Social prescribing links patients in primary care with sources of support within the community. With national policy implementation underway across the UK, there is now a need to understand the impact of social prescribing link worker services and how they can be developed in the future. To understand the effectiveness of the scheme, we need to understand the characteristics of those who have access, those who get referred and those who adhere to social prescribing. This will aid in understanding who requires additional support to engage in the scheme. Once we have identified the characteristics of those who engage in the scheme, we will estimate the role of social prescribing on individuals’ health outcomes to assess if there are any improvements in health and changes in health care utilisation. We will determine whether uptake reduces workload within primary and secondary care. We will then assess the cost effectiveness of social prescribing link workers within primary care We will do this by costing the health and care services used by those who engage in social prescribing and comparing it to a matched cohort of people who have not had contact with a social prescribing link worker.
Social prescribing links patients in primary care with sources of support within the community. With national policy implementation underway across the UK, there is a need to understand the impact of social prescribing link worker services and how they can be developed in the future. We aim to analyse variations in the uptake of social prescribing and impacts on patients’ health and service outcomes.
The study has three stages. The first is a population cohort study to determine who has access, uptake, and engagement in social prescribing. This will be identified via SNOMED codes within CPRD GOLD and Aurum between 2016 and 2023. We will then use multi-variable logistic regression modelling to identify which population groups require additional support to use social prescribing schemes across population and area-level characteristics. The second stage is a comparative cohort-study analysis using matching algorithms to compare health and service outcomes between those referred in social prescribing (exposed) and non-referred individuals. These outcomes will be identified in primary care through CPRD and in secondary care through data linkages with HES. The third stage will estimate link worker cost-effectiveness in terms of cost per additional person linked to social prescribing schemes and then develop a model to produce a cost-utility analysis. There will also be a consideration of whether a distributional approach substantially affects the future results and assessment of different funding models for link workers. The findings from this research will inform the longevity of the scheme and demonstrate the potential benefits of engaging with social prescribing.
The first part of the research will determine the characteristics of those who have engagement with social prescribing schemes. This will be identified by the following SNOMED codes:
871691000000100 | Social prescribing offered (finding)
871711000000103 | Social prescribing declined (situation)
871731000000106 | Referral to social prescribing service (procedure)
Given the aim of the scheme is to reduce workload within primary care, in the second part of the research we will assess health care utilisation of those referred into social prescribing compared to a similar comparator group. The primary outcome will be measures of primary care activity and workload as defined in Hobbs et al. (1). These will be the number of consultations via a GP, nurse or other medical practitioner, and the consult mode – face-to-face or telephone. We will identify frequent attenders to determine if social prescribing has affected those patients, as they contribute to high workload for GPs (2).
We will additionally consider the subsequent onset and management of health conditions (including prescribed medications) as secondary outcomes. Past findings have determined the onset and prevalence of medical conditions across age, sex and ethnicity (3). We will use these conditions and relevant SNOMED codes to identify diagnosis and progression of medical conditions. The hypothesis is that social prescribing is to improve management of health conditions (4). We will assess whether a referral of social prescribing has an effect on prescriptions for patients.
We will also assess the effect of social prescribing on secondary care outcomes, as past research has found that there is a reduction in non-elective services (5). We will use the data linkages available within CPRD to assess whether there is a change in the volume of appointments and type of visit – elective or non-elective, and whether in or outpatient.
In the third stage of the research, we will cost the primary and secondary care activity to assess the cost effectiveness of the link workers social prescribing. From the outcomes identified previously we will apply unit costs (6) to determine the cost of services used and combine this with information of the fixed and variables costs of operating social prescribing schemes.
Paul Wilson - Chief Investigator - University of Manchester
Anna Wilding - Corresponding Applicant - University of Manchester
Efundem Agboraw - Collaborator - University of Manchester
Luke Munford - Collaborator - University of Manchester
Matt Sutton - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation Domains;CPRD Aurum Ethnicity Record;Practice Level Rural-Urban Classification