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We need less rhetoric and more reality on social prescribing

It is unacceptable to keep promoting social prescribing schemes on the basis of current evidence, argues Paul Wilson

Social prescribing is being widely promoted and as a way of making general practice more sustainable. The Kings Fund have claimed that there is emerging evidence that social prescribing can lead to a range of positive health and well-being outcomes,[1] and social prescribing schemes feature in many of the New Care Models and Sustainability and Transformation plans or STPs currently being rolled out across the country.

Social prescribing provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and well-being. Schemes commonly refer patients to a link worker who then works with the person to co-design a nonclinical social prescription to services, usually provided by the voluntary and community sector. The types of activities offered as part of a social prescribing service can aim to help address the psychological problems and low levels of well-being often manifest in frequent attenders in general practice. By addressing these, it is often hoped that there will be a positive impact on frequency of GP attendance.

So does it work?

Building on previous work that aimed to help CCGs make better use of evidence obtained from research in their commissioning decisions and supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care in Greater Manchester, we looked at the evidence for social prescribing programmes.[2]

Overall, we identified 15 evaluations conducted in the UK but no convincing evidence for either effectiveness or value for money. Most of the evaluations were small scale and limited by poor design, conduct and reporting. Missing information made it difficult to assess who received what, for what duration, with what effect and at what cost. Since completing our review, we have unearthed another two evaluations that also share the same limitations.

Despite significant methodological shortcomings and a limited evidence base with a high risk of bias, most evaluations present positive conclusions generating a momentum for social prescribing that really isn’t warranted.

Why is evaluation important?

The reality of the evidence base for social prescribing is it is a mess. As such, we are not yet able to reliably judge which, if any, social prescribing programmes are worth pursuing further and or what the added value may be to existing services. Indeed, it could be argued that as the evidence base is so poor, no evaluation would be better, as at least then we would remain certain of our uncertainties.

In the current financially constrained climate this is unacceptable. New ideas and ways of working are not without cost or consequences. They compete with existing services for finite resources. Determining whether new services can deliver gains in health benefits over and above those from existing services is therefore crucial.

If social prescribing is to realise its potential then the evidence base needs to be improved. We need less rhetoric and more reality.

Paul Wilson is Senior Research Fellow at the Alliance Manchester Business School and National institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLARHC) Greater Manchester.

Reference

1. King’s Fund. What is social prescribing? 2 February 2017. https://www.kingsfund.org.uk/topics/primary-and-community-care/social-prescribing

2. Bickerdike L, Booth A, Wilson PM, Farley K, Wright K. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017; 7(4):e013384. http://bmjopen.bmj.com/content/7/4/e013384

 

 

 

Readers' comments (6)

  • Just as a cancer patient might cling to some hope in Alternative Medicine to do what conventional medicine cannot, or without risks, so I wonder if Healthcare Planners are doing the same with Social Prescribing. There may not be good evidence in its favour, but neither is there good avidence against it, so in the desperation of a cash- and resource-starved NHS, let's try something new that MIGHT be cheaper, MIGHT be effective, MIGHT be more accessible to communities... Remember we are living in the post-truth era, where statistical evidence has little bearing on policy choice

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  • Should we invest in.........

    a- General Practice (proven benefit, cost effective), or....

    b- Social Prescrbing (unproven, expensive, but high public popularity)

    Easy choice. Now, let's dump the SP referral forms (and clinical responsibility) on the GPs.

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  • We have social prescribing available Gloucestershire, and it reduces my workload.

    1. reception staff can divert people to the social prescriber if they contact the surgery for non-medical issues.

    2. The patient asking for a housing letter, or who keeps coming back about the same thing which has no medical cause can be referred to social prescriber.

    This really does genuinely reduce my workload - and given the huge increases in everything else, I am very grateful to the social prescriber. It's a bit like referring people to the citizens advice bureau in days of old, except that the social prescriber covers a much wider range of services, and you don't have to wait 12 weeks for an appointment.

    And they collect data on patient satisfaction (which is always high), but not on doctor satisfaction (which is possibly higher!). It is the "heartsink" patients they are best with - particularly the ones whose problems are not medical.

    Absence of evidence is not the same as evidence of absence. I am all in favour of evidence based use of money, but could we please try to get a decent evidence base before throwing out the baby with the bathwater..!

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  • Excellently put proud cardigan
    Evidence means studies,and studies are based on the nul hypothesis.
    But the nul hypothesis does not exist in the demand led component of general practice,which is why we give so many unnecessary antibiotics etc
    A truly harmless placebo should not be criticised

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  • Is the issue here rhetoric in the absence of good supporting figures? Or is it the incorrect application of quantitative data collection techniques and an insistence on the need to satisfy our (as GPs) agenda? Signposting services are intended to make qualitative, non medical improvements to people's lives and communities. Whereas GP Practices are well-placed as a community hub to direct towards information, we should not be deluded in thinking they are there to help the practice directly. We, as healthcare workers, are just another factor in the complex network determining the health and welfare of the communities we strive to benefit, and Social Signposting (not Prescribing!) could be a useful complimentary support service.

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  • Social prescribing is a phenomenally expensive waste of resources which could be used to support traditional general practice -- except the government and NHSE/CCGs are hell bent on destroying the independent practitioner model of general practice. Why not get the organisations to which the social prescribers signpost to up their game and actually let patients know they exist -- too scared of the demand on their services that might result ?

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