Charlotte Osborne Ford, the Chief Executive for the National Academy for Social Prescribing, explains how social prescribing is helping reduce GP appointments and boosting patient satisfaction, while supporting health creation and connecting us to nature.
Can you tell me a little bit about social prescribing?
Social prescribing is about understanding the root causes of ill health. It’s about helping people identify what could help them improve their health and wellbeing.
It’s typically done through a link worker, who is a professional within a GP practice or in the NHS. The healthcare professional meets with a patient and asks them “what matters to you and what do you enjoy?” and “What are your concerns?”
They will then connect them to specific community activities and support services. These can be anything from debt advice to cooking classes, art groups, or even just walking.
How widespread is social prescribing?
“More than a million patients are referred by GP practices to social prescribing link workers every year”
Social prescribing is now incredibly widespread. It became a universal part of the GP contract in 2019, which means that every GP practice in England should offer social prescribing to their patients.
Social prescribing link workers are employed in almost every GP in England and in many parts of Scotland and Wales as well.
Recent research by University College London in The Lancet shows that more than a million patients are referred by GPs to social prescribing link workers every year.
What specific changes and benefits has social prescribing made to the NHS?
“There is typically a reduction in GP appointments for patients who are referred for social prescribing”
Although social prescribing is universally available in GP practices, it’s also in lots of other parts of the NHS.
There have been various studies, both evaluations done by the NHS and research by academic bodies, which show that there is typically a reduction in GP appointments for patients who are referred for social prescribing. But also, patients are less likely to go to A&E and they’re less likely to have unplanned hospital admissions.
The National Academy reviewed the research and evaluation of the impact on the NHS at the end of last year. We looked at nine different NHS organisations where they tracked GP appointments and hospital admissions and almost all saw reductions, and some saw very, very significant reductions.
Many of those didn’t just track the patients that had accessed social prescribing. They looked at control groups as well to see what would typically happen to a patient who isn’t accessing social prescribing. Would they have an increase in their A&E attendance and their GP appointments if they have similar health conditions? And often, they do.
So, I think there’s now really robust evidence that social prescribing has a positive impact on the NHS as well as a really positive impact on people.
Another important study published this year was from The University of Manchester, funded by the National Institute for Health Research. It looked at satisfaction with GPs and various other patient-reported data. It showed social prescribing is leading to statistically-significant improvements on patient satisfaction and confidence to manage their health.
These changes you mention, do we see any differences between more affluent and less affluent areas? Also do we see any change between urban and rural areas as well, with the difficulty of accessing spaces perhaps and then classes? Finally, is this where green social prescribing comes into this conversation?
“The reality is that the people who could most benefit, are people who are living in deprived areas, facing life challenges and inequalities”
The research that I mentioned published in The Lancet from UCL looks at whether social prescribing is reaching the right people.
What it shows is that over the five-year roll out, social prescribing has, every year, got better at reaching people living in the most deprived areas.
In 2023, more than 40% of patients accessing social prescribing were living in more deprived areas and a high proportion were from different ethnic communities.
There was also a study from the Race Equality Foundation last year which looked at whether social prescribing in primary care is reaching ethnic minority communities.
They found that there were higher proportions of social prescribing referrals for those from ethnic minority communities compared to their population, but they did call for greater research to understand who is accessing social prescribing, what are the barriers and how we can best support more people and work more proactively to reach those who most need it.
I don’t think there’s been a detailed study as to whether green social prescribing helps people in more rural areas. But one would assume, because it uses the natural environment to empower people to improve their health and their confidence, that there’s greater access for people living in rural areas.
However, the reality is that the people who could most benefit are people who are living in deprived areas, facing life challenges and inequalities. They often have issues accessing transport so there might be some amazing nature-based activities on their doorstep, but if they’ve got mobility issues, low income, low confidence, it can still be really difficult for them to get out and actually make the most of those opportunities.
How does social prescribing link into the idea of health creation rather than health prevention?
“People using recognised scales for anxiety and depression scored themselves so much lower after the social prescribing intervention”
There was always the hope and ambition that, through improving people’s health and wellbeing, they would have less reliance on NHS services, whether that’s medication or appointments.
Many studies have looked at appointments, as opposed to medication, because it’s very complex to track people’s medication usage.
What is really interesting is, in the evaluation of the first phase of the cross-government green social prescribing project, it showed people who went through nature-based social prescribing saw a reduction in their symptoms of anxiety and depression.
What that means is people using recognised scales for anxiety and depression scored themselves much lower after the social prescribing intervention. Therefore, there is a potential assumption that they would be less likely to have been prescribed antidepressants. But, I think that is definitely an area of research that’s needed in the future and we will look at that.
In terms of the genesis of social prescribing, it certainly comes from the concept of health creation, because it’s about helping people do the things that they enjoy, that make them feel more satisfied with their life.
The reality of what we’ve seen from the roll out of social prescribing is so many people in England have complex health and social needs. There’s cost of living issues and lots of people facing incredible financial pressure.
There is a huge demand to address those really complex challenges, as well as to connect people to the more life-enhancing and life-affirming activities like arts and culture and nature.
What we need is a greater expansion of social prescribing so that it’s more easily available for people, not just those with really complex needs. Everybody needs to be encouraged, connected and aware of what might be available to them. This could help them maintain and build their health rather than respond to sorts of crises that many people are facing at the moment.
How is social prescribing infused into the NHS? And how successful are we seeing it being incorporated into the guidance that we give to the public?
“We would call for much greater national leadership and infrastructure in terms of helping the NHS workforce think differently and think more holistically about what patients need”
At the moment, the government is consulting on the NHS workforce plan. One of the things we’ll be saying is that there needs to be much greater opportunity for people across the NHS to understand what social prescribing is, to understand the benefits of taking a more health-creation approach, and to link people to all of the assets that are available in communities.
Even when social prescribing became part of the GP contract, there was little education or training on how to recruit and manage link workers or how to embed social prescribing. Luckily, many GPs are big advocates for social prescribing anyway because they understand from their patients that medical solutions aren’t always the only solutions. So, many GPs really took an interest. But we would call for greater national leadership and infrastructure in terms of helping the NHS workforce think differently and think more holistically about what their patients need.
We also need to look at training. Social prescribing is now on the curriculum of every medical school in England, but that is largely as a result of students.
There was a huge student movement for social prescribing engaging about 20,000 students, to try to embed social prescribing within the curriculum, and that was really successful.
What we don’t know is what the quality is of that teaching and exactly what’s being taught. That’s obviously a key role for the National Academy, but we are a a small charity.
We’ve talked a lot about the NHS. Is there any scope for social prescribing being part of non-NHS government and public healthcare procedures or even private healthcare?
“The Ministry of Justice has been looking at how social prescribing could be both within prisons and probation”
Yes. There have been lots of conversations over the years about how social prescribing should be part of more organisations that think about health and wellbeing.
For example, the Ministry of Justice has been looking at how social prescribing could be both in prisons and probation services. Many prisoners will have complex physical and mental health issues. How can they be positively connected to things that can help? Equally, how can social prescribing support people that are unemployed and facing challenges, can it help them access work if their health is poor?
One of the things that we’ve been calling for is a national strategy for social prescribing. This would look not just at social prescribing in the NHS, but actually how all different parts of government, local authorities, public health, prisons, schools, colleges, universities can connect ordinary people into health-creating activities in their community
Social prescribing is really taking off in other healthcare systems around the world, who typically have either an insurance-based system or private healthcare. For example, we recently attended the first social prescribing summit in the USA, exploring how social prescribing can grow in a in their system.
Just to finish up, with the NHS 10-year plan, neighbourhood Health was a big part of the government’s aims for future, what role do you see it having?
“It’s really encouraging to hear ministers say that social prescribing is a core part of neighbourhood health”
It’s absolutely central to that. When we think of the NHS definition of social prescribing, it means understanding somebody’s holistic needs, helping them develop a holistic care and support plan and then connecting them to community services. So that’s really the very ethos of neighbourhood health.
Beyond the purely clinical model and beyond the GP practice, it’s really encouraging to hear ministers, particularly Stephen Kinnock, the Minister of State for Care, say that social prescribing is a core part of neighbourhood health and that we need to get much better at understanding what the root causes are of patients’ needs.
What we haven’t yet seen is what that means in practice. The commitments around neighbourhood health are really encouraging and there are 42 areas testing this locally.
But what we really need is a shift in finance and resources to make sure that these commitments don’t just fall upon local voluntary sector leaders and local GPs, and there’s really clear guidance and national leadership.
We mean shifting care not just from hospitals to GP practices, but really making the most of everything that’s provided in the community. Ensuring community organisations and groups are properly resourced and that there are social prescribing link workers and others within the NHS who can support and connect patients.
This is my final question. The new online NHS hospital service was really announced to go live in 2027. Do you foresee social prescribing as part of this? For example, will there be a tab on the app that says social prescribing and give you some examples or something like that, how do you see it?
There’s no mention of social prescribing in this particular hospital service, but the 10 year plan does explicitly mention social prescribing being part of a future NHS digital offer. So the NHS app may potentially have a social prescribing function.
With this, you could be connected to local community groups, so absolutely it is part of this digital model and that broader shift from analogue to digital. It’s vital there’s a strategy to help local voluntary and community groups understand the opportunity and connect. It’s also really important that we don’t forget people who either can’t or don’t want to join the digital functions, and I think that’s another important role of social prescribing, as it does provide that link for those who aren’t as digitally savvy.
