More than signposting: Findings from an evaluation of a social prescribing service

Abstract

This paper presents findings from an evaluation of a social prescribing service, undertaken between January 2019 and December 2020. Data was collected through interviews and focus groups with a range of groups including social prescribing managers, link workers (LWs), referrers (GPs and social work practitioners), clients, Voluntary and Community Sector (VCS) agencies and groups. Thematic analysis of data was undertaken, and findings were presented in respect of clients' journeys into social prescribing; the support received from LWs; their onward journeys to VCS support. The findings highlight the challenges for individuals in contacting new agencies/groups and the importance of practitioner referral into and onwards from social prescribing, as well as buddying to support clients on initial agency visits. The depth of the LW role is highlighted, as well as the complexity of client circumstances, highlighting a need for ‘more than signposting’, and challenging the notion of self‐referral as an indicator of motivation. Social prescribing has been positioned as amongst the solutions to the challenges of primary care. However, referrals from GPs were low and significantly outnumbered by those from social workers; this suggests a need to explore in greater depth the use of social prescribing by social workers, who have, to date, been absent from social prescribing research.

Implementation and impact of a social prescribing intervention: an ethnographic exploration

“…The tension observed in the current study between divergent understandings of social prescribing within the intervention reflects diverse understandings of social prescribing within policy discourses and the scientific literature. 6 , 13 A drift over time within interventions to an understanding that shifts responsibility onto individuals targeted by interventions has previously been identified 31 , 36 and has been attributed partly to the pressures of targets and workload. 37 Such drift, and associated ‘citizen shift’, 36 is also a reflection of dominant discourses that construct individuals as capable of exercising autonomy and personal responsibility.…”

“…Challenges establishing new roles within primary care have previously been observed, including for social prescribing link workers. 13 , 30 , 31 Like those in other new roles within healthcare teams, link workers were required to engage in ‘boundary work’ 32 (that is, work to negotiate changes in boundaries between different professions following the introduction of a new role), with primary care and VCSE services, in an effort to develop effective working relationships. They found this work to be time consuming and often dispiriting, partly because of tensions between organisations competing within an underfunded VCSE landscape.…”

A meta-ethnography of the factors that shape link workers’ experiences of social prescribing

“…The exible nature of the link worker role meant it had been operationalised in different ways across different organisations (35), with "their job scope and remit being poorly de ned from the outset" and their role being "not well understood by external referrers" (47) (p.3). This could lead to unrealistic expectations or confusion around what is achievable through social prescribing (50) and to the referral of patients with complex needs that exceeded the remit of the link worker role (35,38,39).…”

“…Link workers were described as a "companion" with whom patients could share their stories; these close relationships were necessary for the success of social prescribing (52). This relational nature of social prescribing work was described as being "a bit of a balancing act" between being a "friend but not a friend" (51) (p.996), where it was also vital to maintain boundaries in a way that did not foster patient dependency (38) and protected link workers' time and headspace (50). A key strategy for setting boundaries with service users involved referrals into other agencies, although as described later, local community infrastructure may not always be readily available to permit this to happen (51).…”

“…In cases where practices were not as engaged or did not fully understand what the service could offer, link workers had to take a more active role promoting the service, leaving less time to provide focused and holistic person-centred care (46, 51). Co-locating link workers in primary care, providing space for them in practices, was noted to help referrers to understand and remember the link worker role (50), as well as making the service seem trustworthy and credible to patients/service-users (35).…”