Equal, equitable or exacerbating inequalities? Patterns and predictors of social prescribing referrals in 160,128 UK patients
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Background
Social prescribing (SP) is growing rapidly across the world as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear.
Methods
This study undertook the first analyses of a large database of administrative data from over 160,000 individuals referred to SP across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables.
Findings
72-85% of referrals for SP were from medical routes (primary or secondary health care). While these referrals demonstrate equality in reaching across socio-demographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical referral routes. Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities - especially ones relevant to mental health, practical support, and social relationships - was evident. There was also substantial heterogeneity in how SP is being implemented across UK nations.
Interpretation
Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing, therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.
Significance statement
Social prescribing - linking patients with non-medical forms of support in local communities - has been proposed as a way to address social determinants of health and improve health and wellbeing outcomes, leading to increasing implementation of programmes globally. But reviews into the use of SP suggest that referrals are not equitable and could even be disproportionately reaching individuals who are less disadvantaged. Analysing data from the most widely adopted digital SP platform in the UK, we show that medical referral routes (e.g. via GPs) reach people across all demographic groups equally, even though some demographic groups have greater health needs. But non-medical referral routes (e.g. through social care or communities) are helping to address inequalities and provide more equitable access.
