Guidance

Social prescribing: applying All Our Health

Updated 27 January 2022

The Public Health England team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021

Introduction

This guide will help frontline health and care staff use their trusted relationships with patients, families and communities to promote the benefits of social prescribing.

We also recommend important actions that managers and staff holding strategic roles can take.

View the full range of All Our Health topics.

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A free interactive e-learning version of this topic is now available to use.

The e-learning session is based on the All Our Health content below. It is designed to be interactive and easy to use. If you are registered on the e-learning for healthcare site, it will count towards your continued professional development.

The session is intended to build both skills and confidence in health and care professionals, to embed prevention in their day-to-day practice.

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Social prescribing

Social prescribing – sometimes referred to as community referral – is a means of enabling GPs, nurses and other health and care professionals to refer people to a range of local, non-clinical services.

Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.

Social prescribing schemes can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.

There are many different models for social prescribing, but most involve a link worker or navigator who works with people to access local sources of support.^{[footnote 1]}

Community-centred ways of working can be more effective than more traditional services in improving the health and wellbeing of marginalised groups and vulnerable individuals. For this reason, they are an essential way of reducing health inequalities within a local area or community.

Those who find themselves excluded from society, discriminated against, or lacking power and control because of living in extreme poverty, can be the least likely to access and benefit from services – despite often having the worst health. Adopting more community-centred practice can help provide more appropriate and effective ways of engaging people and improving their health and wellbeing.

The extent to which we have control over our lives, have good social connections and live in healthy, safe neighbourhoods are all important influences on health. These community-level determinants are protective of good mental and physical health and can be a buffer against stressors during a lifetime.

Social prescribing and community-based support is part of the NHS Long Term Plan’s commitment to make personalised care business as usual across the health and care system. Personalised care means people have choice and control over the way their care is planned and delivered, based on ‘what matters’ to them and their individual strengths and needs. Social prescribing is one of the 6 components of universal personalised care. The NHS Long Term Plan published in January 2019 has a commitment to personalised care and increasing access to social prescribing for the whole population.

Social prescribing enables all local agencies to refer people to a link worker. Link workers give people time and focus on what matters to the person as identified through shared decision making or personalised care and support planning. They connect people to community groups and agencies for practical and emotional support. Link workers collaborate with local partners to help community groups be accessible and sustainable and support people starting new groups.

Referrals to link workers can come from a wide range of local agencies, including general practice, local authorities, pharmacies, multi-disciplinary teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations. Self-referral is also encouraged. Some health and care professionals whose roles involve long-term intensive support may undertake social prescribing directly.

Social prescribing complements other approaches, such as active signposting by health and care professionals. Active signposting is a ‘light touch’ approach using a making every contact count approach where existing staff in local agencies engage individuals in conversations about what matters to them and provide information to signpost people to services, using local knowledge and resource directories. Active signposting works best for people who are confident and skilled enough to find their own way to services after a brief intervention.

Personalised care relies on people having health literacy; the knowledge, skills, understanding and confidence they need to be able to use health and care information and services. In 2015 the Institute of Health Equity published a report about improving health literacy to reduce health inequalities. This showed that up to 61% of the working age population in England finds it difficult to understand health and wellbeing information.

Low levels of health literacy impact significantly upon a person’s ability to:

• manage long term conditions
• engage with preventative programmes and make informed healthy lifestyle choices
• keep to medication regimes

This leads to worse health outcomes across a range of indicators, increased health inequalities for affected individuals and increased preventable mortality. A health literacy toolkit has been published to raise awareness of health literacy and support the health, care and the wider public health workforce to make services accessible.

Promoting social prescribing in your professional practice

Social prescribing improves outcomes for people by giving more choice and control over their lives and an improved sense of belonging when people get involved in community groups. It is also effective at targeting the causes of health inequalities and is an important facet of community-centred practice. It is particularly useful for people who need more support with their mental health, have one or more long-term conditions, are lonely or isolated, or have complex social needs that affect their wellbeing.

Social prescribing can meet many different types of non-clinical need, ranging from support and advice for individuals experiencing debt, unemployment, housing or mobility issues to tackling loneliness by building social connections through joining local community groups, such as walking, singing or gardening groups.

There is a growing body of evidence that social prescribing reduces pressure on the NHS by directing people to more appropriate services and groups – an evidence summary published by the University of Westminster suggests that where an individual has support through social prescribing, their GP consultations reduce by an average of 28% and A&E attendances by 24%.

Core principles for healthcare professionals

The core principles of social prescribing are that it:

• is a holistic approach focussing on individual need
• promotes health and wellbeing and reduces health inequalities in a community setting, using non-clinical methods
• addresses barriers to engagement and enables people to play an active part in their care
• utilises and builds on the local community assets in developing and delivering the service or activity
• aims to increase people’s control over their health and lives

Taking action

If you’re a front-line health professional:

• adopt person-centred and strengths-based practice when communicating with patients to ascertain whether they have non-clinical needs that may be met through social prescribing. See the person-centred care framework
• consider how people’s social and emotional needs are affecting their health, for example, their relationships, social networks, and support in their neighbourhood
• read the UK Health Security Agency’s (UKHSA) blog about brief advice, motivational interviewing and health coaching to help you have non-judgemental conversations tailored to individual patients
• read the UKHSA’s blog about the type of local services that may be available and how to find them and investigate whether your local area has a social prescribing directory
• find out whether your local link workers have referral criteria
• if you are a health and care professional providing a socially prescribed service, ensure that local health and care professionals and link workers are aware of the service and its referral criteria

If you’re a team leader or manager:

• ensure the teams you manage are aware of the social prescribing services and groups in your local area
• promote a culture where social prescribing is encouraged as part of ‘What matters to you?’ conversations
• encourage collaborative relationships between health and care professionals, link workers and service providers
• consider how community centred approaches can be adopted by your team to strengthen communities and build local services and groups
• create a culture where all staff understand the benefits of measuring the impact and demonstrating the value of their social prescribing work
• support your team to access making every contact count training

If you’re a senior or strategic leader:

• work to ensure social prescribing is promoted prominently within commissioned health and care services
• use the implementation checklist for local partners and commissioners in Annex C of the NHS England social prescribing and community-based support summary guide to ensure that the key elements of an effective social prescribing service are in place
• include social prescribing in health and wellbeing boards’ Joint Strategic Needs Assessment (JSNA)
• look at the education and training needs of the workforce to equip them to deliver high quality social prescribing advice and interventions
• link social prescribing and making every contact count to support staff to see the range of opportunities to support improvements in health and wellbeing

Understanding local needs

A good understanding of local needs in relation to community life is best collected locally by:

• speaking to communities
• listening to patients and carers
• conducting local research to gain insight

Local needs include, but are not limited to, social isolation, neighbourhood belonging, housing, debt and unemployment, and people’s emotional wellbeing and resilience.

The local authority and voluntary, community and social enterprise organisations (including faith-based) can be a good source of information. Health and care professionals are in a good position to listen and learn about what’s happening locally in their patch.

Routinely collected local data is available on the Office for Health Improvement and Disparities (OHID) health profiles.

Related measures include:

• self-reported wellbeing
• social connectedness
• wider determinants data, which will give an indication of the level of need in the community and populations

Indicators on loneliness, social isolation, social capital, and wellbeing are included in the mental health profiles

Many of the community measures are from national-level data from the UK Household Longitudinal Study, for example, Social Capital.

Further local wellbeing indicators are available from the What Works Centre for Wellbeing.

Measuring impact

A common outcomes framework for measuring the impact of social prescribing has been developed, based on the impact of social prescribing on the person, the health and care system and community groups. It is available in Annex D of the social prescribing and community-based support summary guide.

Part of the process of measuring the impact of social prescribing is having shared IT codes for capturing referrals. Two national codes have been developed using the SNOMED CT IT system, which is being deployed across all GP surgeries. These codes include ‘social prescribing referral’ and ‘social prescribing declined’. More information is available in the NHS England summary guide to social prescribing.

Further reading, resources and good practice

Advice for patients and the public

Link workers will be well placed to know what services and groups are available locally and to share information with patients about the specific services and groups available. Some local groups may have produced their own leaflets and have their own websites that can be shared with patients.

Professional resources and tools

NHS England has set up an online learning platform to share the latest resources to support successful implementation of social prescribing. Contact england.socialprescribing@nhs.net to join the platform.

A summary of key resources can also be found on NHS England social prescribing webpages under ‘Resources’. This includes items produced by a range of partners, including the:

• King’s Fund
• Healthy London Partnership
• University of Westminster
• Work Foundation at Lancaster University
• Royal College of GPs
• Local Government Association
• All Party Parliamentary Group for Arts, Health and Wellbeing

NHS England also delivers a free e-learning programme aimed at social prescribing link workers

Good practice examples

Case studies are available on NHS England online learning platform, (see details in the ‘Professional resources and tools’ section above for how to access). There are also case studies available in the following documents:

• Ways to Wellness Newcastle for people with long-term conditions

• Social prescribing - Rotherham

• Social prescribing in north-west England (PDF, 241KB)

• Social prescribing: a guide for local authorities

1. Definition taken from the Kings Fund ↩