Very limited evidence for overall effectiveness of social prescribing health policy

Term also helps to promote idea that every problem can be solved with a prescription

There’s very limited evidence for the overall effectiveness of social prescribing--a key plinth of UK government health policy, concludes an editorial in the latest issue of the Drug and Therapeutics Bulletin (DTB).

The term also helps to promote the idea that every problem can be solved with a prescription, suggests DTB deputy editor, David Phizackerley.

Social prescribing enables primary care health professionals to refer people to a link worker for access to non-medical services to enable them to take greater control of their health.

In England, the reconfiguration of the NHS has created primary care networks: groups of general practices providing integrated health and social care services in primary care.

These networks will be funded to employ 1,000 social prescribing link workers, who will be expected to be making upwards of 900,000 referrals by 2023-24 to local services, the author points out.

These might include exercise, education, books, art, healthy living and green gyms (outdoor exercise) on prescription. But there are many other activities provided by voluntary organisations that could also be prescribed.

“For some of the interventions, there are reported benefits in participants’ self esteem and confidence, sense of control and empowerment, and psychological and mental wellbeing,” writes the author.

“However, overall, the evidence on the effectiveness of social prescribing and many of the prescribed interventions is very limited,” he continues.

He cites a report by health think tank, The King’s Fund, which concluded that the published research on social prescribing tends to involve small numbers of participants, lack comparison groups, and provide little hard data on outcomes.

“It has also been noted that much of the evidence is based on evaluations of pilot projects and did not allow assessment of success or cost effectiveness,” he adds.

Whether social prescribing will curb demand for other primary and community health services is unknown, he says. And there are little or no data on the possible side effects either.

Helping people to access non-medical interventions to better manage their health “seems eminently sensible,” he suggests.

“Unfortunately, social prescribing and the individual interventions are still hampered by a lack of robust high quality evidence of efficacy and effectiveness.”

What’s more, there’s a risk that social prescribing “will be expected to provide a low cost solution to many complex societal problems,” he adds.

He also questions the term itself. 

“The use of the words ‘prescribing,’ ‘prescription,’ and ‘referral’ reinforces the medical model, suggests that healthcare professionals and social prescribers are also gatekeepers to a menu of interventions, and perhaps perpetuates an expectation that every problem requires a prescription.”

In line with DTB’s own history of evidence based assessments of treatments, devices, and interventions, he writes: “We believe that it is reasonable to expect that interventions are supported by high quality evidence showing that they make a significant difference to patients.”

29/08/2019

Notes for editors
Editorial: Social prescribing: right idea, wrong name? Doi 10.1136/dtb-2019-000046
Journal: Drug and Therapeutics Bulletin

Link to AMS labelling system: https://press.psprings.co.uk/AMSlabels.pdf

Peer reviewed? Yes
Evidence type: Opinion
Subjects: UK government health policy

Link to editorial: https://dtb.bmj.com/content/57/9/130