This introduction to the themed special issue raises provocative questions about the nature and meaning of co‐production by engaging specifically with voices from the margins – groups and individuals who occupy marginalised embodied subjectivities. Key themes emerging from the papers raise questions about the nature and meaning of co‐production. We suggest a need to move away from a focus on co‐production or even participation towards empowerment and inclusivity. We urge researchers to be explicit about the meaning of the terms “participation” or “co‐production” to think critically about the “communities” with whom we research and how research forges positive social change.

Link worker social prescribing has become a prominent part of NHS England's personalisation agenda. However, approaches to social prescribing vary, with multiple discourses emerging about the potential of social prescribing and different interpretations of personalisation. The transformational promise of social prescribing is the subject of ongoing debate, whilst the factors that shape the nature of front-line link working practices remain unclear. Based on 11 months of in-depth ethnographic research with link workers delivering social prescribing, we show how link workers' practices were shaped by the context of the intervention and how individual link workers navigated varied understandings of social prescribing. Following the work of Mol, we showhow link workers drew differentially on the interacting logics of choice and care and trace a multiplicity in front-line link working practices within a single intervention. However, over time, it appeared that a logic of choice was becoming increasingly dominant, making it harder to deliver practices that aligned with a logic of care. We conclude that interpreting personalisation through a logic of choice could potentially undermine

Funding informationEuropean Social Fund.The care of older people is being radically reformulated by placing the individual at the centre of care process through the introduction of individual care plans. This marks a significant transition for the care of older people away from acute responsive clinical care towards a greater emphasis on co-produced preventative health and social care and relations of care "with" older people. Geographies of volunteerism are yet to consider the effect of co-production as a dominant rhetoric in UK health and social care. In this paper we show that the Health and Social Care Act (2012) and the Care Act (2014) has the potential to fundamentally alter discourses of care by introducing new spatialities to older people's care. New spatialities of care will not only rely on the reciprocity and interdependence of care between individuals and organisations but also the mobilisation of a voluntary care-force to be attentive to individuals. Spatialising co-production reveals the institutional and professional boundaries that prevent the type of open partnership that sits at the heart of the rhetoric. Our ethnographic and qualitative methodology was developed to understand how our case study of Living Well (Cornwall, UK), as a philosophy of care, is realised in practice and to consider the main collaborators' views of different methods of co-production involving volunteers. We discuss two principal spaces of co-production, highlighting the opportunities provided for, and barriers to, co-production expressed by volunteers and other partners by attending to the relations of care that are recognised through: (1) formal meetings and coffee mornings, which provide spaces for volunteers to contribute, and (2) multi-disciplinary team (MDT) meetings, in which volunteers are largely absent.

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Background Link worker social prescribing enables health-care professionals to address patients’ non-medical needs by linking patients into various services. Evidence for its effectiveness and how it is experienced by link workers and clients is lacking. Objectives To evaluate the impact and costs of a link worker social prescribing intervention on health and health-care costs and utilisation and to observe link worker delivery and patient engagement. Data sources Quality Outcomes Framework and Secondary Services Use data. Design Multimethods comprising (1) quasi-experimental evaluation of effects of social prescribing on health and health-care use, (2) cost-effectiveness analysis, (3) ethnographic methods to explore intervention delivery and receipt, and (4) a supplementary interview study examining intervention impact during the first UK COVID-19 lockdown (April–July 2020). Study population and setting Community-dwelling adults aged 40–74 years with type 2 diabetes and link workers in a socioeconomically deprived locality of North East England, UK. Intervention Link worker social prescribing to improve health and well-being-related outcomes among people with long-term conditions. Participants (1) Health outcomes study, approximately n = 8400 patients; EuroQol-5 Dimensions, five-level version (EQ-5D-5L), study, n = 694 (baseline) and n = 474 (follow-up); (2) ethnography, n = 20 link workers and n = 19 clients; and COVID-19 interviews, n = 14 staff and n = 44 clients. Main outcome measures The main outcome measures were glycated haemoglobin level (HbA1c; primary outcome), body mass index, blood pressure, cholesterol level, smoking status, health-care costs and utilisation, and EQ-5D-5L score. Results Intention-to-treat analysis of approximately 8400 patients in 13 intervention and 11 control general practices demonstrated a statistically significant, although not clinically significant, difference in HbA1c level (–1.11 mmol/mol) and a non-statistically significant 1.5-percentage-point reduction in the probability of having high blood pressure, but no statistically significant effects on other outcomes. Health-care cost estimates ranged from £18.22 (individuals with one extra comorbidity) to –£50.35 (individuals with no extra comorbidity). A statistically non-significant shift from unplanned (non-elective and accident and emergency admissions) to planned care (elective and outpatient care) was observed. Subgroup analysis showed more benefit for individuals living in more deprived areas, for the ethnically white and those with fewer comorbidities. The mean cost of the intervention itself was £1345 per participant; the incremental mean health gain was 0.004 quality-adjusted life-years (95% confidence interval –0.022 to 0.029 quality-adjusted life-years); and the incremental cost-effectiveness ratio was £327,250 per quality-adjusted life-year gained. Ethnographic data showed that successfully embedded, holistic social prescribing providing supported linking to navigate social determinants of health was challenging to deliver, but could offer opportunities for improving health and well-being. However, the intervention was heterogeneous and was shaped in unanticipated ways by the delivery context. Pressures to generate referrals and meet targets detracted from face-to-face contact and capacity to address setbacks among those with complex health and social problems. Limitations The limitations of the study include (1) a reduced sample size because of non-participation of seven general practices; (2) incompleteness and unreliability of some of the Quality and Outcomes Framework data; (3) unavailability of accurate data on intervention intensity and patient comorbidity; (4) reliance on an exploratory analysis with significant sensitivity analysis; and (5) limited perspectives from voluntary, community and social enterprise. Conclusions This social prescribing model resulted in a small improvement in glycaemic control. Outcome effects varied across different groups and the experience of social prescribing differed depending on client circumstances. Future work To examine how the NHS Primary Care Network social prescribing is being operationalised; its impact on health outcomes, service use and costs; and its tailoring to different contexts. Trial registration This trial is registered as ISRCTN13880272. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme, Community Groups and Health Promotion (grant no. 16/122/33) and will be published in full in Public Health Research; Vol. 11, No. 2. See the NIHR Journals Library website for further project information.