Source: BMJ Journals 31/10/2022
Social prescribing is a way of linking people with complex needs to non-medical supports in the community. There are different models of social prescribing, ranging from online signposting services to individual support from a link worker to access community resource. The link worker model of social prescribing is most frequently used in the UK.1 Link workers are non-health or social care professionals, usually based in primary care or community organisations, who determine the health and well-being needs of people referred to them (usually by healthcare professionals), co-produce a health and well-being plan, and provide support to connect with community resources to meet these needs. No qualifications are specified for link workers, rather there is a focus on relevant experience and skills, such as listening and empathising, to perform the role.2 Many health systems are developing social prescribing initiatives and NHS England is funding link workers in primary care and recommends their use for people who have one or more chronic conditions, need support with their mental health, are isolated or who have complex social problems.3
People experiencing multimorbidity (defined as two or more chronic health conditions) experience fragmented care, poorer health outcomes and more psychological stress, and as multimorbidity becomes the norm among an ageing population, it poses a significant challenge to health systems.4 People with complex multimorbidity account for a higher proportion of hospital admissions and therefore costs, and have higher consultation rates than those without.5 In socially deprived areas, the impact is greater as people experience earlier onset of multimorbidity and are more likely to have mental health comorbidities.6 A 2021 systematic review of interventions targeting people with multimorbidity in primary care identified 16 randomised controlled trials (RCTs) but found limited evidence for interventions that improve outcomes including health-related quality of life (HRQoL) and mental health outcomes.7 The review did not identify any eligible social prescribing link worker interventions but concluded that existing evidence suggests that future research should target a range of areas including patient health behaviours that can be addressed though social prescribing.
Social prescribing link workers may have an impact on health outcomes for people experiencing multimorbidity, particularly in areas of social deprivation, but despite their widespread roll out in the UK, there is limited evidence for their effectiveness.8 If effective, social prescribing link workers should reduce healthcare costs, by addressing the social problems that reportedly drive 20% of primary care attendances and the social determinants of health that lead to poorer outcomes.9 A recent systematic review, however, concluded that there was a lack of evidence for how, for whom and when social prescribing was effective or how much it cost.10 Previous reviews have only looked at UK-based interventions and included a broad range of studies including those with uncontrolled designs.11 12 Social prescribing is, however, gaining momentum internationally, and while interventions are adapted to the local context, there are similarities and potential to learn from experiences in other countries.13 We aimed to systematically review the evidence of effectiveness and costs of social prescribing link worker interventions internationally and to establish the evidence, if any, for their effectiveness in people with multimorbidity and social deprivation.
BMJ - Link_Worker_social_prescribing.pdf
commissioning_social_prescribing_services_-_report_-_bbbc_2019 - useful for co-commissioning info.pdf
SP Realist Evaluation.pdf
What approaches to social prescribing work, for whom, and in what circumstances. A protocol for a realist review.pdf
Social prescribing less rhetoric and more reality.pdf