Social prescribing, evidence and progress; the view from England

Social prescribing enables primary care to refer individuals with health and/or social issues to a ‘link worker' whom provides ‘holistic' support to patients and refers them to further agreed non-clinical activities (e.g. walking group) and/or social services (e.g. housing). Social prescribing has the potential to help managing or addressing a wide range of health and social issues, particularly pertinent in a pandemic and post pandemic world, centred around individual choice, and based on maximising the asset offered by the voluntary sector. Yet, evidence and policy development have gone hand in hand, and sometimes in reverse in England. The NHS made a good case and rationale for implementing social prescribing before the concomitant evidence base had rigorously proven its impact. Researchers are now in a position of trying to evidence (and communicate what good evidence might be) whether what has been rolled out works, in what ways, and for whom. In contributing to the development of the evaluation of social prescribing, the main challenge experienced was that what counts as good evidence depends entirely on ‘what is meant' by social prescribing. Social prescribing was found to be a pathway consisting of a set of relationships and set of activities/complex interventions as part of that pathway, therefore asking ‘what works' is not trivial. So, for the patient pathway there is a need for robust, well conducted evidence syntheses from different parts of the pathway, good qualitative work around the experiences of referrers and individuals, secondary data analysis of the health service use, effectiveness work on the activities themselves, all crucially underpinned by strong data monitoring and capture. Working with a very broad range of stakeholders (commissioners, healthcare providers, activity providers, link workers, and individuals with lived experience) goes some way to communicating this complexity and helping base decisions on the most appropriate evidence.

Physical activity and the prevention, reduction, and treatment of alcohol and other drug use across the lifespan (The PHASE review): A systematic review

The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval -0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings.

Mapping, guiding, and assessing social prescription services in the UK

Background

The use of non-health service referral, or ’social prescribing’ interventions have been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. We are generating theory through review and primary data collection relating to the social prescribing system, how to maximise the benefits of this system and how it might be implemented.

Methods

A realist synthesis and evaluation. Working with three UK case-sites who are all at various stages in the process of setting up social prescription services, we are conducting patient pathway analyses, focus groups, and interviews. An important component of this work is iterative, targeted reviews of the literature relating to these pathways and identified mechanisms to assess effectiveness and reach.

Results

The study is ongoing; however, we are testing prototype theory generated in a previous realist review (presented last year) and elaborating on which mechanisms within each pathway relate to suitable population types and aspects of wellbeing.

Conclusions

We aim to draw together service delivery practitioners, users, researchers and clinicians to create specified theory for setting up social prescription services. This guidance will be context sensitive and make recommendations for increasing acceptability and spread of complex system service delivery and interventions.

Key messages

We are building highly specified, context sensitive system specification and ‘lessons learned’ implementation guidance for social prescribing programmes in the UK. We are producing these outputs through collaborative partnerships with services delivering programmes as they develop, using realist evaluation and qualitative comparative methods.