Does GP Referral to Gardening Clubs Work?

It’s been 5 years since social prescribing was embraced by NHS England in its 2019 long-term plan. The idea was to give GPs the ability to refer people without a medical need to a “social prescribing link worker” who would be better placed to help them. It would also reduce pressure on GPs.

It’s widely been estimated that a fifth of GP appointments are for social issues like loneliness and isolation or from people with other multiple long-term conditions or complex needs.

Social prescribing can connect people to non-medical support to address these issues. Examples of social prescribing schemes include art, gardening and befriending groups, healthy eating or financial advice classes, as well as fitness and sports activities and dementia choirs. 

Is Social Prescribing Effective?

Yes, according to the National Academy for Social Prescribing (NASP), the charity that raises awareness and supports the philosophy.

Charlotte Osbourne-Forde

NASP chief executive, Charlotte Osbourn-Forde, told Medscape News UK, ” There are now more than 3500 social prescribing link workers in post across England, addressing the social factors related to poor health and wellbeing. Since 2019, more than 2.5 million people have been referred to a link worker.”

It appears that social prescribing could have a bigger role to play moving forward. The Commons Health and Social Care Committee has recently published a report that recommends the creation of a national social prescribing strategy. 

However, that report did make clear that there should be steps taken to improve GPs’ understanding of the benefits of social prescribing and to improve their confidence in doing so. The report also suggested that older adults were well served in a social prescribing context but that children and young people were underserved. 

What Are the Benefits?

Osbourn-Forde said:”The evidence shows that social prescribing can help reduce loneliness, improve wellbeing and mental health, build social connections, and support people living with a wide range of physical health conditions.” 

She added: “It can also lead to reduced health service usage within both primary and secondary care. For example, an evaluation of a social prescribing service in Shropshire showed a 40% reduction in GP appointments for people who had accessed social prescribing after 3 months. 

“Most importantly, we see all the time the impact that social prescribing has on individual people. It’s incredible to see someone who’s isolated, inactive, and depressed becoming part of a community and finding a new sense of hope and belonging,” explained Osbourn-Forde. 

What’s the Evidence?

Because of the scope and range of social prescribing, it can be hard to assess the evidence and quantify the benefits. 

Does it save money? Osbourn-Ford says it does: ” There are lots of different ways you can measure this, but a range of studies show that social prescribing can take pressure off the health system. If you look at social return on investment, which takes into account wider social and economic benefits, studies show that social prescribing can deliver between £2.14 and £8.56 for every £1 invested.”

The NASP has published 13 evidence-based publications that suggest social prescribing is beneficial. 

However, a 2022 systematic review in the journal BMJ Open looked at data from eight studies involving 6500 people and suggested 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, though they may improve self-rated health. It pointed to an absence of evidence surrounding social prescribing.

Peter Tyrer, emeritus professor of community psychiatry at Imperial College London, has reservations about the current status of social prescribing when it comes to its evidence base.

He told Medscape News UK: “Social prescribing is a marvellous idea, but it has to be done in a systematic way. There is a problem in the nature of the interventions. They can vary from being very intensive to the lowest level of just sign-posting a set of options. There needs to be some sort of standardised, formalised way of doing things, even if it’s just a sequence of approaches.” 

He added: “It would be good to know which parts of social prescribing are effective and which parts aren’t so that resources aren’t wasted. Cost-effectiveness can only be determined when costs are measured in other services not exposed to social prescribing in a randomised trial, and this has not yet been done.” 

Money Is an Issue

Dr Rachel Sumner, senior research fellow at Cardiff Metropolitan University, has worked on evaluating a range of social prescribing programmes over the last decade.

Dr Rachel Sumner

She told Medscape News UK: ” What we’ve found so far is that patients know that it works, they understand the value of these programmes, and they speak of the profound and unexpected positive impact these programmes have on their mental and physical health. Our statistical analyses have shown that these programmes are similarly beneficial to all sorts of groups of people, meaning that they have the potential to help anyone in need, and that they increase not just their wellbeing but also clinically meaningful levels of anxiety and depression as well.”

But she said money is an issue in the longer term. ” Without more formalised and meaningful financial support to help charities implement these programmes, the benefit [they] have may be short-lived, as patients run out of opportunities for support and may relapse into loneliness, social isolation, and poor mental health.” 

Social prescribing has been practiced informally over many years but formalising the practice with link workers is still a relatively new method of delivering care. As it continues to become a more integral part of the wider health and social care system, as looks increasingly likely, more evidence and evaluation will be needed to make sure the full potential of social prescribing is realised.

The government is expected to respond to the Health and Social Care Report in March 2024.

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Publish date : 2024-02-12 16:24:13

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