Social prescribing is unlikely to reduce health inequalities, according to a study published today.

Researchers in Scotland completed a two-year evaluation of the Deep End Links Worker Programme (LWP), which was set up as part of a key health policy in primary care practices to reduce health inequalities.

The Scottish Government is promoting social prescribing to help mitigate health inequalities and has pledged to roll out 250 link workers nationally by the end of the parliament in 2021. Before this, it piloted the Deep End Links Worker Programme (LWP), which targeted GPs based in practices serving some of the most deprived patients in Glasgow.

The researchers, from the universities of Glasgow and Edinburgh, followed the progress of seven general practices in deprived areas of Glasgow and used thematic analysis to identify the extent of LWP integration in each practice and the key factors associated with implementation. They then used normalisation process theory (NPT) to analyse the outcomes and success, writing their results in the latest edition of the British Journal of General Practice.

In the two-year study period, only three of seven practices fully implemented the programme as planned and the team found practices that fully integrated the LWP had a better shared understanding of the programme, higher staff engagement, and implemented the LWP at all three of its intended levels of impact of patient, practice, and community. They also said success of the scheme was influenced by leadership, team relationships, how practices dealt with disrupted community link practitioner (CLP) support, and how practices dealt with other ongoing interventions in and around the practice.

The two practice types did not differ in terms of their list size or ethnicity of patients, but there were more Partially Integrated Practices (PIPs) with training practice status compared with Fully Integrated Practices (FIPs). Training practices were found to be more innovative than non-training practices, which would not explain these findings. Even in a well-resourced government funded social prescribing programme, the majority of general practices involved in this study had not fully integrated the programme within the first two years. This is important as it shows that implementing social prescribing within primary care at scale is unlikely to be a ‘quick fix’ for mitigating health inequalities, the researchers say.

The researchers conclude that even in a well-resourced government-funded programme, the majority of practices involved had not fully integrated the LWP within the first two years, which would mean implementing social prescribing and link workers within primary care at scale is unlikely to be a “quick fix” for mitigating health inequalities in deprived areas.They add that embedding new innovations in primary care can take many years and admit they do not know if the PIPs would become FIPs or if the interventions would continue to be sustained in the FIPs.