Social prescribing can be a breath of fresh air for GPs
Letter from the Social Prescribing Network Steering Group
We wish to respond to your report 'GP Social Prescribing Drive is “Unacceptable” given lack of evidence’. This is a provocative piece which is based on social prescribing knowledge up to January 2016. We appreciate the concerns raised by the author and respectfully disagree .
We are glad to see that the review by Bickerdike et al (2017), utilised an inclusive approach to critically appraising the evidence, from various types of studies, albeit still failing to include some key reports (e.g Bertotti et al 2015) and reports published more recently (e.g. Dayson and Bennett 2016; Kimberlee, 2016).
Before undertaking a comparative effectiveness study, much research needs to be undertaken to determine that interventions are achieving what they set out to do, and that there is a good understanding of all relevant outcomes being achieved, how to measure these outcomes, and to determine effect sizes from these feasibility data. (Craig, 2006)
We agree with the authors that the comparative data is lacking, however, a large amount of qualitative data has been collected and reported, which is not commented upon in this Pulse article, neither is it represented in the conclusions in Bickerdike (2017).
In fact we would argue that in line with MRC guidance, this qualitative data has made a large contribution to identifying the many outcomes that are being achieved in successful social prescribing schemes. It has greatly contributed to the knowledge of why professionals and patients value social prescribing, what the key barriers and enablers are, what the key ingredients of successful social prescribing schemes are and importantly the wider value of social prescribing. Moreover, it firmly demonstrates the acceptability of schemes to professionals and patients alike. There are now approximately 90 reports showing quantitative data of positive outcomes. They are varying quality but they represent a focus that no other intervention has had.
Taken as a whole these qualitative and quantitative data alert us to the fact that further research is warranted to establish appropriate methodologies and reflect the wide range of potential models and outcomes, as opposed to 'no more evaluation'. Furthermore, to recommend no evaluation at all is to dissuade more widespread evaluation being embedded within new schemes that are being rolled out in response to local needs. The findings of a realist (systematic) review which aims to take a more explanatory approach to synthesising the evidence on social prescribing by researchers in Exeter (Husk et al. 2016) will also be of interest.
Social prescribing as an intervention and a research field is young, There has been little funding to support the roll out, less money still to support the development of robust evaluation that is recommended by the author. We welcome more funders accepting applications in this field. The recommendation that ‘If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost’ is therefore welcomed as a positive recommendation that resonates with the social prescribing movement in the UK.
The social prescribing network was formed in January 2016 and within 15 months have grown to 880 members. These are professionals from all stakeholder sectors who have seen the value of social prescribing in their own localities and are passionate about providing a better offer to patients. Furthermore many of these providers have a deep understanding of how existing schemes works. When it works both patients and GPs value it highly and for GPs it comes as a breath of fresh air to their overstretched working day, as well as addressing the wider determinants of health. To an extent, the social prescribing movement exists to extract greater value from existing resources in the community, many of which have long track records in helping people address historic disadvantage. The key new element – the link worker – ensures an effective link between busy primary care and a diverse and complex range of community services.
The social prescription movement has been based on dire reality (as opposed to rhetoric), and frontline healthcare professionals wanting to better meet the needs of some of their most deprived and deserving patients. Those leading social prescription have been living in the real world trying to engineer real solutions and better outcomes. We therefore question the value of headlines 'We need less rhetoric and more reality on social prescribing'.
There are clear and urgent requirements to make efficiency savings in the NHS, which are stated in the Five Year Forward View (NHS, 2014), and the General Practice Forward View (NHS, 2016). We therefore argue that it is out of place to recommend no social prescribing and discourage evaluation when social prescribing has been identified by health leaders as a high impact actions to address within sustainability and transformation plans and the GP Forward View, and is supported by positive feasibility data.
Unfortunately we can’t get out a magic wand and produce comparative effectiveness data but neither can the relentless transformation of the NHS be halted - and that is the reality of situation on the ground. The social prescribing network is working as quickly as possible to share learning through our network and beyond, to encourage increased quality of design and reporting of data whilst innovation is occurring at pace (e.g. AESOP PHE evaluation framework), and to support collaborative learning and research applications that seek to address the questions raised by the authors in their article (amongst other things).
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Dr Mike Dixon
Dr Marie Polley
Dr Anfilogoff Tim
Dr Caroline Frostick
Dr Chris Drinkwater
Dr Damien Ridge
Dr Dan Hopewell
Dr James Fleming
Dr Karen Pilkington
Dr Lev Pedro
Dr Marcello Bertotti
Dr Alyson McGregor
Dr Richard Kimberlee
Dr Sheinaz Stansfield
Bickerdike L, Booth A, Wilson PM, et al.(2017) Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open;7:e013384. doi:10.1136/bmjopen-2016-
Bertotti, M., et al (2015) Shine 2014 final report Social Prescribing: integrating GP and Community Assets for Health, Health Foundation;
Dayson C and Bennett E (2016) Evaluation of the Rotherham Mental Health Social Prescribing Pilot:, Sheffield Hallam University, Sheffield
Kimberlee, R. (2016) Gloucestershire Clinical Commissioning Group Social Prescribing Service: Evaluation Report, University of the West of England, Bristol,;
Craig P., et al (2006) Developing and evaluating complex interventions: new guidance. Medical Research Council.
Husk et al (2016) What approaches to social prescribing work for whom, and in what circumstances? A protocol for a realist review. Systematic Reviews 5:93
NHS (2014) Five Year Forward View, London
NHS England (2016) General Practice Forward View. London
AESOP PHE evaluation framework (last accessed 31 March 2017)