This blog entry was written by Dan Hopewell. Dan is a founder member of the Social Prescribing Network. I've collaborated with Dan on various social prescribing initiatives for over a decade, starting before the NHS strategy was established. Our work includes co-designing the first-ever Level 3 social prescribing qualification, delivered by Conexus and Bromley by Bow. I greatly admire his passion and dedication for making a positive difference for people experiencing inequalities in communities and consistently challenging decision making that doesn't align to the principles of social justice. His impact on social prescribing, at both local and national levels, has been deeply appreciated and much needed.
Dan is a lifelong advocate for social justice and community empowerment who has been instrumental in shaping and advancing the field of social prescribing. His work, which began with grassroots activism and public art projects internationally, is founded on the core belief that community connection and holistic, person-centred support are crucial for health and well-being. Through his involvement with the pioneering Bromley by Bow Centre in London and his influence on the broader UK social prescribing model, Dan has consistently championed a system that looks beyond clinical treatments to address the social determinants of health.
At the heart of Dan's work is the development of community-led health models that integrate creative, social, and practical support. During his time at Bromley by Bow he helped to develop its Healthy Living Centre model which transformed a run-down church into a vibrant community hub that reversed traditional, top-down approaches to health. Instead, it integrated arts programmes, employment support, and social services, demonstrating a model where health and wellness are nurtured through engagement and belonging. This ethos, that health is fundamentally linked to a person's environment and social connections, forms the very foundation of social prescribing. Dan's experience in fostering this integrated, community-based approach has provided a crucial framework for how social prescribing link workers operate today.
Dan's contributions have also supported social prescribing by challenging the narrow, biomedical view of health. He, along with others, recognised that many health problems stem from social factors like loneliness, debt, poor housing, and unemployment. Instead of merely managing symptoms, Dan advocates for social prescribing as a way to tackle root causes by linking individuals to non-clinical activities and community support networks. This perspective has been vital in advocating for social prescribing as an appropriate response to health problems with social determinants.
I hope you enjoy reading Dan's blog.
Social Prescribing, Past, Present and Future
by Dan Hopewell, Director of Knowledge and Innovation, Bromley by Bow Health
D'ou Venons Nous
In 1997, Bromley by Bow Centre and Bromley by Bow Health opened the first Healthy Living Centre in the UK, born out of a dilapidated church, the agency of a community and their organisation, the Bromley by Bow Centre and the partnership developed with a General Practice team. The premise was that clinicians would have holistic consultations with patients and introduce them to the services and activities, such as welfare advice, adult learning, employability, arts and horticulture, run by the Centre.
Through the 2000s and 2010s, from maverik to mainstream
By 2015 Bromley by Bow had employed its first social prescribing link worker and other early adopter schemes had developed across the country. Social prescribing was becoming an innovation that was taking hold.
The first conference on social prescribing, 2015, launched the Social Prescribing Network and work began on persuading the NHS to adopt it. A year later social prescribing appeared in General Practice - Five Year Forward View and in 2019 the NHS Long Term Plan spoke of Personalised Care and the introduction of three new roles in General Practice, Social Prescribing Link Workers, Care Coordinators and Health and Wellbeing Coaches. Social Prescribing was specified as a universal service, to be available through Primary Care Networks (PCNs) and GP Practices to all patients in England. There were to be 4,500, social prescribing link workers to be in post by March 2024 paid through the Additional Roles Reimbursement Scheme (ARRS).
Social Prescribing had gone from an innovation developed by 'outsiders', usually inspired, unconventional GPs working in deprived communities with local voluntary sector organisations and communities, to something being rolled out by a national 'command and control' organisation. Social prescribing was going from maverick to mainstream.
Que Sommes Nous
Through the 2020s ...to 2025 celebration and concern
The adoption of social prescribing across England's 1,200 PCNs and 6,000+ GP practices, (2019/2020 onwards), was taken on with huge enthusiasm. NHS England created a national Social Prescribing team to support roll out, co-designing with many stakeholders and disseminating guidance and employing an army of Regional Facilitators and Regional Learning Coordinators to support systems change and the new social prescribing workforce. The Social Prescribing Network and the newly established National Academy for Social Prescribing supported this evolution too.
Roll out coincided with Covid, perhaps a double edge sword, as many GP practices' initial use of social prescribing link workers was to make thousands of brief 'wellbeing calls' which has skewed their understanding of the role ever since.
After five years of implementation there is much to celebrate, but also cause for concern.
Having trained around 1,000 social prescribing link workers across the four home nations and beyond and co-facilitated the London Social Prescribing Managers' network for many years, I have been acutely aware of the huge variability of adoption of social prescribing. (We have pointed out to CQC that such variability would not be acceptable if it were found in other aspects of health and care).
I am constantly impressed by the calibre, authenticity and dedication, and at times heroism of social prescribing link workers and their managers. And in many cases, they recount how well they are resourced, and integrated, both at the clinical end of the telescope, and at the community end, and how well they are supported and supervised.
However, I also get to hear many distressing stories too. Of single handed, isolated, social prescribing link workers, with no meaningful management or supervision, trying to support an annual case load four times greater than the NHS considers feasible. And in doing so, becoming little more than a signposting service delivered through ten-minute phone calls. This is often due to PCNs and GP Partners still not understanding the social prescribing model and it's potential to support capacity and demand issues, or under resourcing it.
This under-resourcing translated into the NHS missing the target of 3.5 link workers per PCN by March 2024 by a considerable margin. Since then, and despite the target being revised to 9,000 by March 2037, the numbers have plateaued, in many areas are in decline, a process accelerated by the opening up of the ARRS funding stream to pay for the traditional and more recognised GPs and Nurses, reinforcing the pathogenic model. One in which 20-30% of consultation time is taken up with social issues, (housing, debt, employment etc.), and their impacts.
On the positive side social prescribing is beginning to diversify and spread, into hospitals, HIV clinics, schools and prisons, and with social prescribing link workers focussed on children and young people, mental health, and combining the social prescribing role with that of a welfare benefits advisor, youth worker or HIV Peer Mentor to name but a few.
However, from my experience over many years of co-facilitating the London Social Prescribing Managers' network, the one abiding theme is how social prescribing as a whole community approach and opportunity is often not properly understood or supported. And in many parts of the capital social prescribing is continually under threat of disinvestment, and fragmentation, limping along from one annual settlement to another, each year haemorrhaging experienced link workers in February and March as they have no idea if they will have a job in April.
Où Allons Nous
2025 and beyond, following the science or the disproven dogma
The evidence suggests that the current healthcare system is not only failing, but also failing to improve. Life expectancy gaps are increasing, (in London, in the 15 years before Covid they doubled to 18 years), people are developing long term conditions at ever earlier ages, and there are significant levels of over medicalisation, with substantial over-prescribing (25% of the NHS CO2 footprint is medication), and unnecessary medical interventions, estimated at up to 1 in 7 in hospitals.
Despite the science, that 70+% of health outcomes are socio-economically determined, in the current system, the bio always trumps the psycho and the social, and treatment always trumps prevention.
Even the most modest interventions intended to improve patients' socio-economic determinants of health such as social prescribing are constantly questioned and threatened with de-funding. And evidence that Green prescribing could save the NHS £650 million a year, or of the value of creative health interventions is largely ignored.
Indeed, although there are positives in the 10 Year Health Plan, including the potential adoption of the Brazilian Community Health and Wellbeing Worker model (trialled in Westminster, Cornwall and elsewhere) and the development of Integrated neighbourhoods, it is noticeable that social prescribing, Green prescribing and creative health are all conspicuous by their complete absence in the Plan.
The model of Community Health and Wellbeing Workers assigns one worker per 120 adjacent households, with a remit of getting to know those families and visit each, every month in perpetuity. The role promotes screening and vaccination uptake, long term condition management and supporting the household members with anything else, just a social prescribing link worker would. Their roll out may initially be confined to the 10% most deprived areas and the households within them.
The concept of Integrated Neighbourhoods, first promoted in the Fuller Stocktake, now appears in the 10 Year Health Plan as one of the main vehicles of change in the way healthcare and other provision, including Debt Advice and Employment support, are delivered to, and hopefully with, communities.
Moving forwards, it's worth recalling that social prescribing wasn't originally developed by the NHS, but by visionary, unconventional thinkers within healthcare, who were deeply embedded in and working with, mostly, very deprived communities and their organisations. Community agency was a common feature of the development process and the intention of pre-NHS models, which informed delivery.
If Integrated Neighbourhoods are to be transformative, they too will need to be developed by those on the ground and Social Prescribing Link Workers and Community Health and Wellbeing Workers should be central to helping to shape and deliver models of integrated neighbourhoods. They are the 'super connectors' bar none, and have a very keen understanding of when and how things work well, as well as the disconnects that Integrated Neighbourhoods are intended to address. They can also help to ensure that Integrated Neighbourhoods are about more than the 'delivery 'of services, but also about strengthening communities, their networks and their agency. And thus, further the shift towards more truly bio-psychosocial and preventative models of health and wellbeing.
About Dan:
Name: Dan Hopewell
Part of the world I live: North London
Occupation: Activist
What makes You well? Activism
Why is social prescribing important? Because its a way of shining a light on what needs to change in our society
Your favourite nature-based space? The tree in my living room
Your favourite music? Silvio Rodriguez
Your favourite pastime? Drawing and painting murals
If you had one wish for social prescribing, what would it be? To link it more strongly to community development
What are your leadership tips for others who want to set up social prescribing projects? Social prescribing is counter culture. Find like minded folk, build alliances and work within your locus of control/influence
Which one person has most influenced you and why? Karl Marx. Communism made sense to me from my early teens, and it still does today.
Any advice for others when working in this space with communities? Find those who are interested in social justice and community building and work with them.