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Impact of a social prescribing intervention in North East England on adults with type 2 diabetes: the SPRING_NE multimethod study

Moffatt, Suzanne; Wildman, John; Pollard, Tessa M; Gibson, Kate; Wildman, Josephine M; O’Brien, Nicola; Griffith, Bethan; Morris, Stephanie L; Moloney, Eoin; Jeffries, Jayne; Pearce, Mark; Mohammed, Wael

Impact of a social prescribing intervention in North East England on adults with type 2 diabetes: the SPRING_NE multimethod study Thumbnail


Suzanne Moffatt

John Wildman

Kate Gibson

Josephine M Wildman

Nicola O’Brien

Bethan Griffith

Stephanie L Morris

Eoin Moloney

Jayne Jeffries

Mark Pearce

Wael Mohammed


Background: Link worker social prescribing enables health-care professionals to address patients’ nonmedical needs by linking patients into various services. Evidence for its effectiveness and how it is experienced by link workers and clients is lacking. Objectives: To evaluate the impact and costs of a link worker social prescribing intervention on health and health-care costs and utilisation and to observe link worker delivery and patient engagement. Data sources: Quality Outcomes Framework and Secondary Services Use data. Design: Multimethods comprising (1) quasi-experimental evaluation of effects of social prescribing on health and health-care use, (2) cost-effectiveness analysis, (3) ethnographic methods to explore intervention delivery and receipt, and (4) a supplementary interview study examining intervention impact during the first UK COVID-19 lockdown (April–July 2020). Study population and setting: Community-dwelling adults aged 40–74 years with type 2 diabetes and link workers in a socioeconomically deprived locality of North East England, UK. Intervention: Link worker social prescribing to improve health and well-being-related outcomes among people with long-term conditions. Participants: (1) Health outcomes study, approximately n = 8400 patients; EuroQol-5 Dimensions, fivelevel version (EQ-5D-5L), study, n = 694 (baseline) and n = 474 (follow-up); (2) ethnography, n = 20 link workers and n = 19 clients; and COVID-19 interviews, n = 14 staff and n = 44 clients. Main outcome measures: The main outcome measures were glycated haemoglobin level (HbA1c; primary outcome), body mass index, blood pressure, cholesterol level, smoking status, health-care costs and utilisation, and EQ-5D-5L score. Results: Intention-to-treat analysis of approximately 8400 patients in 13 intervention and 11 control general practices demonstrated a statistically significant, although not clinically significant, difference in Abstract vi NIHR Journals Library HbA1c level (–1.11 mmol/mol) and a non-statistically significant 1.5-percentage-point reduction in the probability of having high blood pressure, but no statistically significant effects on other outcomes. Health-care cost estimates ranged from £18.22 (individuals with one extra comorbidity) to –£50.35 (individuals with no extra comorbidity). A statistically non-significant shift from unplanned (non-elective and accident and emergency admissions) to planned care (elective and outpatient care) was observed. Subgroup analysis showed more benefit for individuals living in more deprived areas, for the ethnically white and those with fewer comorbidities. The mean cost of the intervention itself was £1345 per participant; the incremental mean health gain was 0.004 quality-adjusted life-years (95% confidence interval –0.022 to 0.029 quality-adjusted life-years); and the incremental cost-effectiveness ratio was £327,250 per quality-adjusted life-year gained. Ethnographic data showed that successfully embedded, holistic social prescribing providing supported linking to navigate social determinants of health was challenging to deliver, but could offer opportunities for improving health and well-being. However, the intervention was heterogeneous and was shaped in unanticipated ways by the delivery context. Pressures to generate referrals and meet targets detracted from face-to-face contact and capacity to address setbacks among those with complex health and social problems. Limitations: The limitations of the study include (1) a reduced sample size because of non-participation of seven general practices; (2) incompleteness and unreliability of some of the Quality and Outcomes Framework data; (3) unavailability of accurate data on intervention intensity and patient comorbidity; (4) reliance on an exploratory analysis with significant sensitivity analysis; and (5) limited perspectives from voluntary, community and social enterprise. Conclusions: This social prescribing model resulted in a small improvement in glycaemic control. Outcome effects varied across different groups and the experience of social prescribing differed depending on client circumstances. Future work: To examine how the NHS Primary Care Network social prescribing is being operationalised; its impact on health outcomes, service use and costs; and its tailoring to different contexts. Trial registration: This trial is registered as ISRCTN13880272.

Journal Article Type Article
Acceptance Date Dec 1, 2021
Online Publication Date Mar 1, 2023
Publication Date 2023-03
Deposit Date Apr 24, 2023
Publicly Available Date Apr 25, 2023
Journal Public Health Research
Print ISSN 2050-4381
Electronic ISSN 2050-439X
Publisher NIHR Journals Library
Peer Reviewed Peer Reviewed
Volume 11
Issue 2
Public URL


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Copyright Statement
Copyright © 2023 Moffatt et al. This work was produced by Moffatt et al. under the terms of a commissioning contract issued by
the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative
Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium
and for any purpose provided that it is properly attributed. See: For attribution
the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.

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