New research from RCSI University of Medicine and Health Sciences reveals there is limited evidence to show that social prescribing is effective.

Published in BMJ Open, the study found no consistent evidence that social prescribing improves social support, physical function, or reduces use of primary health services, and only limited evidence that it improves subjective assessment of personal health or quality of care received.

Social prescribing is a way of linking people with complex needs to non-medical support in their local community as part of a holistic approach to care. GPs 'prescribe' social activities or supports for people instead of medication, usually making a referral to a social prescribing link worker who works with the patient to make a personal plan or 'social prescription'. This might include joining community groups or simpler changes like doing more exercise.

Social prescribing is a rapidly evolving field and gaining momentum, with the Irish health service rolling out social prescribing link workers in disadvantaged areas and recommending them for people with mild mental health problems or more than one health condition. Despite widespread use in the UK, however, previous reviews show little evidence that link workers make a difference there.

In this study, the researchers systematically reviewed the evidence on effectiveness and costs of the link worker model of social prescribing internationally, to establish the evidence, if any, on how well this approach works in people with several coexisting health conditions and who are living in deprived communities.

They searched 11 research databases for relevant comparative (controlled) clinical trials, as well as 'grey literature', such as government reports and conference proceedings, published up to July 2021.

The search generated eight studies, involving 6,500 people. Five were randomised controlled trials; three were controlled before and after studies; one reported the economic evaluation of an included trial. Four included people with several coexisting conditions and who were living in deprived communities. Three studies were from the US; five were from the UK.

The intervention periods ranged from 1 month to 2 years, with most lasting 3 to 9 months. Few studies reported on link worker caseload or number of contacts. Resources to which clients were signposted included counselling services, social and craft groups, exercise classes, addiction support services, and welfare and employment advice.

Four studies (2,186 participants) found that social prescribing made no difference to health-related quality of life. Of the four (1,924 participants) reporting mental health outcomes, three found no impact for social prescribing.

Of the four studies that reported a measure of physical activity and function, one found an improvement in functional health; two found no evidence of a difference in activities of daily living or physical activity; and one found a reduction in routine activities.

Of the four studies reporting on primary healthcare use, one reported a reduction in primary care attendance in the intervention group, but the comparison group was very different. Of the remainder, two found no evidence of a change in use, while one US-based study found that attendance actually increased.

Two US studies found that clients rated the quality of their care more highly and that social prescribing reduced hospital admissions for people with several co-existing conditions and who were socially isolated.

However, none of the studies included in the review formally analysed cost effectiveness. And while one study found that healthcare costs fell because of fewer referrals, these savings didn’t offset the costs of the intervention itself, indicating that social prescribing is more expensive than usual care.

The limited number of studies and the wide variations in study design, study participants, and interventions precluded a pooled data analysis of the results of the eight studies, so weakening the strength of the review findings, caution the researchers.

Dr Bridget Kiely, RCSI Department of General Practice and lead author on the paper, said: "Policymakers need to be aware that there is insufficient evidence to assess the effectiveness of social prescribing link workers. Our systematic review suggests that link workers providing social prescribing may have little or no impact on health-related quality of life, mental health or a range of patient-reported outcomes, although they may improve self-rated health.

"The opportunity costs of investing in social prescribing link workers are unknown and it is essential that high-quality trials determining cost-effectiveness are conducted so that the evidence can catch up with the policy and to avoid wasting valuable time and resources."