This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Social prescribing led to slight improvements in blood sugar control for people with type 2 diabetes, but for clinical outcomes was not shown to be good value for money, research found. Improvements in blood sugar control were statistically significant but not clinically meaningful.
Social prescribing helps people access health and community services to improve their health and well-being. Numbers of social prescribers are increasing in the NHS, but to date, the impact of the role has not been widely studied. Researchers therefore examined the medical records of people with type 2 diabetes. They interviewed and observed social prescribers and patients, and ran focus groups. The study also evaluated value for money.
Blood sugar control was slightly better with social prescribing but other health measures were unchanged. When support matched the needs of the person, social prescribing could help people make positive changes and deal with social and health-related problems. But providing the right support could be time-consuming and challenging. It also cost more than usual care. The experience of social prescribing depended on client circumstances.
The study describes the challenges social prescribers face – balancing heavy workloads with meeting targets – as well as costs and outcomes for people with type 2 diabetes. The findings indicate that good planning, integration with local community groups, and well-funded public and voluntary sector services could help.
The findings could help commissioners plan and implement social prescribing.
For more information about social prescribing, visit the NHS website.
The issue: is social prescribing effective and how is it experienced?
Poverty, unemployment, and other stressors which are not medical can impact people’s health and wellbeing.
According to a 2015 Citizens Advice report, one-fifth of GPs’ time is spent on non-medical matters such as relationship problems or housing issues. Social prescribing aims to reduce this workload. Healthcare professionals refer people to a social prescriber to help them access community services (such as exercise classes and welfare rights). People discuss their problems and goals with social prescribers, and together they find solutions to improve health and well-being.
According to the NHS Long Term Plan, social prescribing is being rolled out as part of the NHS Personalised Care Model, aiming to reach 2.5 million people by 2023/24. But its effectiveness has not been widely studied. Researchers therefore explored the impact and value for money of social prescribing for adults with type 2 diabetes. They considered how social prescribing was delivered and how patients engaged with it.
What’s new?
The researchers examined the medical records of 8,357 adults between 2015 and 2019. They were aged 40 – 74 and had type 2 diabetes. 24 general practices, in a disadvantaged area of North East England, took part. Just over half (13) provided social prescribing; 11 did not.
Researchers compared health measures for people who received social prescribing, with those who did not.
The findings showed that:
- people who received social prescribing had slightly better blood sugar control than those who did not (a statistically significant improvement which was not clinically meaningful)
- other health measures (including high blood pressure, body mass index and cholesterol) were similar, whether or not people received social prescribing.
During the course of the study, people received an average of 2 years of social prescribing, and it cost an extra £1345 per person (on average) more than usual care.
The researchers interviewed 20 social prescribers and 19 service users, and observed them over 20 months. They also conducted focus groups with 16 social prescribers.
Staff perspectives
Approaches to social prescribing varied. Some approaches provided intensive support; others were lighter touch and emphasised empowerment. Over time, there was a switch away from intensive support towards empowerment, partly because meeting targets became more important under the funding model.
Some social prescribers said targets for referrals and assessments were a barrier to providing one to one support. They often defined success as an increase in a patient’s confidence or a reduction in the support they needed, rather than a change to clinical measures such as blood sugar control. During the pandemic, many social prescribers helped people source food, medicines and financial support.
Service user perspectives
People described support to attend appointments, including reminders. In some cases, a social prescriber attended with them. Social prescribers provided both practical and emotional support. The partner of one service user said: ‘Sort of practical help that he was offering as well as the just having somebody to talk to ... and just reinforce the healthy eating side of things.’
Some service users received little support and had no follow-up after an initial phone call. Frequency of contact varied and lack of follow-up could reduce service users’ engagement with advice.
Why is this important?
Social prescribing led to a small but significant improvement in blood sugar control in people with type 2 diabetes (compared to those who did not receive it). But it did not improve blood pressure, body mass index or cholesterol. Social prescribing provided other benefits, such as facilitating connections with community services that support health and well-being. But social prescribing was challenging to deliver, its effects were difficult to measure and varied from patient to patient.
Social prescribing is about more than improved markers of disease (such as blood sugar levels); it aims to tackle social and behavioural contributors to disease. But this needs to be balanced against the cost to the NHS.
Some of the health outcomes explored (for instance body mass index and cholesterol) might not have been recorded accurately, the researchers caution. The sample size was also not as large as originally intended because 7 practices did not share their data. The study was carried out in a single area of England, so findings might not be generalisable elsewhere.
Participants lost to follow-up were more likely to be living in the most deprived areas and from ethnic minority groups. Given that these groups were more likely to benefit from social prescribing, the findings might underestimate the true impact of the intervention.
What’s next?
Claims that social prescribing can reduce health inequalities are premature, but social prescribing can reduce pressures on clinical staff by managing non-medical queries and helping to improve wellbeing.
For social prescribing to be effective, the type and amount of support available needs to align with client need. Providing the right support is time consuming and some social prescribers struggled because of their high caseload of people living in difficult circumstances.
The researchers say that effective social prescribing in primary care takes:
- careful planning
- integration with local community groups
- well-funded public and voluntary sector services.
The researchers met with the charity, National Academy of Social Prescribing, to discuss and map the ongoing research needed to evaluate social prescribing.
You may be interested to read
This summary is based on: Moffat S, and others. Impact of a social prescribing intervention in North East England on adults with type 2 diabetes: the SPRING_NE multimethod study. Public Health Research 2023; 11 (2).
A paper summarising the perspectives of social prescribers and service users: Pollard T, and others. Implementation and impact of a social prescribing intervention: an ethnographic exploration. British Journal of General Practice 2023; 73: e789 – e797.
A paper describing the effect of a social prescribing programme in type 2 diabetes: Wildman J, Wildman JM. Evaluation of a community health worker social prescribing program among UK patients with type 2 diabetes. JAMA Network Open 2021; 4: e2126236.
Funding: This study was funded by the NIHR Public Health Research Programme.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
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