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When you go to the doctor, you probably don’t expect them to prescribe you social or physical activities. But social prescribing—referring patients to non-clinical services and services in their community—is emerging as a part of Australian GPs’ toolkits in preventative healthcare.

From gardening groups, befriending service to physical activity programs and art therapy, various activities are being prescribed by healthcare professionals to connect patients with their community and enhance their health and wellbeing. But what’s the logic behind this practice and what determines its effectiveness?

Below, Dr Uday Yadav from the National Centre for Aboriginal and Torres Strait Islander Wellbeing Research explains more about this practical way of addressing chronic health conditions, and the evidence that supports it.

What is social prescribing?

Social prescribing (SP), also known as community referral, is a community-based, person-centred holistic approach to help individuals identify their healthcare needs and improve health and well-being, thereby reducing the demand for secondary healthcare services.

Several social prescribing models are delivered through different platforms, catering to diverse community needs.

An emerging model for delivering SP programs is through primary health care (PHC) settings, where PHC providers, such as general practitioners (GPs) or practice nurses, refer patients to a specialised link worker. These link workers identify individual’s holistic needs, match them with fitting services, co-design personalised plans, and encourage healthy behaviours to promote their well-being.

It is designed to support people with a wider range of social, cultural, emotional, or practical needs, including self-management support, legal aid support, financial debt support, housing services, physical activity community gardens, and so on.

Who can benefit from social prescribing?

Social prescribing programs can be applied to diverse groups, particularly those with long-term chronic conditions and with mental health conditions, to prevent their conditions from deteriorating into more serious conditions.

Individuals living with chronic conditions often face limitations in social engagement activities, practice healthy lifestyle behaviours, and financial crisis management, significantly impacting their health and wellbeing.

Social prescribing can play a key role in both preventing disease progression and addressing the complex and intertwined health and social inequalities faced by individuals with long-term conditions.

To reduce disparities, public health programs, and social services need to be integrated to address the holistic needs of people with long-term chronic conditions.

What factors shape the effectiveness of social prescribing interventions?

Our recent research* identified that effective implementation of programs relies on building strong relationships between social prescribers and patients, characterised by trust, empathy, and effective communication.

Vital components of a successful SP program include digital technology utilisation, competent social prescribers, collaborative healthcare partnerships, clinical leadership, access to local resources, and a holistic approach to addressing the unmet needs of people with long-term chronic conditions.

However, implementation faces numerous challenges, including accessibility and utilisation barriers, communication gaps, staffing issues, an unsupportive work environment, inadequate training of social prescribers, lack of awareness, time management struggles, coordination and collaboration difficulties, and resource constraints.

Uncertainties surrounding SP processes and procedures, including standard tools for holistic need assessment, coupled with high turnover rates among social prescribers, further complicate matters.

To the best of my knowledge, our research is the first review sought to understand existing SP programs for people living with long-term chronic conditions. It underscores the requirement for a well-defined comprehensive implementation and evaluation framework that incorporates the perspectives of patients, healthcare practitioners, service providers and social prescribers to optimise intervention components and steer the development of effective SP program models.

^{An effective SP program should addresses the needs of people with long-term chronic conditions holistically. A comprehensive implementation and evaluation framework can facilitate the development of such programs. Image: OpenWHO}

What considerations should be taken for real-world application?

Our research focused on people with long-term chronic conditions, with all but one study conducted in the United Kingdom. Therefore, caution is needed when applying these findings within the UK or elsewhere.

Program managers, implementation scientists, and funders can apply our findings by valuing the local contextual factors and health system designs that enhance the likelihood of SP programs for equitable outcomes.

In designing and implementing SP interventions for people from Indigenous and marginalised communities, it is important to recognise that health is not solely the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole community.

Therefore,  programs should consider a holistic approach that addresses social, emotional, spiritual and cultural determinants of health and well-being.

What are some unique challenges and opportunities around social prescription in Australia?

In Australia, social prescription has received significant attention from the local government, the Royal Australian College of GPs, the Consumers Health Forum of Australia, and academics.

Nevertheless, we are at a very early stage of implementing the social prescription program here in Australia. Workforce training and well-maintained platforms providing information about the locally available support and community services are essential.

Also, while social prescription intervention holds promise in international settings, the scope, uptake, and impact of social prescription for Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse communities remain unknown.

This necessitates investment in implementation research in this space from government and funding bodies to build the capacity of communities to ensure social prescribing intervention is available to all people who need it.

It’s important to acknowledge that some Aboriginal community-controlled health services have already been implementing initiatives to address the holistic needs of Aboriginal and Torres Strait Islander people. We must take the opportunity to apply their knowledge to guide the design and delivery of social prescription intervention in the broader Australian context.

*Read more about social prescription in Dr Uday Yadav and colleagues’ recent publication on the topic.

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