Developing a research agenda for social prescribing in the UK using lessons from the US

Introduction

‘Social prescribing’ is a central component of NHS England’s long-term plan to provide more personalised care and reduce health inequalities. In social prescribing programmes, general practice staff refer patients to ‘link workers’ who connect patients with community-based services to address non-medical needs. In 2019, NHS England committed to a national rollout of social prescribing by funding a link worker for each of England’s 1300 Primary Care Networks — groups of general practices covering populations of around 30 000–50 000 people.¹

Despite widespread policy support, research on the implementation and impact of social prescribing is limited and inconclusive.² Many social prescribing evaluations have been of low methodological quality — with small numbers of participants, weak designs, no control groups, short durations, little consideration of confounding factors, and considerable loss to follow-up.³

In response to the weak evidence base, researchers have called for a coordinated evaluation framework to help develop a common body of knowledge on social prescribing.³ The National Academy of Social Prescribing in the UK launched an academic collaborative to define evidence gaps. The National Institute for Health and Care Research recently funded a multi-region evaluation of the national rollout in primary care.

As these efforts develop, researchers in the UK could learn from parallel efforts to evaluate social prescribing in the US. Healthcare systems in the US and UK vary widely in structure, cultures, and values — as do approaches to funding and delivering social services.

Nonetheless, like in the UK, efforts to identify and respond to patients’ social and economic conditions within the healthcare system have proliferated in the US.⁴ This may be down to a mix of factors, including growing awareness of the role of social factors in shaping health, and relatively low investment in social spending compared with other high-income countries. Regardless, forms of social prescribing are recommended by multiple US professional organisations, and have been incentivised by policymakers and payers. In 2019, the US National Academy of Medicine released a consensus report on integrating non-medical care into healthcare delivery that described the state of research, policy, and practice on social prescribing.⁵ The American Journal of Preventive Medicine also published a special issue on the evidence and evidence gaps on integrated health and social care in the US.⁶

In this article, we highlight major findings from US-based consensus and dissemination efforts on social prescribing research, and describe how the research agenda in the US might be used to inform similar research in the UK. Research could be strengthened in three areas: 1) social needs assessment, 2) intervention effectiveness, and 3) the sustainable implementation of effective programmes. Given that social prescribing involves a complex mix of interventions spanning multiple agencies and with impacts spread widely over space and time, a mix of methods will be needed to understand how these interventions are implemented in real-world settings, how they achieve their intended outcomes, for whom, and how this varies by context.