Across the UK, social prescribing is being used as a means of connecting people of all ages to activities designed to help enhance their mental health, wellbeing and reduce isolation in their day to day lives. Typically, social prescribing might be recommended for a patient in two main ways:

• By healthcare staff working in a primary care setting, for example a GP or practice nurse.
• By adult social care professionals working for a local authority.

Once referred, most patients then work with a local Link Worker to identify schemes together that might help them improve mental health, wellbeing or reduce isolation. These might include anything from support with housing or finances, sports and cooking, but increasingly, arts and cultural activities.

Social prescribing is described as something that is part of Universal Personalised Care, which is part of the NHS long term approach to health and social care in the UK. It gives people more agency in deciding what is best for them in relation to their health.

Social prescribing is delivered in many different ways across the UK, as individual local authorities are best placed to provide the most effective delivery solution. As a result, it is difficult to provide a single database of effective social prescribing arts and cultural activities, as each regional area has its own social needs, and different levels of arts and cultural provision. Simply Connect is piloting a database of social prescribing activities across London that you can search by a variety of filters.

There are many resources that can help you find out more about social prescribing in your area. The Healthy London Partnership have produced this YouTube video about social prescribing in London, as well as forming The London Social Prescribing Network, which encourages connections, knowledge, improvement, influence and community in the sector.

The Culture Health and Wellbeing Alliance (CHWA) curated this webpage about social prescribing, which includes a summary of the government’s position on social prescribing and further publications and resources for the sector. There is also regional support available through The Social Prescribing Network. The National Academy of Social Prescribing (NASP) has many resources including webinars, a podcast and forums to support organisations delivering social prescribing in the UK.

The NHS England Long Term Plan aims to incorporate social prescribing into its comprehensive model of care. This means that across the UK there is an increase in funding for activities such as arts and culture on prescription through the social prescribing model. At a practical level as the NHS rolls out its comprehensive model for personalised care across England, it will mean that 2.5 million people will have more choice and control over support for their mental and physical health. This will be achieved by ensuring that up to 200,000 people benefit from a personal health budget by 2023/24, so they can control their own care, improve their life experiences whilst achieving better value for money for the NHS. These people will be empowered to use the money provided to pay for social prescribing activities, including arts and culture on prescription. The model also supports putting in place more than:

‘1,000 Social Prescribing Link Workers and community connectors by the end of 2021, rising further by 2023/24, with the aim that more than 900,000 people are connected to wider community services that can help improve health and well-being.’ (NHS England, Universal Personalised Care).

Practitioners in the capital will be pleased to know that there are now over 300 NHS funded Link Workers in London. The NHS plans to have 3-4 social prescribing link workers in every Primary Care Network (PCN) by 2023/24. There are 200 PCNs in London, each covering populations of roughly 30,000-50,000 at ward level. Some social prescribing Link Worker schemes are also part funded by the local authority.

But what does this mean for arts and cultural organisations? Although funding is not clear cut, many individuals or organisations can usually apply to their local authority for funding to help pilot or run social prescribing projects. Some have also been successful securing support from local healthcare partners, including PCNs and Clinical Commissioning Groups (CCGs). It is worth noting that CCGs will formally disappear by July 2022 to be replaced by Integrated Care Systems (ICS) and it will be up to ICS boards to work together with Voluntary, Community, Social Enterprise (VCSE) organisations to assert the role of culture and cultural social prescribing in these new local partnerships.

Independent trusts and foundations, and National Lottery distributors Arts Council England, The National Lottery Community Fund, and the National Lottery Heritage Fund may all also be able to support certain delivery or partnership activities in the social prescribing space (check their websites to see which compatible funds are open). NHS Charities Together have also launched a Community Together Partnerships grant. It is worth thinking from the outset about how you will sustain a project long term, as many patients need long term arts and cultural interventions, rather than short-term, one-off projects.

In 2019, The National Academy for Social Prescribing (NASP) was launched by the Secretary of State for Health and Social Care, the Rt Hon Matt Hancock MP. Last autumn, the Academy announced its Thriving Communities programme to unleash the power of social prescribing. Thriving Communities is a support programme for voluntary, community, faith and social enterprise groups who are supporting communities impacted by COVID19 in England and working alongside social prescribing link workers, to share their learning, gain new ideas and develop partnerships across sectors. It is supported by the Thriving Communities Fund (administered by the Arts Council), which seeks to improve and increase social prescribing community activities. The Arts Council is currently administering the Thriving Communities Fund on behalf of the National Academy for Social Prescribing and other partners including Natural England, Historic England and Sport England. As of March 2022, there have not been any further announcements to say that Thriving Communities funding will be available for the next year 2022/23.

As highlighted above, the funding landscape is vast, and we strongly encourage seeking funding from multiple partners to develop and sustain both new and pre-existing projects, rather than relying on funding from one sole source such as the NHS.

This diagram demonstrates the huge variety and combination of existing commissioning sources that VCSE organisations are harnessing to fund their activities for socially prescribed clients. We know that funding may not come from one sole entity, and that the duration of funding will differ depending on the source. Within the diagram you can find highlighted case studies which can be found below, that give more detail on real examples of how different sized projects are being funded.

Research into the practice of social prescribing from service delivery, to client participation in activities, has made the following recommendations, with regard to funding. To ensure that the increased demand to support socially prescribed clients in new and pre-existing services can be met.

To ensure that social prescribing has a future this report recommends that:

1. Any organisations or services that are asked to support a person through referral from social prescribing link workers, receive financial investment for it.
2. Long-term (e.g. five year) core funding, to cover the costs generated by providing activities and service in response to social prescribing referrals, has to use a model that enables all sizes of social prescribing providers to receive appropriate payment.

Source: Enabling the potential of Social Prescribing. Polley, Seers, Johnson and Lister (2020)

Link Workers, sometimes called community health workers, are the go-to point people for social prescribing referrals. There is an increased use of terminology to describe them, including but not limited to: Community Navigator/Connector, Facilitator, Care Coordinator and Wellbeing Coach. Link Workers may also be stationed across many different organisations, not just GP practices. Examples of these organisations include: Local Councils, Voluntary Organisations (e.g. Age UK), Housing Associations, Hospital Discharge Teams, Mental Health services. The NHS sees Link Workers as pivotal as part of its national rollout of social prescribing. Primary Care Networks (PCNs) provide a coordinated group of GP surgeries which act as a conduit for most Link Workers. This approach enables PCNs to be reimbursed for the cost of a Link Worker  if they serve (as a group) a population of 30,000 or more. In autumn 2020, the NHS reported that more than 1,200 Link Workers were in post. Results like this help the process, the continued growth of the scheme and generating more demand for a greater range of arts and cultural projects to refer patients to.

This diagram from London Plus demonstrates a social prescribing approach when a client is referred to a Link Worker  via their GP, and gives one example of an outcome from this social prescription, which is being referred to a befriending service. In practice, clients may be referred to multiple agencies at once from debt advice to occupational therapy. Contact with local Link Workers can really vary, which can be a source of frustration for cultural organisations. What’s useful to note though is that Link Workers often are dealing with huge volumes of enquiries. Making sure your cultural offering fits with local referral pathways, evaluation models and that your marketing materials are clear in their offering.

As mentioned in myth two, more Link Workers are being recruited than ever before in London. To support the development of the workforce, London Link Worker  training happens at the Bromley by Bow Centre, the specialist organisation who is the lead in the capital for this kind of training. Link Workers act as a broker between GPs or local authorities who made the referral, and the organisations that patients may be referred to. It's their job to have local knowledge of relevant charities, sports, arts, community & cultural organisations, groups and support that can be offered to a patient. Link Workers stay in touch with a patient, and sometimes evaluate how well that person is doing through their participation in their social prescription. They can also refer a patient back to their GP, if they need a more medicalised intervention.

We interviewed five Link Workers operating in different London boroughs to understand their clients' interactions with arts and culture and discuss engagement, partnership and referrals into VCSE organisations.

The evidence for the role of arts in improving health and wellbeing has been pulled together in this summary published in 2020. So how do we use this evidence to plan appropriate evaluation strategies for arts and culture projects? Jane Willis, founder and director of Willis Newton, one of the UK’s leading arts and health consultancies, shares her ideas on how best to approach evaluation in this context.

Measuring the impact of social prescribing has been varied. Building clinical and arts-based evidence is vital to secure funding and support the continued growth of the scheme. The NHS recommends following the Common Outcomes Framework as a clear starting point for how to approach evaluation of social prescribing projects. An academic study by the University of Westminster showed that many outcomes could be recorded more effectively in social prescribing evaluations. Simply put; this means that many brilliant examples of social prescribing in arts and culture are not being captured and highlighted for others to build upon.

Setting up good evaluation of your project means that tangible health and wellbeing outcomes can be measured, showcasing how well your project is working and contributing to the overall evidence base for the scheme. Developing your social prescribing work using the Quality Assurance for Social Prescribing framework will help you consider what project protocols you might need to have in place. This could range from measurement and evaluation processes to data compliance and mental health training.

Sometimes, the thought of developing a project evaluation can feel overwhelming and confusing. A good place to start is to examine other arts and cultural organisations approaches to evaluation and build on already and effectively used scales of health and wellbeing in relation to arts and culture. Creative and Credible have produced a very clear guide to how to approach evaluation within an arts and health context. Furthermore, the Culture Health and Wellbeing Alliance have a clear and concise evaluation page showcasing many acceptable approaches to evaluation and evidencing the arts, and social prescribing.

One clear outcome that might be measured is whether participants' access to GP services, A&E attendance and hospital bed days increases or decreases after participation in social prescribing. In the 2017 Creative Health report, some of the most compelling evidence was from Arts on Prescription Gloucestershire, a scheme supported by Gloucestershire Clinical Commissioning Group (CCG) and Wiltshire County Council and operated by the charity Artlift. The scheme showed a 37% drop in GP consultation rates and a 27% reduction in hospital admissions. A social return on investment of between £4 and £11 was calculated for every £1 invested in arts on prescription.

Some boroughs prefer the use of particular outcome tools for evaluation as well, and it’s worth finding out what makes the most compelling case for cultural social prescribing evaluation in your borough. For example, some boroughs now use the MyCaW (Measure yourself concerns and wellbeing) evaluation tool, a simple but clinically useful tool used during consultation to understand and prioritise what a person most wants support with. MYCaW® allows a more rigorous approach to capturing the voice of service users beyond the anecdotal. During the first engagement with the tool a service user writes down the thing that most concerns them, that they want help with, in a box. MYCaW can record two main concerns in total. The concerns are rated for severity using a simple numerical Likert scale and a person’s wellbeing is also scored. At follow-up - the original concerns are rescored, and wellbeing is rescored.  Two further questions ask if anything else important is happening in a person’s life and what has been most important about the service received. MYCaW will capture concerns that are medically related, but more often people report concerns that affect their psycho-emotional wellbeing. People also report practical concerns around finance, housing, job status, concerns about their future, their life purpose, relationships and career burden. All of these concerns may impact a person’s overall wellbeing, yet, many of these topics are not routinely recorded.

Dr. Daisy Fancourt also provides a clear approach to research and evaluation in her (2017) book Arts in Health: Designing and Researching Interventions. Westminster University details approaches to evaluation in their work about social prescribing. Arts for health and wellbeing: an evaluation framework was developed by AESOP and Public Health England, and provides a clear framework in which to approach evaluation and implement findings. Ultimately find what works for you, your funders and your participants. Over-evaluating and surveying participants also may not help them in their recovery, so think about who you might partner with to approach evaluation in a creative and sensitive way.

Many arts in health practitioners have been working for many years, as freelance practitioners. They sense that their practice has therapeutic, health and wellbeing effects for participants, and may have regular clients or run small weekly groups engaging the local community in arts practices. It can therefore feel confusing and overwhelming to begin to engage with the social prescribing infrastructure, as a lone practitioner. But it is possible. In London there are also opportunities to enrich your practice in relation to social prescribing through training, such as provided by Performing Medicine. There are clear steps you can put in place if you believe your practice could help someone being referred for social prescribing.

Step 1

People being referred into social prescribing may have many complex psychological, social and economic needs. Firstly, consider if your practice is set up in an optimal way to support someone who might have these kinds of needs. Think about any adjustments you might need to make, for example securing additional funding to offer longer-term arts courses or brushing up on your evaluation skills. Training such as the Performing Medicine social prescribing course, or the CHWA Culture, Health and Wellbeing online course can help to strengthen your skills. NASP has also put together a learning programme, that runs over 6 months, to support VCSE to build new partnerships across sectors, network and more. This programme is open to anyone across the country and applications can be made here. Signing up to NASP’s monthly webinars, will also keep you up to date on work and best practice in a variety of topics relevant to the social prescribing sector.

Step 2

Social prescribing works better when we all work together. Contact your local arts and culture organisations and offer to collaborate on funding bids. You will have expertise that an organisation might lack, they might have space and resources that you do not have access to. Utilise free tools like London Arts in Health's Partner Up website to find people to collaborate with.

Step 3

Contact your local community GP or PCN and request to find out who the Link Worker  might be, or for London practitioners use this map to determine who runs the social prescribing service in your borough. Make them aware of the kinds of arts in health practice you offer and how someone might be referred. Make sure you make it clear how you might be able to offer support for any referred patients through your practice. Provide the Link Worker  with leaflets or a link to a website so referees can access information about what you offer.

Many arts and cultural organisations are already set up to engage with social prescribing. This might be through existing activities that are on offer, or through the use of rehearsal or studio space that can be used by a local community arts in health freelancer. Encouraging the take up of arts in health activities through social prescribing in your organisation will widen the reach and diversity of audiences and help people to think differently about what arts and cultural organisations/venues can offer. We recommend following these three steps if you think your arts and cultural organisation is ready to be more actively involved in social prescribing.

Step 1

Think about what provision you already have in place that might have arts in health benefits for people being referred through the scheme. Is there a project, group or class already running that might already be beneficial to the scheme you can rebrand with a health and wellbeing efficacy? To get started, why not look at this systematic review of 86 culture, health and wellbeing schemes.

Step 2

Social prescribing works better when we all work together. Connect with local arts in health practitioners to widen your creative freelancers’ network. You might be able to work with new practitioners who can offer arts in health activities on behalf of your organisation. Utilise free tools like London Arts in Health's Partner Up website to find practitioners to collaborate with, you could also work with local freelance experts to engage in funding bids.

Step 3

Contact your local community GP or PCN and request to find out who the link worker might be. London Plus offers good resources and ideas for making this contact. Make them aware of the kinds of groups and classes you offer, and how they might be relevant to someone looking to engage and be referred to arts and cultural organisations for health in your local area. Did you know? Arts and cultural practitioners also make great link workers. Find out more about link worker training and accreditation from the National Association of Link Workers.

This is not the case and more referrals are on the increase.

Be proactive, get out and about, and take time to build relationships with local arts and cultural organisations, arts and health freelancers and local community health organisations. Most referrals tend to come via GPs. But in our grant holders’ experience, relying on this route has meant some schemes struggled to find enough patients.

Ageing Better projects, which offer services to prevent loneliness for the over 50s, now aim for a mix of referral partners to ensure a constant flow of people. Working with partners that include adult health and social care, other local voluntary and community sector (VCS) organisations, and encouraging referrals from friends/family, including self-referrals has been more successful in identifying isolated and lonely clients than working with GPs and pharmacists alone.

You can expand your network by talking to a range of local organisations and residents. This could be through attending events run by local VCS support organisations or joining targeted networks run by larger charities such as Age UK or Mind. You can market your services directly to patients by advertising in local newsletters and newspapers, running open days, and organising taster sessions of activities at local community events.

Our podcast interviewing Veronica from Arts 4 Dementia explores referrals and how you might approach this.

One of the responsibilities within the Link Worker role is to reach out to VCSE groups and understand their quality assurance policies, before offering suggestions to their client on groups or organisations they could connect with.

It is widely acknowledged that the extent to which groups will have formal, written policies surrounding principles such as; Safeguarding, Training and Development and Health and Safety, will be proportional to the formality and size of the group. For example, it is not expected there will be the same policies in a group which meets in a Library Cafe to have a coffee and knit together, in comparison to an arts and cultural organisation that works with participants struggling with severe mental health difficulties. In that instance, for example, much more robust safeguarding and mental health first aid training would be expected to be in place, in order to protect more vulnerable participants.

Therefore it is important to stress that smaller community groups, which may offer significant health benefits to a client, are not excluded from the menu of options Link Workers are bringing to the table in their personalised discussions. In order to instil confidence and trust in the work you or your organisation is providing, having a conversation using the quality assurance prompt sheets (annex H) developed by NHS England, with your local Link Worker is a great initial step to understand where your strengths are and where there is need for improvement. Prompts could include checking your organisation’s insurance policies, confidentiality and risk assessment processes or disclosure and baring (DBS) certificates. We’ve distilled the most important prompts here. After going through the checklists, you may have actions that need to be addressed, for example, developing your policies on risk assessment. It is advised to seek out your local borough Council for Voluntary Service (CVS) website, to find out what support they can provide in relation to relevant training. In London, London Plus provides a comprehensive list of local borough CVS contacts that you can email directly to access training and help. Other resources surrounding training can be found in our updated resources google sheet.

Organisations which engage with the suggested quality assurance requirements will have a better chance of meeting funding criteria, especially when seeking funding for socially prescribed clients, who often represent some of the most vulnerable individuals within the community, who need to be well supported and safeguarded.

It’s important to make your cultural social prescribing offering clear and communicable for both the participants you want to get interested in the project and the Link Workers who might share your project with prospective clients. You cannot rely on the link workers to ‘translate’ your service to the people they see. Without the skills to market and promote your offering to participants and link workers, there is a risk of reduced engagement and participation. In this marketing checklist, we offer practical guidance from sector professionals and academic research, on aspects to consider throughout your project journey, in relation to the set-up and communication of your cultural, social prescribing offer.

Academic research in marketing:

Dr Katey Warran, a research fellow working within the UCL Department of Behavioural Science and Health,  has been working with UCL MARCH network to review and unpick what are the ‘active ingredients’ of arts and cultural activities that result in the health and wellbeing outcomes in participants we see. 139 potential active ingredients were identified, and put into 3 categories: Contexts, People and Project.  From this research, the INNATE framework has been developed to support the design, implementation and evaluation of arts in health activities. Throughout the Mythbuster, we have alluded to examples of these active ingredients and colleagues’ experiences of interacting and changing ingredients to develop and improve their programmes.  It is suggested that this framework could be useful to consider what you may be lacking in your activity/ group, or used to help consider how you could diversify your offering to other participants.