BackgroundSocial prescribing is targeted at isolated and lonely patients. Practitioners and patients jointly develop bespoke well-being plans to promote social integration and or social reactivation. Our aim was to investigate: whether a social prescribing service could be implemented in a general practice (GP) setting and to evaluate its effect on well-being and primary care resource use.MethodsWe used a mixed method evaluation approach using patient surveys with matched control groups and a qualitative interview study. The study was conducted in a mixed socio-economic, multi-ethnic, inner city London borough with socially isolated patients who frequently visited their GP. The intervention was implemented by ‘social prescribing coordinators’. Outcomes of interest were psychological and social well-being and health care resource use.ResultsAt 8 months follow-up there were no differences between patients referred to social prescribing and the controls for general health, depression, anxiety and ‘positive and active engagement in life’. Social prescribing patients had high GP consultation rates, which fell in the year following referral. The qualitative study indicated that most patients had a positive experience with social prescribing but the service was not utilised to its full extent.ConclusionChanges in general health and well-being following referral were very limited and comprehensive implementation was difficult to optimise. Although GP consultation rates fell, these may have reflected regression to the mean rather than changes related to the intervention. Whether social prescribing can contribute to the health of a nation for social and psychological wellbeing is still to be determined.

This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders’ experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including ‘buy in’ from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.

There has been much enthusiasm over the past 10 years for the potential contribution of social enterprises to the regeneration of disadvantaged urban areas. This enthusiasm has far outstripped the availability of empirical evidence. This paper reports a qualitative study of one social enterprise, a community café, and its contribution to building social capital in a disadvantaged urban area in London.The analysis reveals how the café builds 'bonding' and 'bridging' social capital whilst also addressing 'downside' social capital. Overall, the manager of the social enterprise played a considerable role in facilitating the development of social capital, thus emphasising the importance of individuals and their attitudes, skills, and background in urban regeneration. However, the role of the social enterprise in building 'linking' social capital was minor. In this instance, more effective mechanisms of community engagement need to be put in place in order to empower local residents and organisations.

Objective To identify the training, skills and experience social prescribing Link Workers, working with patients presenting with long-term conditions, need to carry out their role safely and effectively within primary care services. Method Qualitative data were collected from Link Workers as part of the evaluation of three social prescribing schemes. Interviews and focus groups were audio-recorded and transcribed. Results Link Workers describe the complexity of the work and the need to define the boundaries of their role within existing services. Previous life and work experience were invaluable and empathy was seen as a key skill. A variety of training was valued with counselling skills felt to be most critical. Clinical supervision and support were felt to be essential to conduct the work safely. Discussion Social prescribing is a significant theme within UK health policy and internationally and schemes in primary care services are common. Patient accounts consistently suggest that the Link Worker is key to the success of the pathway. Link Workers can facilitate positive behaviour change; however they must be recruited, trained and supported with a clear understanding of the demands of this complex role.

Copyright and moral rights to this thesis/research project are retained by the author and/or other copyright owners. The work is supplied on the understanding that any use for commercial gain is strictly forbidden. A copy may be downloaded for personal, non-commercial, research or study without prior permission and without charge. Any use of the thesis/research project for private study or research must be properly acknowledged with reference to the work's full bibliographic details.This thesis/research project may not be reproduced in any format or medium, or extensive quotations taken from it, or its content changed in any way, without first obtaining permission in writing from the copyright holder(s).If you believe that any material held in the repository infringes copyright law, please contact the Repository Team at Middlesex University via the following email address:eprints@mdx.ac.ukThe item will be removed from the repository while any claim is being investigated. Diversification in ethnic minority businessThe case of Asians in London's creative industries David SmallboneSmall Business Research Centre, Kingston University, Kingston-upon-Thames, UK Marcello BertottiMiddlesex University, Enfield, UK, and Ignatius EkanemCentre for Enterprise and Economic Development Research (CEEDR), Middlesex University Business School, Hendon, London, UK Abstract Purpose -To provide an initial assessment of the nature and extent of the involvement of Asian-owned firms in the creative industries in London; to identify and assess any barriers they face; and draw out the implications for policy. Design/methodology/approach -An empirical study, undertaken in late 2002. Data sources included official statistical data and previous reports, as well as a programme of semi-structured, in-depth interviews with 23 Asian entrepreneurs spread across eight sub-sectors. Findings -Asians are making a significant contribution to London's creative sectors, although they do face a number of specific constraints. Some of these are specific to the creative industries but others are shared with other small firms. However, few of these constraints appear to be exclusively Asian.Research limitations/implications -There are some limitations relating to the small scale of the study and its focus on a single geographical location.Practical implications -The research shows how (cultural) diversity can contribute to creativity and the competitiveness of regional economies, as well as individual businesses. This particularly applies in the creative industries because of extensive interlinkage with firms in other sectors. Originality/value -In creative activities, cultural diversity is a source of potential competitiveness, because of the positive relationships between diversity, creativity and innovation. Asian owned firms in the creative sectors contrast with the low value added nature of many traditional areas of Asian business activity in the UK.