Social prescribing is a new approach that aims to improve individuals' health and wellbeing by addressing non-medical needs such as loneliness. Social prescribing initiatives running in England’s National Health Service typically involve healthcare professionals referring people who might benefit from a non-medical community service to a “link worker”. The link worker will then meet with the patient to find out what support they need, develop an action plan together, and link the patient to the relevant community resources. This approach aligns with a shift towards recognising the impact of wider social, economic, behavioural and environmental factors affecting health and aims to address the rising issue of overmedication.
It is important to understand who has access to social prescribing, and why, to understand how it is being used, whether it improves health, and whether it might make existing inequalities in health better or worse. We will describe the characteristics of patients who receive a social prescription, the reasons for the prescription, and whether the prescription is accepted or declined by the patients. A first step to understanding the effectiveness of social prescribing involves the relationships between social prescribing and healthcare use and health outcomes. Once we have looked at the characteristics of those who are offered a social prescription, we will assess whether there are any changes in patients’ medication prescription or more general healthcare use and health outcomes in those who have been offered social prescribing.
The aim of this study is to describe how social prescribing is used in England in terms of the patients who receive this, the geographical areas where social prescriptions are given and whether prescribing has changed over time. A cohort of people over 18 years who have received a social prescription after 1/1/2021 and have at least six months of data in CPRD Aurum before their social prescription will be included. The dataset will be linked to the patient level index of Multiple Deprivation Domain in order that any differences between levels of socioeconomic status and social prescribing can be highlighted.
Social prescribing is the primary exposure and while the focus is descriptive analyses, the primary outcomes are measures of healthcare usage in terms of numbers of pharmacological prescriptions, healthcare appointments and diagnoses received following the social prescription compared with the 6 months before. The people within the cohort will be described in terms of their demographics, pharmacological prescriptions and diagnoses. If there is a record suggesting that the social prescription has been refused, this will be reported. Comparisons will be made descriptively and using Poisson regression to determine if there is evidence for an effect of the social prescription in changing levels of healthcare uptake or prescription counts or new diagnoses being made. As well as comparing the impact of the social prescription on an individual’s healthcare use, comparisons will also be made with a group who have an NHS Health Review or housing consultation but who do not receive a social prescription. The impact of this work for public health is in giving an overview of the use of social prescribing in England and find areas where social prescribing is having an effect on use of healthcare resources. Any disparities by ethnicity or socioeconomic group will be described.
Healthcare use
• Total number of primary care healthcare appointments
• Referrals to secondary care
• ‘Did not attend’ primary care appointments
Prescribing
• Number of prescriptions for antidepressants, anxiolytics, hypnotics or other mental health prescribing.
• Number and profile of prescriptions for pain management
• Number of prescriptions for hypertension, diabetes, and total number of prescriptions for long term conditions.
Health outcomes
• Incidence of new common mental health condition (first record of a diagnosis or symptom of depression or anxiety)
• Incidence of new diagnosis of diabetes
• Among patients with a baseline diagnosis of diabetes, glycaemic control (HbA1C level)
• Incidence of new diagnosis of hypertension
• Among patients with a baseline diagnosis of hypertension, blood pressure control (blood pressure levels)
• Incidence of falls
• Warwick Edinburgh Wellbeing score
Anita McGrogan - Chief Investigator - University of Bath
Estelle Corbett - Corresponding Applicant - University of Bath
Helen McDonald - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Julie Barnett - Collaborator - University of Bath
Saoirse Fitzgerald - Collaborator - University of Bath
Patient Level Index of Multiple Deprivation