National roll-out of social prescribing in England's primary care system: a longitudinal observational study using Clinical Practice Research Datalink data

Abstract

Background

Social prescribing is growing rapidly in England and across the world. However, it remains unclear who it is reaching and how effectively it is being implemented. This study aimed to assess longitudinal trends in social prescribing in England's primary care system, including growth trajectories and target alignment, sociodemographic profiles of referred patients, and predictors of service refusal over time.

Methods

This nationwide, longitudinal observational study analysed primary care records from 1·2 million patients from 1736 general practitioner (GP) practices in the Clinical Practice Research Datalink in England. We estimated social prescribing trends between 2019 and 2023 using growth curve modelling on social prescribing numbers at the practice level. Descriptive analyses were used to show changes in sociodemographic profiles of social prescribing patients over time. To assess sociodemographic disparities in service refusal (defined as having a medical code of social prescribing declined), we used multilevel logistic regression models stratified by year, accounting for nested data structure where patients were nested within practices.

Findings

As of the end of 2023, an estimated 9·4 million GP consultations in England have involved social prescribing codes, and 5·5 million consultations have specifically led to social prescribing referrals. In 2023 alone, an estimated 1·3 million patients were referred to social prescribing. 60% of patients offered social prescribing were female and 23% were from ethnic minority groups. Representation from patients living in more deprived areas increased from 23% to 42% between 2017 and 2023. Service refusal declined from 22% to 12% between 2019 and 2023. Age, sex, and ethnicity were associated with service refusal across multiple years. Notably, in 2023, all age groups had higher odds of refusal compared with the youngest age group. Female patients had 21% (95% CI 0·77–0·82) lower odds of refusal than males, and patients from White ethnic backgrounds had 32% (1·26–1·39) higher odds of refusal than ethnic minority patients.

Interpretation

Social prescribing has expanded rapidly in England, far exceeding initial targets of 900 000 patients by 2023–24, suggesting broad service acceptability. Progress is being made in reaching specific target groups, such as more deprived communities. However, there are still disparities in accessibility and uptake, calling for targeted strategies to address underlying inequalities.

Funding

MQ Transforming Mental Health, Rosetrees-Stoneygate Trust Fellowship, National Academy for Social Prescribing.