Abstract
Background The 2019 NHS Long Term Plan sought to address health inequalities through the national roll-out of social prescribing link workers, funded by the Additional Roles Reimbursement Scheme. There is evidence that recruitment of link workers is inversely related to need, by rurality and deprivation.
Aim To assess the rollout for inequalities in its impact on population outcomes.
Method We used the English General Practice Patient Survey from 2018–2023, in 6991 general practices. Binary outcomes measured from the NHS aims for social prescribing — managing long-term conditions, feeling supported, less isolated, satisfied with general practice and mental health understood. Measured provision of social prescribing using full-time equivalent link worker per 10 000 patients.
Estimate impact of rollout on outcomes using linear probability models, controlling for patient- and area-level factors with year-fixed effects, including interactions of treatment effect with practice-level deprivation and rurality to assess inequalities in effects. Estimate concentration indices to assess inequalities further.
Results Positive significant effects across all outcomes in rural areas (satisfaction with general practice [ 2.0pp, P<0.001] managing conditions [1.1pp, P-value <0.001]). Least deprived areas had significant effects in 1/5 outcomes; managing conditions (4th quintile [1.1pp, P = 0.001]). Concentration indices show concentration of link workers in least deprived areas [Index = 0.03, P <0.001].
Conclusion Rollout of link workers has improved outcomes. However, there are inequalities in effects on patient outcomes, with more deprived and urban practices having insignificant effects from link worker rollout. These inequalities need to be addressed to improve outcomes and lessen health inequalities.
