Charlotte Osborn-Forde, chief executive of National Academy for Social Prescribing, highlights the value of adopting a social prescribing approach in neighbourhood health.

The NHS 10 Year Health Plan for England, published in July, outlines an admirable ambition to shift care from treatment to prevention and from hospitals to communities. Social prescribing can play an important role in this, as part of a neighbourhood health service, but it will be crucial to build on what’s already working well. 

There is now strong evidence for the benefits of social prescribing. The recent NIHR-funded national evaluation, based on more than four million patient records, suggests that increasing the number of social prescribing link workers in a practice leads to better outcomes and improved satisfaction among patients.

The evaluation concludes that the national rollout of link workers ‘has had the intended outcomes specified in the NHS Long-Term Plan’. 

This is the largest study on the impact of social prescribing so far, but it builds on a wide range of smaller-scale research – including last year’s evaluation of the national Green Social Prescribing programme, which showed statistically significant improvements to mental health in a way that was cost-effective compared to other interventions. 

Our own research looks at system data and shows that social prescribing can lead to substantial reductions in GP appointments, A&E attendances and hospital admissions. 

There is much more research underway in the UK and overseas – including projects focused on children and young people, and a major European randomised control trial called Social Prescribing-EU – to improve the evidence for what works in different contexts.

But we know that there are also challenges. Because of changes to ARRS funding, numbers of link workers in PCNs have gradually fallen. And while 98% of link workers believe their work positively impacts the people they work with, many would like more training and support, and some feel that their roles are not well enough understood by colleagues.

The NHS 10 Year Health Plan highlights the importance of what we would describe as a social prescribing approach – addressing issues such as employment and debt that impact health and wellbeing and highlighting the importance of joining health services with the voluntary sector more effectively. 

Specific commitments in the plan which will progress social prescribing include the adoption of new roles such as community health workers, who offer holistic support and community connection, and the integration of services including debt advice within neighbourhood health centres. 

But the plan does not specifically focus on the role of link workers, and it will be important to build on what’s working well – and focus on challenges – when it comes to implementation.

Evidence of impact

That is why we have been developing a tool to help commissioners assess the value of link workers. Based on the available studies, we provisionally estimate an average return on investment of £4 for every £1 spent on link worker salaries, although some of these savings are likely to be workload-reducing rather than cashable. For example, reduced GP contacts may not yield financial savings, but can create clinical headroom – shorter waits, more time for complex care and improved staff wellbeing.

We have also created a training roadmap, to help PCNs, managers and link workers plan training and development, building on the recommended core competencies outlined in the Workforce Development Framework. And through our Champions schemes, posters and leaflets, we hope to help health leaders spread the word about social prescribing both among patients and colleagues. 

The most common referrals reported by link workers are to services addressing financial support, mental health and housing issues, reflecting the complex, interrelated challenges faced by many patients. 

While GPs simply don’t have the time or resources to support people with these issues, link workers are able to listen to people and help address these factors, which we all know can have such a profound impact on people’s health. With the right support and ongoing investment, they can play a key role in bridging the gap between health services and community support, and help make the shift towards prevention a reality.

 For more information, visit www.socialprescribingacademy.org.uk