Tensions and opportunities in social prescribing. Developing a framework to facilitate its implementation and evaluation in primary care: a realist review.

Sara Calderón-Larrañaga,Megan Clinch,Yasmin Milner,Sarah Finer,Trisha Greenhalgh

doi:10.3399/bjgpo.2021.0017

Abstract

BackgroundSocial prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector (VCS). Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice.AimTo define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorising and evaluating SP within primary care.Design & settingRealist review of secondary data from primary care-based SP schemes.MethodAcademic articles and grey literature were searched for qualitative and quantitative evidence following the Realist And Meta-narrative Evidence Syntheses — Evolving Standards (RAMESES). Common SP practices were characterised in three settings (general practice, link workers, and community sector) using archetypes that ranged from best to worst practice.ResultsA total of 140 studies were included for analysis. Resources were identified influencing the type and potential impact of SP practices and four dimensions were outlined in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, and knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, and transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy, accessibility, and continuity of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding, and suitable monitoring strategies). Findings were synthesised in a multilevel, dynamic, and usable SP framework.ConclusionThe realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational, and policy resources are needed to ensure SP best practice in primary care.

Highlights

Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector (VCS)(1)
We identified resources influencing the type and potential impact of SP practices and outlined four dimensions in which opportunities for good practice arise: 1) individual characteristics; 2) interpersonal relations; 3) organisational contingencies; and 4) policy structures
Findings where synthesised in a multi-level, dynamic and usable SP Framework

Summary

Introduction

INTRODUCTION: Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector (VCS)(1). The link between the health and the third sectors is often provided by a ‘social prescriber’ ( called ‘link worker’), whose role ranges from signposting to more intensive approaches involving patients’ needs assessments, ongoing support and recommendations of relevant VCS services[2,3]. Social Prescribing (SP) is being widely adopted in the UK, including at policy-level within the National Health Service (NHS) ‘Long Term Plan’(5). It is argued that SP could improve the efficient use of health and social care resources, by enhancing self-care and community support networks[7]. Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector. Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice

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