Social prescribing: rethinking health

Social prescribing is a means for individuals to be connected to non-medical forms of support within the community. This can be everything from art to nature to voluntary and community groups, to also things like advice for benefits, for housing or for other social challenges they might be facing. It is a really innovative idea because it is strength-based; it looks at what the assets are in communities that we can be drawing on to support health and healthcare. It also focuses on what is important to individuals, what matters to them; we think about what their goals are, what the needs within their lives can be.

Social prescribing had a major national rollout as part of the long-term plan, so there were link workers that began to be embedded in medical practices all around the country. Already in the first four years of that scheme, it reached over 5.5 million patients, who have between them nearly 10 million consultations. That number has continued increasing since, and social prescribing has also now rolled out to over 40 countries around the world. The whole idea has become a major international rethinking about how we can help to support people's health by connecting them to these community sources of support.

They can also provide motivational coaching and support that might help them recognize which activities are best, how they can overcome the barriers to engaging and look, over perhaps multiple consultations, at whether the program of activities that they are thinking of is helping. It is not the only model. Actually, what we see is there are many other ways that people can engage in social prescribing. They can refer themselves. They could be referred through social care or through voluntary organizations, and we are also starting to see even more plurality in terms of where the link workers are involved or whether there are other kinds of trusted individuals who might be supporting somebody in engaging.

Social prescriptions can be anything from attending arts, music, heritage or cultural activities in the community to going to other nature-based or green activities or exercise programs. It can also be referrals to job centers, to benefits advice, to lawyers for legal support with social issues. It can also be really tiny steps that are necessary to achieve that. Some social prescriptions are for a bus pass so that somebody is actually able to get to town centers where some of these services might be available. For some people, social prescribing can involve one activity; for others, it involves many different things. Sometimes we see people engaging in social prescribing just for a few weeks to get the kind of support they need, whereas for others it can be something that they continue doing as a way of helping with the long-term management of their health and well-being.

The young people have then had up to six sessions with those link workers, sometimes online, sometimes in person, depending on their interests and needs. In those sessions they have done things like talk about their goals and aspirations. They have done gentle, creative activities to put the young people at ease, and they have helped them to map out a roadmap for where they want to get to and what kind of steps could be helpful along the way. What has been really good about this as well is it has been integrated with the waiting list. There has been lots of safeguarding and support. If the young people start to experience more problems, this can be referred back to the clinical staff within the mental health service. We have some really lovely case studies and examples of how this has worked.

If we think about the activities themselves, there are now dozens and dozens of meta-analyses of trials showing that if people engage in these activities — arts, nature, social groups, voluntary activities — this helps to improve multiple aspects of health and well-being, reducing symptoms of depression and anxiety, increasing life satisfaction, helping people to stay physically active, reducing blood pressure, supporting cognition, providing social support and reducing loneliness. We also know that other activities common in social prescribing, like job centers and benefits advice, can practically very much help people to get the support that they need and change their life situations.

This is really promising because it is exactly what we would hope social prescribing would be achieving. In fact, year on year, we are finding that social prescribing is going more and more to people who live in the most deprived areas.

This actually found that these referrals were leading to improvements in mental health and reductions in anxiety. They were also leading to a greater ability for individuals to carry out their day-to-day tasks, so a whole range of personal and functional outcomes. Since then, there have been many more trials. Many of them have looked at exercise on prescription, showing that this does indeed help to increase people's physical activity levels. Whether or not it affects things like blood pressure, cholesterol or BMI actually depends on where the people's levels of those were abnormal in the first place. We cannot really expect an improvement if somebody is already happily within the normal range. We have within my team been leading lots of trials, looking at things like arts on prescription as part of social prescribing. One big trial that we have been collaborating on with colleagues in Greece has shown that adults with severe mental illnesses who engage in arts on prescription are seeing really marked improvements in their symptoms of anxiety and depression within just 12 weeks, and we found this as well for more bespoke programs. One that we have worked on a lot is a singing for postnatal depression program, which focuses on mothers experiencing postnatal depression and provides a bespoke music activity they can do for 10 weeks. This has been shown to substantially reduce their symptoms — in fact, faster than non-bespoke activities in the community and faster than usual care on the NHS. All of these kinds of trials are starting to really build the confidence that social prescribing can actually have the specific desired outcomes for specific populations.

Already, some studies at local levels have shown that if people engage in social prescribing, they tend to reduce their levels of doctor visits and Attendances and Emergency Admissions, particularly for those people who actually had very high levels of those attendances in the first place. We are currently doing some really exciting, very large scale national analyses looking at how social prescribing affects people's well-being levels and what the economic implications of this are. One study that was looking at green social prescribing specifically showed really clearly that people who received green social prescribing had subsequent improvements in their well-being, and they were able to equate this to a saving of over £2 versus every £1 that was being spent on the program.

With the support of the link worker, he actually went and signed up for some mentoring and training in this. This culminated with the link worker going to enroll in college to learn how to lead physical activity training sessions. It is a really nice example of how having that person who was able to help him think through those steps, and provide the tangible support of going to places with him to help him to make those key life decisions, has been really valuable in helping him start doing activities that he had previously withdrawn from because of his anxiety.

Moving forward there are definitely really interesting directions that social prescribing is going in, one of which is more of a left-shift model. We are recognizing increasingly that people do not always need the link worker to provide that kind of support. Sometimes the activities themselves, if people are already engaging in them as part of their day-to-day lives, can be preventative, helping to stop people developing the problems that mean they need to be entering healthcare pathways at all. There are some regions of the UK that are now piloting programs where they are putting money directly into the voluntary and community sector organizations to try and achieve this primary prevention objective. These schemes are part of a new innovative model that is happening in the UK, which is to try and develop a social impact finance model. The idea here is that, at the moment, lots of the funding for social prescribing is largely only really going to link worker roles, but there has not been the same investments into community services. This can be a real barrier because we know that often those community services have been having quite large cuts over the last decade, so they do not necessarily now have the capacity to deliver the work that link workers want to be able to send their way. The social funding model is saying, let us match the funding that goes into the link workers and from the NHS with other funding that will be directly supporting community organizations. This is really exciting because it is giving a whole new joined up way of working between the health service but also between businesses, between charities and between other government departments. It is really exciting to see this happening here, but there are also other models. In Greece, for example, they have joined up working on their pilots between the ministries for health and the ministry for culture. This cross-governmental working is becoming more and more common in pilots of social prescribing.

The way that we proportion health budgets is completely the opposite of that. What I would be saying to governments is, can we be more radical in this? Instead of cutting budgets to the community sector at times of austerity and then ending up with health services that have got more and more people that are needing their support, could we be investing substantial funding into those community organizations in the first place, trying to achieve that left shift and hoping that the more preventative approach might reduce the actual demand we end up needing in the health service at all?

For many people, social prescribing is a new thing that they have only heard about recently, but the whole concept of social prescribing is what healthcare used to be centuries ago: the idea that community was providing support that was so important for us. Actually, far from being a new way of thinking, it is more of a return to an older way of thinking that we seem to have stepped away from as we have moved more and more towards biomedical considerations of health. I think it is really valuable for us, as we are looking forward, to really bear that in mind and recognize that social prescribing is an innovation, but it is also a fundamental approach to health with which we need to reconnect.

Editor’s note: This article has been faithfully transcribed from the original interview filmed with the author, and carefully edited and proofread. Edit date: 2025