Social Prescribing and impact on Primary Care: an evaluation of a social prescribing project in east London

Problem

Social interventions for health have arisen in response to an aging population and increasing prevalence of long term conditions, associated with social isolation and increased health care utilisation. Social prescribing, and interventions such as exercise/physical activity on prescription, walking groups and health trainers, aim to support self-management of chronic conditions, and prevent future complications.Despite growth in these services, the effectiveness of social interventions remains uncertain. A review of twelve evaluations of social prescribing, published by UK health care providers, showed limited rigour, with none having an adequate control group. However some reports indicated beneficial changes in anxiety, depression, wellbeing, social isolation and general practice attendance.

Approach

A mixed methods evaluation of a social prescribing scheme covering 22/43 general practices in City and Hackney CCG. • Health care use, attendance at general practice and prescribing data, was extracted for all patients referred into the service. Multiple controls with similar demographic and co-morbidity profiles were identified.• Health outcomes for cases and matched controls were examined using a questionnaire study comparing patient reported outcomes for psychological and social wellbeing.• A qualitative arm used focus groups and interviews with service providers, commissioners and patients.

Findings

The twenty-two general practices referred 381 patients into the service (over a twelve month period). Consultation rates in the year prior to referral differed significantly between cases and controls (10.0 vs 3.9, t-test for difference p<0.001). This difference persisted in the year following referral (8.6 vs 4.3, t-test for difference p<0.001). Among cases there was a significant drop in GP consultations in the year following referral (10.0 vs 8.6, p = 0.003). Annual medication count was greater in cases compared to controls before and after referral to social prescribing. No significant difference between baseline and 8 months follow up was observed between cases and controls, in general health (Census Survey), Wellbeing (MYMOP), Anxiety or Depression (HADS) or Positive and Active Engagement in Life (heiQ)

Consequences

This social prescribing scheme was commissioned with the expectation of providing alternatives to health service use – particularly GP attendance. GPs identified suitable cases for referral into the scheme. Cases consulted more frequently and were prescribed more medication than controls. They were significantly more likely to be living alone and unemployed, with higher scores for anxiety and depression. GP consultations fell in the year following referral. However, it is not possible to distinguish regression to the mean in consultation rates from an effect of the intervention in this non randomised evaluation.Although most participants in the programme reported gaining benefit, the objective measures of social and psychological outcomes show no significant change over time.The broader health and social benefits to which these schemes may contribute may require evaluation beyond their impact on the health economy.