Stakeholder understanding of social prescribing in England: a qualitative study in primary care.

BackgroundSocial prescribing (SP) seeks to support patients' wider needs by connecting them to non-medical community resources. Link workers (LWs) facilitate SP's delivery across the National Health Service (NHS) in England. As a concept, SP may be perceived in different ways by various stakeholders. This study set out to explore how SP is understood among healthcare professionals (HCPs), voluntary and community sector (VCS) representatives, LWs, and patients (Ps) in England.MethodsA secondary qualitative analysis was conducted using interview data from a realist evaluation on the implementation of LWs in primary care. Interview data from 106 participants (HCPs, VCS representatives, LWs, Ps), across seven sites in England, were analysed using reflexive thematic analysis.ResultsAnalysis resulted in 127 codes. These were clustered into the following themes: (1) the need for system optimisation, (2) SP as a tool for personal empowerment, (3) SP's broad and inclusive nature, (4) community engagement through LWs, and (5) a holistic approach to well-being. These themes highlight SP's potential as an integrated and empowering ecosystem; requiring effective collaboration and clearer communication among stakeholders to enhance understanding of its purpose, streamline referral processes, and align expectations for greater impact. Understanding of SP could be related to five broad questions around how, who, what, where, and why; the themes produced from the analysis aligned with these questions, each exploring different dimensions of SP. Through this, we developed the 5Ws Framework, which is outlined in the paper.ConclusionsSP is not a standalone intervention; it is a complex system that requires optimisation and balance across its elements. Its effectiveness as an integrated empowerment ecosystem depends on addressing all facets of the 5Ws-how, who, what, where, and why it operates-engaging the right stakeholders, clearly defining its scope, and implementing it appropriately. Policymakers and commissioners could use the 5Ws Framework to guide decision-making, align health system priorities, and ensure the effective integration of SP within primary care.