Equal, equitable or exacerbating inequalities? Patterns and predictors of social prescribing referrals in 160,128 UK patients

Abstract

AbstractBackgroundSocial prescribing (SP) is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear.AimsTo gain a comprehensive picture of SP in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions.MethodsThis study undertook the first analyses of a large database of administrative data from over 160,000 individuals referred to SP across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables.ResultsMental health was the most common referral reason and mental health interventions the most common interventions prescribed. Between 72% and 85% of SP referrals were from medical routes (primary or secondary health care). While these referrals demonstrate equality in reaching across socio-demographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical routes (e.g. self-referral, school, charity). Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities - especially ones relevant to mental health, practical support, and social relationships - was evident. There was also substantial heterogeneity in how SP is being implemented across UK nations.ConclusionsMental health is the leading reason for SP referrals, demonstrating its relevance to psychiatrists. But there are inequalities in referrals. Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing, therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.