Social prescribing

1. Introduction

Version followed: NHS England, Social prescribing: Reference guide and technical annex for primary care networks (current long-read edition; publication year not confirmed [uncertain]), supplemented by the NHS England-derived SPLW Workforce Development Framework summary (Transformation Partners in Health and Care), the National Academy for Social Prescribing (NASP) Social Prescribing Link Worker Induction Guide, and WHO Western Pacific Regional Office, A toolkit on how to implement social prescribing (2022; read in the Istituto Superiore di Sanità Italian translation, January 2024). Where the WHO and NHS England versions differ, both are named.

What it is. Social prescribing is not a psychotherapy and has no founder-authored treatment manual. It is a referral pathway and service model: a clinician or other agency refers a person to a link worker (in England, a social prescribing link worker, SPLW), who holds a person-centred conversation about "what matters to you", co-produces a simple personalised care and support plan, and connects the person to non-medical community activities, groups and services (arts and culture, nature, physical activity, advice services on debt, housing and benefits, work and volunteering) [source: NHS England reference guide]. The WHO toolkit states the key point plainly: social prescribing is a pathway that addresses needs, not an intervention in itself, and its results depend on the community services it connects people to [source: WHO/ISS toolkit, overview].

Core idea of change. Many problems that bring people to health services (loneliness, debt, poor housing, inactivity, low-level distress, the social burden of long-term conditions) are driven by social determinants that medicine and talking treatments cannot reach on their own; a supported, personalised connection to community resources addresses those drivers [source: NHS England; WHO/ISS]. The realist review by Husk et al. locates change in three successive steps: the person agreeing to the referral (enrolment), attending the first session (engagement) and continuing (adherence), each driven by distinct mechanisms such as belief that it will help, practical accessibility, supported transit and skilled, trusting activity leaders [source: Husk et al. 2019/2020, Health & Social Care in the Community].

How a psychotherapist uses this guide. A therapist is usually (a) a referrer into a social prescribing service, (b) a colleague working alongside link workers in primary care or a mental health team, or (c) a clinician adapting the link-worker procedures inside their own work (for instance as part of a behavioural activation or recovery plan). Sections 4 and 5 describe the link-worker pathway as the sources publish it and mark therapist-side adaptations as [synthesis].

2. Framework

Four process models (Husk et al. typology) [source: Husk et al.]:

• Model 1, signposting or information prescription: the person is given information about options.
• Model 2, primary care to activity: the clinician refers directly to a specific activity (e.g. exercise or arts on prescription).
• Model 3, primary care to link worker to activity: a link worker supports the referral; this is the model favoured by UK policy.
• Model 3+, holistic: a flexible, iterative, person-led process in which the person can return to the link worker after trying an activity.

The NHS England version is a Model 3/3+ service. Husk et al. judge signposting alone unlikely to be enough for people with complex mental health needs.

Pathway phases (individual level).

Dose and caseload (England). On average 6 to 12 contacts over about three months, depending on need; typical maximum annual caseload 200 to 250 people per link worker, depending on complexity [source: NHS England; TPHC WDF summary]. The WHO toolkit gives no session count [source: WHO/ISS, as far as read].

Who it suits. People with one or more long-term conditions, low-level mental health needs, loneliness or isolation, or complex social needs affecting wellbeing [source: NHS England]; WHO adds people at high risk of mental illness and people vulnerable through age or finances [source: WHO/ISS].

Service-level phases (WHO version). Seven implementation steps, possibly iterative: situation analysis; core implementation team; workplan with logic model and sustainability plan; mapping community resources; getting everyone (referrers, community organisations, link workers) on board; link worker training; monitoring and evaluation. Plan-Do-Study-Act cycles are recommended for refinement [source: WHO/ISS; steps 6 and 7 not read in detail, uncertain].

Delivery requirements (England). No licence or certification is needed to use the term; within NHS primary care networks, SPLWs complete an induction, mandatory Health Education England e-learning and Personalised Care Institute training, have a named GP supervisor and monthly non-managerial clinical supervision, and evidence competence against the NHS England competency framework and portfolio [source: TPHC WDF summary; NASP].

3. Guiding principles

• Start from what matters to the person, not what is the matter with them. Open with the person's priorities; the plan follows their agenda [source: NHS England; NASP].
• Personalised care is the frame. Social prescribing is one of six components of the NHS Comprehensive Model of Personalised Care (with shared decision making, care and support planning, choice, supported self-management and personal health budgets); combine it with these, not instead of them [source: NHS England].
• Co-production. Plans and goals are made together and kept simple; the link worker does not prescribe an activity to a passive recipient [source: NHS England; NASP].
• Build self-management. Use coaching and motivational interviewing so the person gains confidence to act for themselves [source: NHS England].
• Non-medical, holistic and all-age. Covers mental and physical health and practical, social and emotional needs; the link worker is not a counsellor or clinician [source: NHS England; WHO/ISS].
• A pathway, not an intervention. Outcomes depend on the quality and availability of what you connect people to, so the community offer must be mapped, assessed and developed [source: WHO/ISS].
• Two-way, not passive referral. Community organisations are partners across the whole journey and can report wrong referrals or lack of capacity [source: WHO/ISS].
• Support the transition, not just the signpost. The step from referral to first attendance is where people drop out; practical help (information, calls, accompaniment, transport) bridges it [source: Husk et al.].
• Fit the offer to the person. Match to need, personality, culture and practical circumstances; cultural mismatch and inaccessible activities predict non-uptake [source: Husk et al.].
• Keep the door open. Allow return to the link worker after an activity; iteration is part of the model (Model 3+) [source: Husk et al.].
• Equity and inclusion. Proactively reach groups with unmet need and meet the Public Sector Equality Duty [source: NHS England].
• Measure and feed back. Record referral, contacts, connections and wellbeing outcomes and tell the referrer how things went [source: NHS England; NASP; WHO/ISS].
• Supervised practice and self-care. The worker is supported by supervision, peer networks and attention to their own wellbeing [source: TPHC WDF summary; NASP].

4. Intervention inventory

The sources describe procedures, not proprietary techniques. Items 1 to 11 are the person-level pathway; items 12 to 16 are the service-level work that makes it function; item 17 is therapist-side integration. Example language is illustrative throughout.

1. Identifying and referring a person (referrer task)

• Purpose / when: Get the right people to a link worker. Use when wellbeing or symptoms are being maintained by loneliness, debt, housing, inactivity, caring strain, unemployment or the social burden of a long-term condition [source: NHS England; WHO/ISS].
• Steps: (1) Ask briefly about social and practical circumstances. (2) Judge whether the person could benefit (WHO lists this as the referrer's first responsibility). (3) Explain what the link worker does and does not do: the link worker is not a counsellor but plans connections with the person [source: WHO/ISS]. (4) Present the referral so it fits the person's expectations: address fear of the unknown (a leaflet helps), worries about worsening a condition, and what will actually happen next [source: Husk et al.]. (5) Get consent and refer by the local route; record the referral or the person's decision to decline with the national SNOMED codes [source: NHS England; NASP]. (6) Collect the data your scheme requires [source: WHO/ISS].
• Example language (illustrative): "A lot of what you've described, the money worries and not seeing anyone, isn't something therapy alone can fix. Our practice has a link worker whose job is to sit down with you, work out what matters most, and help you get connected to things locally. Would you be open to me referring you?"
• Watch for: Husk et al. found that a GP's suggestion carries weight but is read differently across cultural groups, and that a letter alone was ineffective. It is working when the person can say in their own words why they are going and what they hope for.

2. Pre-contact and booking (link worker)

• Purpose / when: Turn a referral into a first appointment and reduce early drop-out.
• Steps: Contact the person, confirm the reason for referral, explain the support on offer, book an initial appointment; read the medical notes and think about possible options before you meet [source: NASP].
• Example language (illustrative): "Dr X asked me to get in touch. I'm not a doctor or a counsellor; I help people find support and activities in the area that fit what they want. Could we meet for about an hour next week?"
• Watch for: Unanswered calls or hesitancy; offer phone or in-person options and a time that fits around work and caring [synthesis].

3. The "what matters to you" conversation

• Purpose / when: The core first session. Identify the issues affecting the person's health and wellbeing from their own perspective [source: NHS England].
• Steps: (1) Prepare a private space, in person or by phone, for confidentiality [source: NASP]. (2) Open with the person's priorities rather than their diagnosis. (3) Use active listening (NASP supplies active-listening guidance) [source: NASP]. (4) Explore practical, social and emotional areas: relationships and contact, money, housing, work, daily routine, interests past and present, health worries [synthesis, consistent with NHS England's practical/social/emotional framing]. (5) Summarise and agree which issues the person wants to work on first. (6) Agree a next session if needed [source: NASP].
• Example language (illustrative): "Before we talk about any services, what matters most to you at the moment?" / "When was the last time you felt like yourself? What were you doing then?"
• Watch for: Disclosures of risk or safeguarding concerns (see item 16); the person deferring to what they think you want. Working when the person names their own priorities.

4. Co-producing a personalised care and support plan (PCSP)

• Purpose / when: Turn priorities into a simple, owned plan [source: NHS England].
• Steps: (1) For each priority, write the need, the strategy and a realistic goal together [source: NASP]. (2) Keep it short, in the person's words. (3) Use NASP's Personalised Support Plan template and wellbeing goal-setting worksheet if your service uses them [source: NASP]. (4) Agree who does what before the next contact. (5) Give the person a copy [synthesis].
• Example language (illustrative): "So the first thing is getting the council tax letter sorted, and the second is finding something to get you out of the house once a week. Shall we write those down as your two goals?"
• Watch for: Goals that are yours, not theirs; too many at once. Working when the person can recall the plan at follow-up.

5. Health coaching and motivational interviewing within the link-worker role

• Purpose / when: Support self-management and build confidence to act [source: NHS England]. Use when the person is ambivalent or has low confidence.
• Steps: NHS England names coaching and motivational interviewing but does not give a protocol; apply standard MI practice (open questions, reflections, eliciting the person's own reasons, rolling with ambivalence) and coaching (scaling confidence, small next steps) [synthesis]. WHO says follow-up uses behaviour change techniques without specifying them [source: WHO/ISS].
• Example language (illustrative): "On a scale of 0 to 10, how confident are you that you'll go along on Tuesday? What makes it a 4 and not a 2?"
• Watch for: Drifting into counselling or therapy; stay within the non-clinical remit and refer on if psychological treatment is needed.

6. Matching and connecting: signposting, onward referral, warm referral

• Purpose / when: Find activities and services that fit the plan and make the connection [source: NASP; NHS England].
• Steps: (1) After the session, set aside time to search the local directory for options [source: NASP]. (2) Match to need, personality, culture and practical constraints such as cost, distance, timing, transport and perceived safety [source: Husk et al.]. (3) Choose the connection level: give information (signpost) or make an onward referral, and make sure the person has all the details [source: NASP]. (4) For specialist needs, connect to specialist advice services (debt, benefits, housing) [source: NHS England]. (5) For more vulnerable people, go beyond signposting (item 7).
• Example language (illustrative): "There are two walking groups near you: one on Monday mornings, slower paced, and one on Saturdays that's bigger. Which sounds more like you?"
• Watch for: Offering what exists rather than what fits; cultural mismatch. Working when the person picks an option themselves.

7. Supported transit: preparing for and accompanying the first visit

• Purpose / when: Bridge the drop-out point between referral and first attendance [source: Husk et al.].
• Steps: (1) Give introductory information about the activity and who runs it. (2) Make a follow-up phone call before the first session. (3) Offer a buddy or link-worker accompaniment where needed; intensity varies [source: Husk et al.]. (4) Links2Wellbeing adds: review the participation plan (chosen programmes, mobility, language and accessibility needs), call to confirm date, time, location and transport, and reduce anxiety with a welcome introduction, orientation and volunteer support [source: Links2Wellbeing]. (5) Where possible, introduce the person to the activity leader in advance [synthesis]. Husk et al. report that initial contact with the facilitator was the strongest predictor of engagement in one study.
• Example language (illustrative): "Would it help if someone met you at the door the first time?" (Links2Wellbeing suggests offering this)
• Watch for: Anxiety, transport and cost barriers. Working when the person attends the first session.

8. Follow-up and review

• Purpose / when: Check progress, catch barriers early, decide on more sessions [source: NASP; Links2Wellbeing].
• Steps: (1) Before contact, review attendance history and previous notes [source: Links2Wellbeing]. (2) Ask about progress on goals, whether the person engaged with the referral, and whether another session is needed [source: NASP]. (3) Ask what is making participation harder; record barriers such as transport, declining health, scheduling or anxiety [source: Links2Wellbeing]. (4) Problem-solve or re-match (back to item 6). (5) Report progress to the referrer [source: WHO/ISS]. Timing: England gives 6 to 12 contacts over around three months [source: NHS England]; Links2Wellbeing uses 3-, 6- and 12-month check-ins (a programme-specific schedule).
• Example language (illustrative): "How did the first couple of sessions go? Was there anything that made it harder to get there?"
• Watch for: Polite reports of attendance that the tracker contradicts; lack of felt benefit, which Husk et al. link to drop-out.

9. Measuring outcomes

• Purpose / when: Track wellbeing and evidence impact.
• Steps: (1) Use ONS4 (four Office for National Statistics personal wellbeing questions covering life satisfaction, feeling worthwhile, happiness and anxiety; free) at referral and at least every six months for a year [source: NHS England]; NASP describes it as usually asked at the start and end of support. (2) Add local measures as agreed, e.g. SWEMWBS [source: NHS England] or the Patient Activation Measure (PAM, a licensed instrument) [source: NASP]. (3) Collect a patient impact story [source: NHS England]. (4) Complete the final evaluation at ending [source: NASP]. Do not reproduce instrument items in your own materials beyond what the licence allows.
• Watch for: Measurement crowding out the conversation; administer briefly and explain why.

10. Recording and coding

• Purpose / when: Keep the journey visible in the clinical record and meet national data requirements.
• Steps: Record referral or decline with the national SNOMED codes; record date of referral, referrer, reasons, equality monitoring, contacts and time spent, where the person was connected and outcomes [source: NHS England]; NASP notes newer minimum-dataset codes for needs and concerns and for support received, and a Social Prescribing Information Standard covering the whole journey [source: NASP]. After every interaction note contact date, method, attendance, barriers, actions and next follow-up date [source: Links2Wellbeing].
• Watch for: Missing "declined" codes, which hide unmet need.

11. Ending, final evaluation and the route back

• Purpose / when: Close support when goals are met or the person is settled in community activity.
• Steps: (1) Arrange a follow-up to complete the final evaluation [source: NASP]. (2) Summarise for the referrer [source: NASP; WHO/ISS]. (3) Tell the person how to return if things change, in line with the holistic Model 3+ [source: Husk et al.]. NASP lists a "Managing Endings" resource that is not drawn on here [uncertain].
• Example language (illustrative): "You've been going to the group for two months and the debt plan is in place. Shall we make next month our last check-in? You can always come back to me."
• Watch for: Dependence on the link worker rather than on community ties; plan a tapering contact schedule [synthesis].

12. Community asset mapping and building a directory

• Purpose / when: Know what exists locally before and while taking referrals [source: NASP; WHO/ISS].
• Steps: (1) Walk the area and note services and activities. (2) Research the local population for unmet needs and gaps. (3) Hold one-to-one meetings with key organisations (community centres, mental health services, advice services) to learn what they offer and how to refer. (4) Build a directory combining your research with existing resources. (5) Consider a networking event with local providers and fellow link workers. (6) Match directory entries to the most common referral needs [source: NASP]. WHO's resource categories to cover: welfare, legal, financial, housing and food security; social care including mental health, addiction and disability support; domestic and gender-based violence support; indoor and outdoor social activities; employment, vocational learning and social enterprise; lifelong learning; health promotion, physical activity and nutrition; urban nature; music, arts and culture; volunteering [source: WHO/ISS, step 4].
• Watch for: Stale directories; schedule regular updates [synthesis].

13. Assessing the quality and safety of community services

• Purpose / when: Referred people are often vulnerable and the pathway is only as good as its destinations [source: WHO/ISS].
• Steps: The core team sets minimum standards; suggested areas include organisational health and safety policies, food safety, confidentiality, inclusivity and effectiveness, using existing frameworks as references [source: WHO/ISS]. Build accountability mechanisms and let organisations report wrong referrals or capacity problems [source: WHO/ISS].
• Watch for: Unvetted groups receiving people with safeguarding needs; groups whose leaders lack skills for complex participants (a failure context in Husk et al.).

14. Identifying gaps and developing community provision

• Purpose / when: When needed services do not exist.
• Steps: Capture unmet demand from the start through monitoring [source: WHO/ISS]; work with VCSE organisations, local authorities and others to identify gaps and help build accessible, sustainable community offers [source: NHS England]; contribute to a shared local social prescribing plan co-produced with integrated care systems, local authorities, PCNs, VCSE and people with lived experience [source: NHS England]. WHO notes local volunteer organisations or community associations may fill gaps [source: WHO/ISS].

15. Supervision, peer support and worker self-care

• Purpose / when: Ongoing; protects quality and the worker.
• Steps: Named GP supervisor with regular meetings covering management, role issues, patient concerns and safeguarding; monthly non-managerial clinical supervision with a relevant health professional for emotional support and guidance on patient risk; a first point of contact in each practice; local or regional peer networks; NASP reflective practice tool for peer supervision; regular manager check-ins, caseload review and, if used, a Wellness Action Plan [source: TPHC WDF summary; NASP].
• Watch for: Workloads exceeding the 200 to 250 caseload guide; emotional strain from complex cases.

16. Safeguarding and concern response

• Purpose / when: Whenever a disclosure, risk indicator or concern arises.
• Steps: Know your organisation's procedure for raising concerns and your named point of contact; NASP supplies a Concern Response Plan template and recommends Level 1 adult and child safeguarding training; safeguarding is a standing item in GP supervision [source: NASP; TPHC WDF summary]. The sources used here do not set out a suicide-risk or mental-health crisis protocol for link workers [uncertain]. In practice: if a person discloses suicidal thoughts or acute deterioration, the link worker does not assess or manage it alone but escalates the same day to the GP supervisor or duty clinician and follows local crisis procedures [synthesis].

17. Integrating social prescribing into psychotherapy (therapist-side) [synthesis]

The sources used here do not describe therapist-specific procedures; everything in this item is the author's synthesis built on the pathway above.

• Purpose / when: When social isolation, practical stressors or lack of meaningful activity maintain the presenting problem, or when therapy is ending and the client needs a community base.
• Steps: (1) In assessment, map social and practical drivers alongside symptoms. (2) Formulate how these maintain the problem (e.g. isolation feeding low mood and rumination). (3) Offer referral to the link worker as part of the treatment plan, with consent to share relevant information. (4) Agree roles: the link worker handles connection and practical navigation; therapy handles psychological barriers (social anxiety, avoidance, shame, low motivation). (5) Use therapy sessions to rehearse and process first attendance (behavioural experiments, graded exposure planning for social anxiety, activity scheduling). (6) Exchange brief updates with the link worker with consent. (7) Before discharge from therapy, check that community connections are in place as relapse protection.
• Example language (illustrative): "We've been working on the anxiety about groups. The link worker can find you a group that fits; we can use our sessions to plan how you'll handle the first visit."
• Watch for: Duplication or conflicting advice between therapist and link worker; clients using referral as avoidance of therapeutic work, or vice versa.

5. Handling problems

The sources give barrier lists and failure contexts but few step-by-step responses; responses marked [synthesis] are the author's own.

• Person declines the referral. Record the decline with the SNOMED code [source: NHS England]. Explore why: Husk et al. find enrolment depends on believing it will help and on an acceptable presentation (fear of the unknown, fear of worsening a condition). Offer written information about what the link worker does, leave the offer open, and revisit later [synthesis].
• Referred but never attends the first appointment. Husk et al. identify supported transit (information, follow-up calls, buddying or accompaniment) as the engagement mechanism and found letters alone ineffective. Respond with a phone call rather than a letter, offer phone or home-adjacent meeting, and ask about practical barriers [synthesis based on Husk et al.].
• Practical barriers (cost, transport, timing, safety, caring duties). These are the main barriers in the WHO-cited Australian survey and in Husk et al. Re-match to nearer, free or differently timed options, arrange transport support or accompaniment, or report the gap (item 14) [source: WHO/ISS; Husk et al.].
• Stops attending an activity. Review attendance before contact, ask what makes participation harder, document the reason, support offered and next steps [source: Links2Wellbeing]. Husk et al. link drop-out to lack of perceived change, unrealistic expectations and external pressures: reset expectations, highlight early small gains (sleep, routine), and offer an alternative that fits better [synthesis].
• Activity is a poor fit or the group leader is unskilled. Husk et al. name unsupportive leadership and staff not trained for complex participants as failure contexts. Feed back to the provider through the two-way referral relationship and re-match the person [source: WHO/ISS; Husk et al.].
• Cultural mismatch. Husk et al. describe referral offers that did not fit British South Asian participants. Ask about cultural, faith and language preferences at item 3 and map culturally specific groups in the directory [synthesis].
• Needs exceed the link-worker remit (moderate to severe mental illness, complex trauma). Husk et al. judge signposting alone insufficient for complex mental health needs. Refer for clinical treatment in parallel; social prescribing complements, not replaces, therapy [synthesis].
• Risk, crisis or safeguarding concerns emerge. Follow the organisation's concern procedure and escalate to the GP supervisor or duty clinician; use standard risk-assessment pathways run by clinicians; do not leave the person alone with an unmanaged acute risk [source for procedure: NASP; escalation detail synthesis].
• Overwhelm (person faces too many problems at once). Prioritise one or two goals in the PCSP, start with the most urgent practical issue (e.g. debt advice) and sequence the rest [synthesis].
• Dependence on the link worker. Use the 6 to 12 contact frame [source: NHS England], plan endings openly, transfer the relationship to the activity leader or peer, and keep a return route (Model 3+) [synthesis].
• Rupture with the link worker or referrer (person feels "fobbed off" with a leaflet instead of help). Acknowledge it directly, explain why social factors matter to their health, and show what the link worker will actively do; where the person is in therapy, keep therapy going in parallel so the referral is not experienced as discharge [synthesis].
• Overloaded link worker or service. Keep within the 200 to 250 caseload guide, raise with the line manager, and use supervision and peer networks [source: NHS England; NASP; TPHC WDF summary].
• Wrong or inappropriate referrals. Let community organisations report them and give referrers clear criteria and training [source: WHO/ISS].

Sources

Sources:

• Social prescribing: Reference guide and technical annex for primary care networks (NHS England, long-read)
• A toolkit on how to implement social prescribing (WHO Western Pacific, landing page)
• Prescrizione sociale: Italian translation of the WHO toolkit (Istituto Superiore di Sanità, January 2024) (read to step 5; steps 6 and 7 and the annex not read)
• Summary: SPLW Workforce Development Framework v2 (Transformation Partners in Health and Care, adapted from NHS England)
• Social Prescribing Link Worker Induction Guide (National Academy for Social Prescribing)
• Husk et al., What approaches to social prescribing work, for whom, and in what circumstances? A realist review (University of Exeter repository copy)
• Links2Wellbeing Learning Hub, Module 4, Chapter 3: Client management and follow-up
• Kerryn Husk et al. 2016 realist review protocol record (University of Hull repository)
• RCPsych news: Combat the mental health fallout of COVID-19 by improving access to social prescribing (2021) (no procedural content used)

Papers cited:

• Husk K, et al. (2020; co-author list not verified). What approaches to social prescribing work, for whom, and in what circumstances? A realist review. Health & Social Care in the Community, 28(2), 309–324 (accepted 2019).
• WHO Regional Office for the Western Pacific (2022). A toolkit on how to implement social prescribing. Manila: WHO WPRO.

Further reading (not drawn on) [uncertain]: the full WHO English PDF, NHS England's full SPLW Workforce Development Framework and competency framework, NASP's "Managing Endings" and boundary-setting resources, and the ARC South West summary of Husk et al.