Social prescribers not sufficiently targeted to areas with highest need, study finds

The rollout of social prescribing link workers has not been ‘sufficiently targeted’ to areas with the highest need, according to a study in the BJGP.

The research, called Geographic inequalities in need and provision of social prescribing link workers a retrospective study in primary care, looked at workforce, population, survey and area-level data at PCN-level from April 2020 to October 2023, and assessed whether the employment of the role was in the areas of highest need.

Researchers at the University of Manchester found that initially there was no association between need and provision, but from July 2022, this became ‘negative and significant’.

By October 2023, researchers said that a 10 percentage point higher need for support was associated with a 0.035 lower full-time equivalent per 10,000 patients.

Social prescribing link workers are employed by PCNs through the ARRS scheme, with over 2,800 employed across England as of May 2024. They are the third most popular hire through the scheme, after pharmacists and care coordinators.

The authors concluded: ‘There are geographical inequalities in provision, with some areas of England having very low levels of link worker employment. With the results highlighting link workers being rolled out in areas of lower need, this highlights the necessity for a more targeted approach. This could be achieved through understanding the local PCN needs better and what their barriers are to employing link workers.’

They added that PCNs covering deprived areas require additional support to recruit and retain link workers. But it said that funding was only one part of the issue, with partnerships between the voluntary sector also important.

‘For an optimal social prescribing pathway to function, adequate voluntary and charity sector infrastructure is necessary to support local population needs. PCNs need to work closely with the local community to identify sources of support and services that match patients’ needs,’ the authors said.

‘These onward referral destinations also need to be funded not only to meet the demand for services but also to ensure the long-term economic sustainability of social prescribing as a whole.’  

Chief executive of the National Academy for Social Prescribing, Charlotte Osborn-Forde, said: ‘There is now a wide range of evidence to show that social prescribing can benefit wellbeing, mental health and social connection, reduce loneliness and have a positive impact on a range of physical health conditions. Studies consistently show a positive social return on investment, delivering between £2.14 and £8.56 for every £1 invested.

‘While there has been good progress on rolling out link workers across England, the NIHR study suggests that there is more to do to ensure that areas experiencing most deprivation can benefit. The study only focuses on ARRS-funded link workers rather than those commissioned elsewhere, so it doesn’t paint a complete picture of social prescribing services available in an area, but it’s important to look at what the barriers are to recruitment and how to address these.

‘The Network Contract DES guidance requires social prescribing services to take targeted, outreach approaches to support those most in need – and there excellent examples of this happening across the country.’