Gathering the evidence on social prescribing models

Social prescribing services in Ireland are relatively new, but expanding, writes David Lynch

The last five years have witnessed notable developments in social prescribing in Ireland and globally.

The World Health Organisation (WHO) defines social prescribing as a means of connecting patients to non-clinical services in the community to improve their health and wellbeing.

It is an approach that builds on the evidence that addressing the social determinants of health is key to improving health outcomes.

In 2022, the WHO in the Western Pacific published a new toolkit on social prescribing.  The year previously, the HSE published a social prescribing framework following pilot projects in a number of regions.

According to figures provided to the Medical Independent (MI) by the Executive, there are 44 HSE-funded social prescribing services. These services are typically located in community and voluntary sector organisations such as family resource centres.

In some areas, social prescribing link workers may be co-located in a primary care centre for one or two days a week, according to the HSE. The Executive plans to develop four new social prescribing services in 2025 as part of the expansion of the Sláintecare healthy communities initiative.

The HSE Social Prescribing Framework proposes that there should be one full-time social prescribing link worker per community healthcare network (CHN).

The HSE spokesperson told MI that “whilst this proposal has not yet been achieved” it remains the long-term objective to have a social prescribing service in every CHN.

There are 96 CHNs and 44 HSE-funded social prescribing services. The spokesperson added that the creation of the six health regions would not impact on the proposal.

Module

In June 2023, the HSE launched an e-learning module on social prescribing on HSELand. The target audience for the module is all healthcare professionals.

Some 1,449 healthcare professionals have completed the module to date. The HSE did not provide a breakdown on how many doctors have undertaken the module.

The HSE also conducts a range of communication activities to raise awareness of social prescribing among healthcare professionals, including podcasts, toolkits, and information leaflets.

The community and voluntary sector manage the recruitment of link workers. The Executive was not aware of recruitment challenges related to these roles to date.

According to the HSE, social prescribing offers GPs and other healthcare professionals a means of referring people to non-clinical community supports which can have significant benefits for their overall health and wellbeing.

The service has several “key components” including an intervention between the service-user and a social prescribing link worker. The intervention can take up to eight sessions. The link worker supports the service-user to access local voluntary community and social enterprise organisations or services through discussion and joint decision.

Social prescribing is a service aimed at adults, including those with one or more long-term conditions; those who need support with their mental health, are lonely or isolated; people who frequently attend GPs or emergency departments and may benefit from supports outside of clinical services; and those who have complex social needs that affect their health and wellbeing.

Dr Bridget Kiely, GP and Senior Clinical Lecturer in General Practice at the RCSI, told MI that social prescribing is “relatively new” in Ireland.

“The main model that has been implemented is that of a community-based link worker.”

This is the model used in the HSE healthy communities programme. The programme encompasses 19 socially deprived areas and is based on the HSE Social Prescribing Framework. Dr Kiely added that some GP practices have hired link workers to work in their practice using funds from the social deprivation practice grant.

‘Infancy’

“The current HSE programme is in its infancy, and it is too early to tell if there has been any impact on primary care services,” Dr Kiely told MI. She added that an evaluation is underway to better understand the programme.

“Gaps remain in the evidence to support social prescribing, and more research is needed to understand who can benefit, where and how link workers can work best, as well as looking into effectiveness for individual patients’ health and wellbeing and impact on services.”

Dr Kiely said a trial in Ireland with which she was involved was under-recruited because of the pandemic, yet indicated that practice-based link workers had the potential to be cost-effective.

Dr Kiely is also a member of Deep End Ireland, a group of general practitioners working in the most disadvantaged communities in Ireland.

Asked what actions Deep End Ireland believes could improve social prescribing services, Dr Kiely said the current model of community-based link workers creates two challenges.

“Firstly, there is only one link worker for a population of approximately 20,000,” she said. “Each link worker can see about 100 patients per year. From the research conducted in Deep End GP practices, each practice would have around 100 patients… [who] had a psychosocial need and could benefit from social prescribing.”

The current services are developing waiting lists and struggling to keep up with demand, according to Dr Kiely.

The second challenge is that some link workers are reporting either “inappropriate referrals” or a “lack of engagement from GPs”.

Another issue reported by link workers is the complexity of some referrals and lack of timely access to additional interventions (eg, mental health services).  

“A practice-based model allows for the GPs and link workers to develop a good working relationship,” said Dr Kiely. “Furthermore, link workers in a practice can help GPs to develop a greater awareness of community resources which can benefit patients attending the practice.”

Dr Kiely said consideration could be given to “further developing the practice-based link worker model in more deprived areas”. She said this would require careful planning in terms of management, supervision, and funding of link workers, as well as evaluation.

Overall, building the evidence-base for social prescribing was challenging, because “it is a complex intervention”. However, an evidence-base is “very important in order to get buy-in” from the Department of Health and GPs.

“If social prescribing is going to continue to be part of additional resourcing for deprived areas, consideration needs to be given to the link workers’ capacity so that the service is not overwhelmed,” Dr Kiely added.

“Social prescribing requires adequate resources in an area to support the social determinants of health, such as housing and education, etc, and also adequate health services.”

Further information on Deep End Ireland is available here: www.deepend.ie