A strength of this work was the depth and consistency of participant accounts regarding the impact of the programme. Limitations were that we did not capture the experiences of patients with long-term conditions who refuse a referral or who drop out of the programme early, nor were we able to collect information on the frequency with which participants engaged in activities they were referred to.

Background

Social prescribing enables healthcare practitioners to refer patients to a range of non-clinical services.1 Primarily, but not solely, directed at people with long-term conditions, social prescribing harnesses assets within the voluntary and community sectors to improve and encourage self-care and facilitate health-creating communities.2–4 There is increasing interest in social prescribing as a means of addressing complex health, psychological and social issues presented in primary care, as well as its potential to reduce health inequalities.5 A recent review of social prescribing indicates that, despite a small and largely inconclusive evidence base, there is the potential for credible psychosocial benefits to be incurred by patients with mental health problems, and for health and well-being improvements to be seen in people with long-term conditions.6 While less attention has been paid to the impact of social prescribing on physical health and resource use,4 improvements in physical activity,7 reductions in hospital resource use8 and General Practitioner (GP) attendance9 have been attributed to social prescribing, although longer-term studies with larger sample sizes are required for more definitive evidence.4

As yet there is no agreed definition of social prescribing,2 although there is broad consensus that it helps patients to access non-clinical sources of support, predominantly in the community sector,3 and is a means to address the well documented social and economic factors that accompany long-term illness beyond the healthcare setting.4 In the UK, social prescribing has been taking place on a small scale for a number of years and there are several operating models.10 These models vary in two ways; the actual activities or services offered and the level of support given to patients following referral. Recognising that patients who are simply given information about a service will not necessarily take it up, most schemes involve a ‘facilitator’ coupled with personal support,11 although the level of ongoing support offered varies considerably. Services into which patients are referred vary, and can include activities that involve physical activity such as gyms, walking groups, gardening or dance clubs; weight management and healthy eating activities, such as cooking clubs. Addressing wider economic and social issues can involve referral into services which address welfare, debt, housing and employment issues. Groups, such as those targeted at people with specific long-term conditions, for example diabetes, chronic obstructive pulmonary disease, may also be accessed via social prescription. Our definition concurs with that of the Social Prescribing Network of Ireland and Great Britain, ‘enabling healthcare professionals to refer patients to a link worker, to co-design a non-clinical social prescription to improve their health and well-being’ and use services provided by the voluntary and community sector. (p19)2

Ways to Wellness12 is one of the first UK organisations to deliver social prescribing on a large and prolonged scale, funded for 7 years through a social impact bond model, with an overall target of 11 000 users over this period. Based in west Newcastle upon Tyne, an area with some of the most socioeconomically deprived wards in England, Ways to Wellness covers 17 general practices. Referral criteria are men and women aged 40–74 years with one or more of the following long-term conditions: diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, coronary heart disease, heart failure, epilepsy, osteoporosis, with or without anxiety or depression. Ways to Wellness is delivered by four voluntary sector organisations.

Following extensive consultation with patients and healthcare professionals over an 8-year period,13 Ways to Wellness provides a ‘hub’ model of social prescribing in which a Link Worker trained in behaviour change methods offers a holistic and personalised service. Following referral from a primary care practitioner (GP, practice nurse, healthcare assistant), meaningful health and wellness goals are jointly identified and service users are connected, when desired, to community and voluntary groups and resources. The service comprises: (A) individual assessment, motivational interviewing and action planning; (B) completion of an initial ‘Well-being Star’ assessment and subsequent Well-being Star assessments every 6 months thereafter for the duration of the patient’s involvement; (C) help to access community services (eg, welfare rights advice, walking groups, physical activity classes, arts groups, continuing education); (D) promotion of volunteering opportunities, and; (E) promotion of improved self-care and sustained behaviour change related to healthier lifestyle choices. Thus, the programme is highly individualised with patient engagement varying in terms of intensity, duration, personalised goal-setting and onward referral. Patients can remain with the programme for up to 2 years, but with Link Worker discretion beyond 2 years if required; frequency of contact with the Link Worker is mutually agreed, varies between and within patients depending on current need and circumstances, and can be face to face, via telephone, email and/or text message. Data for this study were collected in the first 14 months of the Link Worker social prescribing programme implementation.

This qualitative study aimed to capture the experiences of patients engaged with Ways to Wellness in its first 14 months of operation and to identify the impact of the Link Worker social prescribing programme on health and well-being.