Multi-region (and multi-level) evaluation of the roll out of social prescribing link workers in primary care.

Background 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. 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. Methods 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. 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. 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). 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. 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. Dissemination 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.