Supporting social prescribing in primary care by linking people to local assets: a realist review

Abstract

Background: Social prescribing is a way of addressing the 'non-medical' needs (e.g. loneliness, debt, housing problems) that can affect people's health and well-being. Connector schemes (e.g. delivered by care navigators or link workers) have become a key component to social prescribing's delivery. Those in this role support patients by either (a) signposting them to relevant local assets (e.g. groups, organisations, charities, activities, events) or (b) taking time to assist them in identifying and prioritising their 'non-medical' needs and connecting them to relevant local assets. To understand how such connector schemes work, for whom, why and in what circumstances, we conducted a realist review. Method: A search of electronic databases was supplemented with Google alerts and reference checking to locate grey literature. In addition, we sent a Freedom of Information request to all Clinical Commissioning Groups in England to identify any further evaluations of social prescribing connector schemes. Included studies were from the UK and focused on connector schemes for adult patients (18+ years) related to primary care. Results: Our searches resulted in 118 included documents, from which data were extracted to produce contextmechanism-outcome configurations (CMOCs). These CMOCs underpinned our emerging programme theory that centred on the essential role of 'buy-in' and connections. This was refined further by turning to existing theories on (a) social capital and (b) patient activation. Conclusion: Our realist review highlights how connector roles, especially link workers, represent a vehicle for accruing social capital (e.g. trust, sense of belonging, practical support). We propose that this then gives patients the confidence, motivation, connections, knowledge and skills to manage their own well-being, thereby reducing their reliance on GPs. We also emphasise within the programme theory situations that could result in unintended consequences (e.g. increased demand on GPs).

Connecting primary care patients to community-based physical activity: a qualitative study of health professional and patient views

“…47 This type of resource and example of SP was also seen to be a key solution to alleviate time pressures within a consultation, provide practical resource support, and supports the consensus that patients can self-refer and take responsibility for their own health improvement. 48 Similar to findings by Flannery et al, 49 social support was acknowledged in terms of creating 'opportunity', which is reflected in this study's findings with suggestions from patients such as a 'buddy' system. HPs and patients discussed that an opportunity to meet 'people like me', who are also trying to engage with an opportunity, would be a supportive solution that the practice and wider community could implement.…”

“… 47 This type of resource and example of SP was also seen to be a key solution to alleviate time pressures within a consultation, provide practical resource support, and supports the consensus that patients can self-refer and take responsibility for their own health improvement. 48 …”

Broadening diversity through creative involvement to identify research priorities

“…Those in these groups may also wish to be involved in the conduct and dissemination of findings from a related review (as PPI contributors). Other reviews we have conducted have involved patients/the public [ 18 , 19 ]; such involvement was successful in helping us to think about data emerging from a review and in providing us with feedback on the presentation and interpretation of its findings.…”

Broadening Diversity Through Creative Engagement in Research Prioritisation

“…Those in these groups may also wish to be involved in the conduct and dissemination of ndings from a related review (as PPI contributors). Other reviews we have conducted have involved patients/the public [15][16];…”