What are we trying to do?

Social prescribing, sometimes known as community referral, is where doctors and nurses work with someone called a 'link worker' to help patients find services from local, voluntary and community groups to improve their health and wellbeing. Link workers have been introduced by the NHS across the UK. Link workers support people with emotional and practical needs by considering all aspects of their lives, not just their medical needs. Their role is to help connect people to information, advice, activities and other services provided by a range of voluntary and community groups. 

 

We have been using a multi-regional approach to map provision and service configuration of social prescribing and to assess whether access, engagement and outcomes vary by delivery model, geography and population characteristics over time. By doing this, we've been finding out how link worker services operate, how well they work, who does and doesn't use them, whether they are of benefit to people and are a good use of NHS resources. 

 

 

Why is it important?

Social prescribing links patients in primary care with sources of support within the community. Previous research on social prescribing has evaluated the effects of individual services, usually in isolation from the wider health system in which they are situated. It is well documented that this evidence base is of a low standard and is subject to a high risk of bias. A lot of the existing evidence is taken from small scale studies that are limited by poor design and reporting, making it difficult to reliably judge how, and in what circumstances, social prescribing could deliver benefits. 

 

There are few rigorous evaluations, and those that are rigorous have failed to demonstrate improved health and wellbeing for service users. They do suggest that finding ways to improve access and engagement with services may lead to better overall outcomes.

 

We know that engagement in community assets can improve health and wellbeing. However, we don't know how people become engaged with community assets and if the link worker model will encourage engagement and/or enhance access and equity

 

With national policy implementation underway across the UK, there is a need to understand the impact of social prescribing link worker services and how they can be developed in the future.

 

How are we doing it?

Over the three year research award, running from 2022 to 2025, we've been using a multi-region mixed methods approach to map provision and service configuration and to assess whether access, engagement and outcomes vary by delivery model, geography and population characteristics over time. Our approach can be broken down into six areas of focus:

 

• WP 1: Implementation - to establish the key features and variations in delivery models for link worker social prescribing services within and between each region.
• WP 2: Access and equity - to assess inequalities in access, uptake and engagement based on area-level and population characteristics (age, gender, ethnicity, area deprivation, availability of community assets, and rurality).
• WP 3: Experience and acceptability - to understand experience and acceptability of the referral process, the therapeutic encounter and the process of accessing and engaging with social prescribing services from a range of perspectives.
• WP 4: Health and wellbeing and service outcomes - to assess health and wellbeing and service outcomes, and whether outcomes vary within and between services delivered and by population characteristics (age, gender, ethnicity, area deprivation, availability of community assets, and rurality).
• WP 5: Economic sustainability - to explore the value and economic sustainability of link workers in primary care
• WP 6: Dissemination and knowledge mobilisation - to ensure relevance to policy need and to maximise the impact and use of findings in decision-making processes as they occur.

 

 

Early findings

In the paper ‘Geographic inequalities in need and provision of social prescribing link workers a retrospective study in primary care’ findings show that:

 

• In April 2020, there were an average of 0.093 FTE link workers within each PCN across England, increasing to 1.289 FTE by the end of 2021/22, and to 2.198 by Q3 of 2023/24.
• Populations in urban, more deprived areas and with higher proportions of people from minority ethnic groups had the highest reported lack of support. Geographically these were in the North West and London. 
• Initially, there was no association between need and provision. Then, from July 2022, the association became negative and significant. By October 2023, places with a 10% higher need for support were associated with a 0.035 lower FTE per 10 000 patients.
• Overall, findings showed that the rollout of link workers has not been sufficiently targeted at areas with the highest need and that future deployments should be targeted at those areas.

 

The following map of England shows employment of FTE link workers per 10,000 patients across integrated care boards (ICB), with darker outlines indicating the NHS regions. We show from March 2020 there are low employment levels of FTE link workers. Across all ICBs this increases, with the South West employing link workers at an increased rate compared to other regions of England. The North East and North Cumbria ICB have the highest number of link workers per 10,000 patients as of March 2023, with ICBs within the Midlands approaching those levels. However, there are distinct areas that are not fulfilling the NHS aims of link worker employment; those include the London region as a whole, Humber and Yorkshire ICBs and parts of the East of England.

 

  

 

More findings will be added as they become available. 

 

 

The research team:

• Paul Wilson (Principle Investigator, WP1 & WP6 Lead)
• Dr. Luke Munford (Co-applicant, WP2 Lead & WP4 Co-lead)
• Prof. Matt Sutton (Co-applicant & WP5 Lead)
• Prof. Caroline Sanders (Co-applicant & WP3 Co-lead)
• Prof. John Wildman (Co-applicant & WP4 Co-lead)
• Prof. Kate O'Donnell (Co-applicant & WP3 Co-lead)
• Prof. Sally Wyke (Co-applicant & WP3 Co-lead)
• Prof. Stewart Mercer (Co-applicant)
• Prof. Chris Salisbury (Co-applicant)
• Dr. Hugh McLeod (Co-applicant)
• Prof. Eileen Kaner (Co-applicant)
• Charlotte Leonhardsen (Co-applicant)
• Claire Stevens (Co-applicant)
• Hugh Evans (Co-applicant) 
• Liam Gilfellon (Co-applicant)

 

Who we are working with:

• NIHR Applied Research Collaboration North East and North Cumbria
• NIHR Applied Research Collaboration West
• NHS Greater Glasgow and Clyde
• NHS Lothian
• NHS Greater Manchester Integrated Care
• University of Glasgow
• University of Edinburgh
• Voluntary Health Scotland
• Bristol City Council
• Mental Health Concern

 

 

Downloable resources:

 

Funding information: 

This study/project is funded by the National Institute for Health and Care Research (NIHR) Health Service and Delivery Research Programme (HS&DR), NIHR134066. 

 

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. 

 

 

Contact:

 

 

Senior Programme Lead

 

Mike Spence

mike.spence@healthinnovationmanchester.com