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‘Absence of evidence’ to support social prescribing, finds major review

‘Absence of evidence’ to support social prescribing, finds major review

A major review has found no consistent evidence that social prescribing improves social support or physical function, or reduces the use of primary care services.

It also found only limited evidence that social prescribing improves subjective assessment of personal health or quality of care received. 

It comes as NHS England recently announced plans for the ‘rapid recruitment’ of up to 2,000 additional social prescribing link workers, health coaches and care coordinators among measures to alleviate GP pressures this winter.  

The study published in BMJ Open set out to systematically review the evidence on the effectiveness and costs of the link worker model of social prescribing internationally. 

The research looked at eight studies involving 6,500 people. Four covering 2,186 participants found that social prescribing made no difference to health-related quality of life.

Meanwhile, out of the four reporting mental health outcomes, which covered 1,924 participants, three found no impact for social prescribing.  

And of the four studies reporting on primary healthcare use, one reported a reduction in primary care attendance in the intervention group. Of the remainder, two found no evidence of a change in use, while one US-based study found that attendance increased. 

However, none of the studies formally analysed cost-effectiveness. While one found that healthcare costs fell because of fewer referrals, these savings didn’t offset the costs of the intervention itself, prompting the study authors to conclude that social prescribing was more expensive than usual care. 

The review concluded that ‘there is an absence of evidence for social prescribing link workers’.

The researchers said: ‘Our systematic review suggests that link workers providing social prescribing may have little or no impact on health-related quality of life, mental health or a range of patient-reported outcomes though they may improve self-rated health.

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‘Policy makers need to be aware that there is insufficient evidence to assess the effectiveness of social prescribing link workers and none on the cost-effectiveness.’ 

They added: ‘The opportunity costs of investing in social prescribing link workers are unknown and it is essential that high-quality trials determining cost-effectiveness are conducted so that the evidence can catch up with the policy and we avoid wasting valuable time and resources.’ 

Emeritus professor in clinical community psychiatry at Imperial College London Professor Peter Tyrer said that the study provides ‘compelling’ evidence that social prescribing ‘has no basis in effectiveness or cost-effectiveness’ – despite the ‘enthusiastic embrace of many planners and providers’.

He added: ‘There are certainly reasons for thinking in principle that it might be useful and could save money, but only when it is given by competent people that are adequately trained and have a clear therapeutic policy.

‘At present, there is a hotchpotch of general advice, case management, signposting and counselling that leads to great heterogeneity and confusion.’

Professor Tyrer said that if social prescribing was formalised, it is ‘quite possible that good data and effectiveness will follow’ but described it currently as ‘an experimental intervention of uncertain efficacy that needs further study’. 

He also highlighted concerns that unregulated social prescribing had the potential for harm ‘with link workers being overwhelmed with inappropriate referrals and having little idea how to respond’.

Dr Rachel Sumner, senior research fellow at Cardiff Metropolitan University, added that as traction gains, ‘it will be more and more important to establish robust methods to evaluate [social prescribing]’ to ensure that it is meeting the ‘challenges faced by our modern health landscape’ effectively. 

In 2019, NHS England announced a goal for PCNs to be supported by the recruitment of 1,000 social prescribing workers by April 2021.

Figures from NHS Digital showed that as of December 2021, 1,108 care coordinators and 1,612 social prescribing link workers were in the full-time equivalent (FTE) PCN workforce.

Social prescribing links people to non-medical support in their community such as counselling, social and craft groups, exercise classes, addiction support services, and welfare and employment advice. 



Please note, only GPs are permitted to add comments to articles

Patrufini Duffy 18 October, 2022 11:40 am

Money made. Back handers sorted. Nannying facilitated trivial blah blocking energy and interest in medicine.

Turn out The Lights 18 October, 2022 12:32 pm

The woods are full of it, bear excrement that is.