Responding to the Global Pandemic: Delivering Social Prescribing in an Ever-Shifting Landscape

Abstract

Background: Social prescribing programmes across the United Kingdom were obliged to adapt and change as a result of COVID-19. However, as we emerge from the pandemic and only now begin to witness the extent to which service users and providers continue to be affected, is it realistic to expect social prescribing services to meet the increasing demands placed upon them? How might schemes manage to deliver effectively against a backlog of referrals, escalating mental health issues and growing health inequalities across the population? This paper explores the challenges faced by service providers and service users of social prescribing programmes during the global pandemic. Drawing from primary and secondary research, the discussion considers how the implementation of one social prescribing programme was impacted by COVID-19, how service providers responded, how service users were affected and, finally, what questions have been raised for the development and delivery of social prescribing in a postpandemic landscape.

Methods: Using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework, this discrete qualitative case study sits within the wider evaluation of Community Connect, London Borough of Bexley’s social prescribing programme. To investigate the impacts upon the programme through the key domains of implementation, maintenance and effectiveness, data were collected between April 2020 and November 2022. One reflexive discussion group and 26 semistructured interviews were conducted with a purposive sample of stakeholders, including social prescribers (n = 6), service users (n = 12), service provider organisations (n = 6), volunteer telephone befrienders (n = 6) and service commissioners (n = 2). Framework analysis was subsequently used to code and analyse the resulting qualitative data.

Results: Following a period of programme interruption, Community Connect adapted to remote delivery in support of both existing and new service users. Service users experiencing multimorbidity, combined with mental health problems, loneliness and isolation were adversely affected physically, emotionally and socially. Volunteers likewise reported feelings of isolation and uselessness, motivating them to support those in need. An interim ‘telephone befriending’ intervention engendered feelings of self-worth and reduced social isolation, having a positive impact on mental wellbeing. However, social prescribers experienced challenges in working from home, while attempting to build relationships with new referrals and/or providing meaningful support to digitally excluded individuals. Limited capacity meant many service users experienced intermittent contact with social prescribers, while few were offered consistent support in managing worsening health and/or mental health conditions. In addition, restricted access to voluntary service provider organisations adversely affected all areas of the programme. Those living in deprived circumstances and/or with complex health needs experienced negative impacts upon their long-term conditions, housing or finances. Many service users now report finding themselves in an escalating state of crisis, while Community Connect and all linked services attempt to address the continuing challenges resulting from COVID-19 and the current economic crisis.

Conclusions: Social prescribing offered valuable support to certain individuals during the first phase of the pandemic but remote contact had limited impact for service users with complex health and/or social needs. Continuing and increasing pressures placed upon social prescribing and voluntary services have resulted in negative outcomes. Findings highlight the vulnerability of social prescribing’s implementation and efficacy when voluntary service organisations and other linked services are disrupted by unforeseen global events.