returns.
Social prescribing initiatives, however, face several challenges. The Open Data Institute published their November 2021 report: “The role of data in unlocking the potential of social prescribing”. The report refers to post-COVID-19 increases in GP waiting times and increased work burden and estimates diversion of GP workload by as much as 2–5% as a result of social prescribing, which could free up 3•2–8 million GP appointments a year in the UK. The report focuses on the current lack of infrastructure in place in the NHS to fully address the demand for social prescriptions across the UK. Specifically, easily accessible and up to date data on local activities, patients requiring specific resources, utilisation of local services and patient satisfaction are highlighted as gaps in the current infrastructure. The ODI report raises concerns on the Information Technology (IT) infrastructure and closed nature of current data utilised in social prescribing efforts. There is a clear need for better IT integration of these external services for social prescription and the primary health-care providers.
In addition, COVID-19 continues to provide a major challenge for the development of social prescribing as many of the services directly rely on in person activities. This presents a specific issue for individuals who might benefit most from these services but who must shield, or during periods of extended lockdown. Primary care practitioners using social prescription have adapted to take advantage of phone and internet activities and the expertise of nurses and health-care assistants in linking patients with appropriate available services.
To equitably create positive health-care outcomes, health-care systems must act beyond the traditional approach of only linking illness to medical interventions. Providing better social prescribing infrastructure, resources, and data can support and empower primary care practitioners and clinicians to provide more holistic interventions to patients. As societies in high-income countries face ageing populations and greater regional inequality in health-care outcomes, social prescribing can have a central role in delivering better health care for all. As we move into 2022 and into the third year of the ongoing COVID-19 pandemic it has never been more important to consider the role health care should play in addressing all aspects of societal wellbeing.