How can social prescribing put communities at the heart of healthcare?

A new report, commissioned by Local Trust, explores the potential for greater community involvement in, and leadership of, social prescribing in England – drawing on the experiences of Big Local areas. Here Local Trust’s research manager, Lucy Terry, reflects on what’s needed to put communities at the heart of healthcare.

What is social prescribing?

Social prescribing is a term for giving people a non-medical ‘prescription’ to something that will improve their health.  

It’s a process in which a healthcare practitioner (often one based in a GP surgery) connects patients with non-medical support, typically at a community or neighbourhood level. This kind of support could be arts-based, a social activity, a form of physical exercise, or information and advice.  

These are all things that Big Local areas and other community groups provide in abundance – whether or not the healthcare system is involved.  

Yet it’s useful to consider the specific role of the NHS.

Exploring the connection between social prescribing and community-led action

In England, a version of social prescribing has been embedded within primary care since 2019.

In theory, this creates opportunities for Big Local areas to work with their local, GP-based social prescribers to identify opportunities for patients to access Big Local activities, and in turn to shape the activities they deliver in response to local healthcare needs and insight.

But in practice, mainstream social prescribing in the NHS seems to have largely worked at the individual level and has not engaged hugely with the community sector.

This is despite substantial evidence for the links between positive health outcomes and community development, as outlined in the 2010 Marmot review and more recently in our work with the NHS Confederation, which notes the importance of a neighbourhood-level approach to preventative healthcare.

Social prescribing, community-led action and Big Local

To explore the links between social prescribing, community-led action and the Big Local programme, Local Trust commissioned new research in late 2023.

We worked with the National Academy of Social Prescribing (NASP) and the Centre for Regional Economic and Social Research (Sheffield Hallam University) to find out more about what community-led social prescribing is, the benefits and the challenges.

This week, the research was published in the report: Community-led Social Prescribing – Lessons from Big Local and Beyond. It defines community leadership of social prescribing as being:

“where residents have been able to influence and/or take a lead in the design, delivery and evaluation of local social prescribing programmes, based on residents’ needs and identified solutions.”

As part of the research, twelve Big Local areas were interviewed, and their perspectives are featured in the report.

The research found that Big Local areas are delivering a range of activities in this space, including taking the lead on new and ambitious projects. These activities include:

• Accepting referrals from social prescribing link workers to existing Big Local activities
• Providing office space to social prescribing services
• Setting up new groups and activities to meet local health needs, which have clear links to social prescribing – for example, the community shed run by one Big Local area.

“A lot [of the work of the Big Local partnership] was informal social prescribing. We partnered with the GP practice so they could refer into those type of things. Because before people [thought it was] just a coffee session, just an activity, just a walk. And we realised it’s not just a walk; it’s good for physical and mental health. It’s good for supporting people with social isolation.”

Big Local partnership member and former worker

These initiatives can work well in expanding residents’ awareness of, and the number of people supported by, a Big Local area – especially when local health stakeholders are supportive.

For example, in Bolton, Tonge with the Haulgh Big Local developed a women-only arts and wellbeing space following a consultation in 2015. The Big Local worker at the time approached a local GP surgery, proposing that this could be a group into which surgery patients who were experiencing chronic pain could be prescribed.

The eventual success of the scheme benefited in part from a proactive and interested GP, who wrote to patients who might benefit from the group, and the fact the group initially met at the health centre, before moving to a community space after the COVID-19 pandemic.

Passing funding to communities and developing stronger relationships

There are also challenges for communities working with health systems. Some groups told the researchers they had received a large number of referrals to small-scale activities, to a point which was unsustainable, as referrals are not routinely accompanied by any extra funding.

Other interviewees said they had had concerns about the appropriateness of referrals, and that community workers needed to do their own safety checks for both the individual being referred and the group.

“I think people still think you can get something for nothing with communities which I don’t think is fair … But I think [the] community delivering, with support, activities that are needed locally is a great idea and I think it is also a way that you will get those volunteers of tomorrow through the door in some way, shape or form.”

Big Local partnership member

This suggests a need for stronger dialogue and mutual understanding between GPs and other health professionals, social prescribing link workers, and community organisations. The background behind this is that all too often, social prescribing link workers are not sufficiently resourced to spend time building relationships and knowledge of the local community sector.

This, and the fact that funding for community activities is not accompanying the increase in demand, are two of the challenges which this new research identifies.

In order to see stronger community leadership in the social prescribing space, funding needs to be passed down to communities, and referrals into community activity need to be accompanied by link workers developing relationships with community groups.

Then, we might see a way forward for the broader goal of putting communities at the heart of healthcare.

Community-led Social Prescribing – Lessons from Big Local and Beyond is available to read and download on the NASP website.