What is social prescribing success, what makes an impactful social prescribing service?
Social prescribing can mean many things. Typically it is defined as a range of non-medical support to address needs related to socioeconomic and psychosocial issues, also referred to as the social determinants of health (NASP; University of Westminster 2017).
In this toolkit, evaluation guidance typically focuses on a Social Prescribing Link Worker model, which refers people onto support in the community, as this is the most common mode of action in the UK and is the model endorsed by the NHS.
You can read more about what makes a social prescribing scheme here, and find out about the role here.
Because social prescribing is multifaceted, its impact is multifaceted. Each stakeholder places importance on different impacts. The next section in this toolkit goes into greater detail on some of the reasons why evaluating the impact of social prescribing is important for different stakeholder groups.
“It is critical that a shared understanding of the aim of any evaluation of a social prescribing scheme is agreed by holding multi-stakeholder meetings at the start of a programme.” (University of Westminster, 2017)
This word cloud shows a summary of descriptions of social prescribing (image taken from the Social Prescribing Network Conference in 2016):
Katie Coleman (Primary care clinical lead, NCL ICB, Clinical lead, TPHC, GP in Islington) said: “The service identifies gaps in community based activities and feeds this information back to the PCN CD and local funders.”
A review of meaningful outcomes for social prescribing includes the below impacts at the patient level (Polley et al., 2020)
- Patient
- Health
- Wellbeing and mental health
- Social determinants of health
However, social prescribing is wider, as it involves multi agency working, with different communities, strengthening existing assets. It is also able to influence health care system pressures by dealing with the causes of the causes (Marmot) and preventing ill health.
Community impacts are often harder to measure and focus on qualitative data such as interviews, focus groups, or community meetings
- Community
- Social connectedness
- Community assets
- Social return on investment
- Partnership working and connectedness between services
Health care system impacts are commonly used to inform commissioning decisions about services and understand potential cost savings.
- Health care system
- Reduced demand – in terms of contacts, appointments and admissions
- Cost savings through reduced demand, length of stay, adherence to medical treatment
The table below details outcomes described by social prescribing stakeholders, gathered by the Social Prescribing Network. 180 people contributed to developing this (Social Prescribing Conference Report, 2016).
There are no nationally set goals by NHS England around the outcomes for social prescribing.
Previously there was a target of referrals according to the population size. This was that 0.8-1.2% (IIF Guidance, 2022/23) of the population was receiving social prescribing. This was designed to support the NHS Long Term Plan ambition for social prescribing to reach over 900,000 people by 2023/24 (NHS Long Term Plan, 2019).
The goal for workforce numbers was for each PCN to have at least one social prescribing link worker; this was a mandatory requirement in the PCN DES Specification (Network Contract DES 2022/23).
Current workforce targets in the NHS Long Term Workforce Delivery Plan are to “increase from over 3,000 current posts (September 2022) to 9,000 by 2036/37” (NHS Long Term Workforce Delivery Plan, 2023, pg 98).
With a lack of targets around quality and impact of social prescribing, there is increasing importance to support health care and social prescribing services to define what ‘good’ looks like for them, to measure impact, improve and gain investment.
What good social prescribing means to different people
To one person, successful social prescribing may mean a multitude of things, this is because social prescribing is more of an approach to health rather than a care pathway that targets one outcome.
What people from around the system see as a successful SP service:
Katie Coleman, Primary care clinical lead, NCL ICB, Clinical lead, TPHC, GP in Islington said:
“People are supported to address the issues that are important to them”
“People are supported by the SPLW to access services if they feel insecure doing this independently”
“The service undertakes evaluation of its services on an annual basis so it can identify approaches that are successful or could be strengthened”
Kalwant Sahota, Personalised Care Lead NWL ICB said:
A service that:
- “Meets the needs of the local community that are at most risk of health inequalities
- Is well connected to their local community assets
- Can clearly show their value and outcomes
- Has happy staff who have excellent job satisfaction, and their wellbeing needs are met”
Seher Kayikci, Public Health Consultant, Social Prescribing Commissioner in Barnet said:
A service that is:
- “Well-embedded into PCNs and BAU for GPs and extended practice teams
- Able to join as a partner into MDTs and placed-based interventions
- Well-connected into the community and good links with local services and organisations
- Improving outcomes for individuals and helping people to become independent through connecting to local activities
- Contributing to reducing pressures on the system e.g. reducing GP appointments for those who have used the service”
Stephanie McKinley, London Social Prescribing Programmes Manager, London Plus said:
“A successful social prescribing service has the following elements and understanding:
- A social prescribing service is only as good as the activities that can be referred into it. These activities need to be fully funded and sustainable in the voluntary sector
- The link worker is given space and time to leave the office and form relationships to find out local assets are in their area
- The link worker understands which voluntary sector organisations can meet clients with complex needs and which can’t, otherwise the clients end up being bounced between services and the organisation risks using its valuable resources on someone it can’t help
- There is sharing of data between the SP service and the organisations it works with to understand what is working well and what isn’t about their referrals
- There is an easy and accessible referral process for voluntary sector organisations to engage the link worker with their service for potential clients.”
