Social prescribing: less rhetoric and more reality. A systematic review of the evidence

Abstract

ObjectivesSocial prescribing is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted and adopted in the UK National Health Service and so we conducted a systematic review to assess the evidence for their effectiveness.Setting/data sourcesNine databases were searched from 2000 to January 2016 for studies conducted in the UK. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. All the searches were restricted to English language only.ParticipantsSystematic reviews and any published evaluation of programmes where patient referral was made from a primary care setting to a link worker or facilitator of social prescribing were eligible for inclusion. Risk of bias for included studies was undertaken independently by two reviewers and a narrative synthesis was performed.Primary and secondary outcome measuresPrimary outcomes of interest were any measures of health and well-being and/or usage of health services.ResultsWe included a total of 15 evaluations of social prescribing programmes. Most were small scale and limited by poor design and reporting. All were rated as a having a high risk of bias. Common design issues included a lack of comparative controls, short follow-up durations, a lack of standardised and validated measuring tools, missing data and a failure to consider potential confounding factors. Despite clear methodological shortcomings, most evaluations presented positive conclusions.ConclusionsSocial prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money. If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost.Trial registration numberPROSPERO Registration: CRD42015023501.

Social prescribing: coffee mornings, singing groups, and dance lessons on the NHS

“…A systematic review of 15 evaluations of UK programmes in 2000-16 that referred patients from primary care to a facilitator found that most evaluations were of poor quality and likely to be biased 14. The researchers found no evidence that schemes were ineffective but said that they could not judge whether any of the schemes showed promise.…”

Social prescribing: community-based referral in public health

“…Of those schemes with evaluation (n=40), 17 employed quantitative methods which included eight randomised controlled trials, 16 employed qualitative methods and seven employed mixed methods. In another review of 15 evaluations of social prescribing programmes, most were reported as being limited by poor design and rated as a having a high risk of bias (Bickerdike et al 2017). In a review of the evidence of social prescribing to reduce the demand for health services and its cost implications, evidence revealed considerable reduction in demand on primary and secondary care, but concluded that the quality of evidence is weak, and without further evaluation, it is be premature to conclude that a proof of concept for demand reduction had been established .…”

Helen Salisbury: Social prescribing and the No 17 bus

“…Evidence for the efficacy of social prescribing is thin,2 with no sign of the rigorous testing before rollout that we would expect from a medical intervention. In a head to head trial, I think that I’d back the No 17 bus.…”