Title: Multi-region (and multi-level) evaluation of the roll out of social prescribing link workers in primary care.
Funder: Department of Health and Social Care

Abstract: Background_x000D_ Social prescribing, sometimes known as community referral, is where doctors and nurses work with someone called a ‘link worker’ to help patients find services from local, voluntary and community groups to improve their health and wellbeing. Link workers are now being introduced by the NHS across the UK._x000D_ _x000D_ Link workers support people with emotional and practical needs by considering all aspects of their lives not just their medical needs. Their role is to help connect people to information, advice, activities and other services provided by a range of voluntary and community groups. _x000D_ _x000D_ We want to find out how link worker services operate, how well they work, who does and doesn’t use them, whether they are of benefit to people and are a good use of NHS resources. The research will benefit patients by identifying how link worker services can be developed. We will study how to help people access social prescribing services and use them effectively, and to make sure that everyone has access no matter where they live or who they are. _x000D_ _x000D_ Our team has done similar work in the past on other national programme evaluations and on social prescribing specifically and has the skills and experience to make the work a success. We met with members of NIHR ARC Greater Manchester Public & Community Involvement & Engagement Panel (PCIE) to discuss our research plan, listened to their comments and put these into our research plan._x000D_ _x000D_ Our Research Plan_x000D_ We will set up a Research Advisory Group of people with social prescribing experience and clinical and service experts to guide our research work as it progresses and help us to identify potential benefits to people and to the NHS._x000D_ _x000D_ We will investigate link worker services in Greater Manchester, the North East of England, Bristol and Gloucestershire, and in parts of Scotland to develop our understanding of how well they are organised and funded in different settings. We will use publicly available information and talk to providers and funders._x000D_ _x000D_ We will examine data from social prescribing services and other sources to see who is referred, for what reasons, and whether people take up the support offered. Using these data, we will look at the ways people are invited to meet link workers, identify gaps in access and participation, as well as the variation in people’s health and wellbeing outcomes._x000D_ _x000D_ We will talk with service users, link workers and providers of community services about how social prescribing services are accessed so that we can understand the role of the link worker, how activities are planned and followed up. We will listen to the different views of people from diverse cultural backgrounds and marginalised groups and to GPs, link workers, and community organisations about their experiences of using and providing social prescribing services._x000D_ _x000D_ Finally, we will look at the economic sustainability of link worker services. The development of any system that encourages people to access community services needs to have the capacity to meet those extra access needs. We will use data collected by the services and data that we have collected to find out which resources will bring most benefit to the NHS in the long term.

Lay abstract: Background_x000D_ Social prescribing links patients in primary care with sources of support within the community. With national policy implementation underway across the UK, there is now a need to understand the impact of social prescribing link worker services and how they can be developed in the future._x000D_ _x000D_ Our overall aim is to take a multi-regional approach to map current provision and service configuration and to assess whether access, engagement and outcomes vary by delivery model, geography and population characteristics over time._x000D_ _x000D_ Methods_x000D_ WP1 Implementation: will map link worker service provision in each region, highlighting key features relating to funding, organisation and delivery and taking account of characteristics that might influence access and experience of delivery. From this, we will develop a taxonomy of services and use this to select a maximum variation sample of eight case study sites for in-depth exploration in the WPs that follow. _x000D_ _x000D_ WP2 Access and Equity: will examine variations in access, uptake and engagement based on area-level and population characteristics (age, gender, ethnicity, area deprivation, availability of community assets, and rurality) using three datasets: Aggregate-level national analysis in England using Oxford RCGP Research and Surveillance Centre’s Observatory on Social Prescribing; Individual-level national analysis using data from CPRD; Individual-level regional analysis using local service datasets._x000D_ _x000D_ WP3 Engagement: will use candidacy and self determination theory as a lens to explore the experience and acceptability of the referral process, the therapeutic encounter and the process of accessing and engaging with social prescribing services. We will do this through qualitative interviews with matched samples of referring professionals, link workers, service users and community service providers across the eight case study sites (20 matched samples per case site)._x000D_ _x000D_ WP4 Outcomes: will assess health and wellbeing and service outcomes, and whether outcomes vary within and between services delivered and by population characteristics (age, gender, ethnicity, area deprivation, availability of community assets, and rurality). We will examine impacts using two analytic approaches: matched comparisons of outcomes between referred and non-referred individuals using data from practice records and a national longitudinal survey; and longitudinal analysis of association between numbers of link workers and outcomes of populations targeted by link workers using data from two very large national surveys._x000D_ _x000D_ WP5 Economic sustainability: will estimate link worker cost-effectiveness in terms of additional cost per additional person linked to social prescribing schemes and then develop a model to produce a cost-utility analysis. This will be supplemented by detailed identification of costs and benefits that fall outside the scope of the NHS and Personal Social Services, consideration of whether a distributional approach substantially affects the results, and assessment of different funding models for link workers in the future. _x000D_ _x000D_ Dissemination_x000D_ In keeping with our successful partnership approach to evaluating policy implementation, we will share insights and learning with the national policy decision makers as the work progresses. We will seek opportunities for wider dissemination to public and professional audiences, involving patients to ensure the most important findings are disseminated clearly.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE