Social prescribing has become a familiar intervention within primary care. Its purpose is to enhance health and wellbeing by linking people with non-medical supports in the community. There are different models of social prescribing, ranging from online signposting services to individual support from a link worker

But while social prescribing feels intuitively right, evidence increasingly tells us that, on its own, it cannot deliver significant improvements in population health outcomes.

A 2022 systematic review published in BMJ Open examined eight trials involving over 6,500 adults, many living with multimorbidity and social deprivation. The findings were sobering. There was no consistent improvement in health related quality of life or mental health and no robust evidence of cost effectiveness. Overall, the reviewers concluded that evidence for social prescribing link workers is weak and inconsistent.

So why is social prescribing failing to produce improvement in health outcomes?  Probably because it's a superficial attempt to solve the far from superficial problem of social isolation. There's no doubt that reducing social isolation and increasing community participation can have a very positive impact on health outcomes. But why do we expect brief sessions with a link worker to undo something that is complex and deeply rooted in the places that our patients live?

Without broader system change, social prescribing risks becoming a sticking plaster. After all, it's just a referral pathway into an already overstretched and underfunded voluntary sector. It does very little to change places or lives.

Fortunately, there is now significant movement in the UK towards a more place-based approach that reaches beyond a simplistic medical model. These initiatives are aligned with the Ottawa Charter's five action areas for health promotion:  

1) Building healthy public policy

2) Creating supportive environments

3) Strengthening community action

4) Developing personal skills

5) Reorienting health services.

One example is the Priority Neighbourhood Development (PND) Programme in Worcestershire.  This is a multi-agency initiative involving public health, NHS and voluntary sector partners that devolves budgets down to working groups made up of local residents and stakeholders.  

Pilots have revealed very promising results from the PND work. In an economically deprived neighbourhood, year-on-year reductions were reported in emergency hospital admissions of -4.9%, which compared well to a countywide increase in admissions of +6.8% (an overall difference of 11.7%). Children's social care referrals also decreased in the area by -12.7%, compared to a countywide reduction of only -3.7% (a difference of 9%).

The PND approach aligns directly with the ambitions of neighbourhood health, which is designed to bring services together at a local level. It shifts powers locally, so communities can drive decisions about what matters to them. It co-ordinates agencies around shared priorities rather than organisational silos. And it builds community capacity, rather than just referring into it.

In this model, social prescribing ceases to be a standalone intervention, but a gateway to collective action and better health outcomes.

Maybe this is where the future lies. Neighbourhood health, together with the concurrent programme of local government reorganisation, presents us with a unique opportunity to transform health improvement from something we do to individuals to something we do with communities. All it takes is a shift in resources, collaboration and mindset.