The success of any social prescribing scheme is contingent on resources available in a given locality. Without a range of options to offer, the scheme may not address the needs of all individuals.

As a mechanism for preventative measures, social prescribing can only be sustainable with a robust ecosystem of support. This includes the local VCSE sector, NHS, PCNs, and CCGs. With good relationships and collaboration among these groups, social prescribing can be successful.

Yet, such a system varies across local areas. A link worker operating in an affluent area will have more options for clients compared to one in a highly-deprived area. Addressing these inequalities is necessary to ensure that social prescribing is viable.

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‍Addressing inequalities

‍There have been significant concerns that social prescribing may exacerbate rather than reduce health inequalities. A lack of VCSE capacity in poorer communities means that link workers have less to offer their clients. This include gaps in the provision of basic services such as:

• housing support,
• welfare rights advice,
• financial advice,
• employment advice,
• and mental health.

Without the fundamentals for good health and wellbeing, individuals in these areas may fall through the cracks.

Another key inequality is that the main route to access support is through primary care. This immediately excludes marginalised communities that cannot access GP services. High-risk groups in this line are homeless people, refugees, asylum seekers, and travellers. In areas with large populations of these groups, an alternative path is necessary. Still, there remains a gap in understanding ways to reach them.

Link workers in highly-deprived areas also struggle with massive inappropriate referrals. These include individuals who may need longer-term support or have more complex needs. While this may be due to over-burdened statutory services, link workers cannot provide the necessary support either.

Other individuals referred to as Link Workers are those GP practices consider “too difficult”. Some of these people need help even to engage with community groups and activities. In these cases, social prescribing becomes misused as an intervention to fill gaps in primary care.

Still, another target group left behind is youth. Children and young people may present issues that GPs and link workers may not have the skills to navigate.

Addressing these levels of inequalities demands solutions beyond employing more link workers.

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‍Finding solutions

‍The pandemic has amplified the need to address health inequalities as a key priority. An effective response means ensuring that social prescribing targets distinct communities and individuals.

A strong, diverse VCSE sector is an essential prerequisite for social prescribing. People have complex practical, emotional and social needs. To address these, there must be additional funding for a range of local groups, activities and services. Only sustainable VCSE activity can meet the growing demands of social prescribing.

There is also a need to ensure access to specialist services. Examples include 1-to-1 advice or mental health support. This is especially for communities with complex needs including refugees and youth. Link workers alone cannot address these.

Further costs may be necessary to train link workers to work with these groups. Still, they are only intermediaries. They cannot be the only source of support for these individuals. Neither can they provide the long-term, multidisciplinary help these people need.

Rather local authorities and commissioners ought to distribute funding for the wider VCSE sector. This would enable instituting new community services and infrastructure for coordination.

In general, financial support is necessary to sustain existing activities and support new activities, especially in the poorest communities. Where social prescribing identifies special demand there must be extra funding for the sector. This ensures a functioning ecosystem of support.