A new review, published in the BMJ Open (Kiely et al, 2022), found that there is no consistent evidence that social prescribing improves social support or physical function, or reduced the use of primary care services. I previously talked about social prescribing in my September editorial where new socially prescribed schemes were being trialled in 11 different areas across the UK (Allaway, 2022). This new report details just why this trial might not be the effective and thought-through scheme the health services were hoping.
The study examined eight studies involving 6500 people. Four studies involving 2186 people found that social prescribing did not affect health-related quality of life.
Meanwhile, three of the four studies that reported mental health outcomes on 1924 participants found no impact on social prescribing. In addition, only one of the four studies reporting on primary healthcare use found a decrease in primary care attendance in the intervention group. Two of the remaining studies found no evidence of a change in usage, while one from the US discovered an increase in attendance.
The authors conclude that ‘[the] link workers providing social prescribing may have little or no impact on health-related quality of life, mental health or a range of patient-reported outcomes though they may improve self–rated health’ (Kiely et al, 2022). This is likely not to be the outcome the currently trialed social prescribing scheme was looking for. Given how overwhelmed our health services currently are, alongside the recent turmoil within our government, with its ever-changing and questionable choices for health secretary, I'm sure the hope was any social prescribing that could be used would not only alleviate the pressures on the NHS, but also improve the overall health and wellbeing of the public. One of the key issues that are currently being flagged as a reason for social prescribing not achieving its targets is the leadership and training that exists in the field. The review concluded that ‘There are certainly reasons for thinking in principle that it might be useful and could save money, but only when it is given by competent people that are adequately trained and have a clear therapeutic policy… At present, there is a hotchpotch of general advice, case management, signposting and counselling that leads to great heterogeneity and confusion’ (Kiely et al, 2022).
There is hope that social prescribing might develop into a more promising and formalised process, but the version that currently exists, which is being as much more of a crutch to try and support primary care services simply isn't hitting the mark. There is a danger within this process, that unregulated, informal social prescribing advice may do more harm than good. You can read some of the current reactions to this BMJ Open paper by visiting the Science Media Centre: https://www.sciencemediacentre.org/expert-reaction-to-review-on-the-effect-of-social-prescribing-on-health-outcomes-in-primary-care-and-community-settings/.
There is some good intention behind the concept of social prescribing. An effort to stabilise and improve the general mental health and wellbeing of the UK has to be a noble one, however, without compelling and researched guidance led by professionals, this scheme will continue to draw criticism from the medical community and the public alike, who may very well just see this as a way to keep them distant from healthcare services.