The feasibility of identifying health inequalities in social prescribing referrals and declines using primary care patient records

Khan, Koser and Al-zzi, Rachel and Montasem, Alexander and Brown, Heather and Gordon, Clare and Goldthorpe, Joanna (2023) The feasibility of identifying health inequalities in social prescribing referrals and declines using primary care patient records. NIHR Open Research.

Abstract

Background Social prescribing (SP) is part of universal personalised care and available to everyone in the UK National Health Service. However, emerging evidence suggests access disparities in social prescribing. This study aimed to investigate the feasibility of accessing and analysing data on social prescribing from primary care records. Our secondary aim was to examine exposure to social prescribing and compare characteristics of patients who decline/accept social prescribing referrals to explore possible health inequalities in access to social prescribing. Methods Patient records (n=3086) were extracted from 11 GP practices across Northwest England for accepted, offered and declined social prescribing referrals. Patient demographics collected included sex, age, ethnicity, mental and physical health diagnoses. Patient characteristics in social prescribing referrals were compared to the overall practice population (practice information from Public Health England). Decline and acceptance rates were compared by group (e.g. male/female decline rates). Results GP referral data showed inconsistent recording of wider determinants of health and variations in referral patterns on a practice-to-practice basis. Some variables had very poor rates of recording and did not yield useful information. Patient age, sex and mental and physical health conditions were consistently recorded. Other variables such as disability and housing status showed sporadic GP recording across our dataset. Our preliminary findings identified underrepresentation of younger age groups and Asians, and higher declined referrals among individuals with physical health diagnoses. Conclusions The differing referral patterns between practices and recording discrepancies meant that many patient factors could not be used to assess trends in social prescribing referrals and declines. Preliminary results suggest that some patient groups may be underrepresented in referral data, however this needs further research and investigation. Consistency is required in social prescribing data recording in primary care. Data on wider determinants is needed to assess variations in referrals and declines and explore inequalities.