What does the literature mean by social prescribing? A critical review using discourse analysis

Abstract

Social prescribing (SP) seeks to enhance the role of the voluntary and community sector in addressing patients' complex needs in primary care. Using discourse analysis, this review investigates how SP is framed in the scientific literature and explores its consequences for service delivery. Theory driven searches identified 89 academic articles and grey literature that included both qualitative and quantitative evidence. Across the literature three main discourses were identified. The first one emphasised increasing social inequalities behind escalating health problems and presented SP as a response to the social determinants of health. The second one problematised people's increasing use of health services and depicted SP as a means of enhancing self‐care. The third one stressed the dearth of human and relational dimensions in general practice and claimed that SP could restore personalised care. Discourses circulated unevenly in the scientific literature, conditioned by a wider political rationality which emphasised individual responsibility and framed SP as ‘solution’ to complex and contentious problems. Critically, this contributed to an oversimplification of the realities of the problems being addressed and the delivery of SP. We propose an alternative ‘care‐based’ framing of SP which prioritises (and evaluates) holistic, sustained and accessible practices within strengthened primary care systems.

Systematic review of social prescribing and older adults: where to from here?

“…Social prescribing may provide a structured approach for PCPs to address social needs in primary care while providing access to resources, such as community link workers and non-medical community services. As per the work by Calderón-Larrañaga and colleagues, 9 future work should determine if and how social prescribing impacts peoples' lives. Furthermore, given the complexity of social prescribing, it is important to understand how the outcomes assessed are affected by the context in which social prescribing is delivered.…”

“…They propose social prescribing 'as a solution' should refocus from impacting the healthcare system to 'evaluating the extent to which SP may (or may not) succeed to support people in greatest need while contributing to stronger, fairer healthcare systems' (p.863). 9 What does social prescribing look like in practice? Although there is no one accepted definition (or operationalisation) for social prescribing, there are at least four primary care pathways with varying levels of support and interactions.…”

“…6 Other research highlights smaller scale social prescribing initiatives outside of the UK, such as in Australia 7 and Canada. 8 In a recent discourse analysis, Calderón-Larrañaga and colleagues 9 summarised three main conceptualisations with potential limitations for social prescribing. These include to: (1) reduce the burden of unmet social needs by shifting non-medical care to the social and community sector; (2) reduce the heavy workload experienced by primary care providers (PCPs) by empowering people’s self-management skills; and (3) support delivery of personalised care in primary care.…”

“…They propose social prescribing ‘ as a solution ’ should refocus from impacting the healthcare system to ‘ evaluating the extent to which SP may (or may not) succeed to support people in greatest need while contributing to stronger, fairer healthcare systems ’ (p.863). 9 …”

“…These include to: (1) reduce the burden of unmet social needs by shifting non-medical care to the social and community sector; (2) reduce the heavy workload experienced by primary care providers (PCPs) by empowering people’s self-management skills; and (3) support delivery of personalised care in primary care. They propose social prescribing ‘ as a solution ’ should refocus from impacting the healthcare system to ‘ evaluating the extent to which SP may (or may not) succeed to support people in greatest need while contributing to stronger, fairer healthcare systems ’ (p.863) 9…”