3.1 Identify individuals who may benefit from accessing social prescribing schemes

This guide will help you answer 3.1 Identify individuals who may benefit from accessing social prescribing schemes.

Recognising those who may benefit from social prescribing is an important part of working in health and social care. Social prescribing connects people with non-medical support in their community. This could mean joining local clubs, volunteering, or accessing advice services. It helps people improve their wellbeing and manage issues that do not need medication.

Social prescribing is not a new idea, but it is now used more often in the NHS to support people’s wider needs. Not everyone will need or benefit from social prescribing. Your role involves knowing which individuals might find it helpful and knowing how to refer them.

In this guide, we will look at how you can identify who may benefit. We will look at common groups, signs to look for, specific needs, and how to approach these conversations.

What is Social Prescribing?

Social prescribing is a way for GPs, nurses, and other professionals to refer people to a range of local, non-clinical services. These services can support people with various needs related to social, emotional, or practical issues.

Examples of social prescribing activities include:

Joining art or music groups
Gardening or walking clubs
Volunteering opportunities
Housing or debt advice services
Befriending schemes or peer support
Physical activity programmes

Social prescribing sees the whole person, not just a set of symptoms. It supports mental, physical, and social health.

Individuals Who May Benefit

It is your job to notice who might need more than medical care. People often see their GP for problems that cannot be solved by medicine, such as loneliness or money worries. Health and social care workers play a key part by recognising unmet social needs.

Here are some groups who may benefit from social prescribing:

People feeling isolated or lonely
Those with mild or moderate mental health needs like anxiety or low mood
Individuals struggling with practical issues, such as food or housing
People who visit services often without improvement in their wellbeing
Individuals with long-term health conditions
Unpaid carers who may be struggling
Those needing more confidence or skills to manage their daily life

It is not just about ticking boxes on a form. You need to notice clues, ask questions, and listen.

Recognising Signs Someone Might Benefit

There is no single test or checklist. But there are clear signs that someone may benefit from social prescribing.

Look for:

Regular non-urgent GP visits for social issues
Loneliness or lack of social support
Mental health symptoms without severe risk (such as mild depression or anxiety)
Lack of motivation, low mood, or feeling hopeless
People asking for help with housing, benefits, or finances
Individuals speaking about being bored or having little purpose
Families facing stress from unpaid caring duties
People who have lost a social role, like after retirement or bereavement
Frequent users of NHS services with little change in health
Signs of stress from job loss or relationship breakdown

Paying Attention to Social Needs

The focus is on people whose problems could be helped by practical or social support. This does not replace medical care. It works alongside it.

You may get clues by:

Listening for worries not directly related to health
Noticing when someone has little community contact
Picking up on low confidence or motivation
Seeing a pattern of non-medical issues (money, loneliness, housing) in regular visits

Groups More Likely to Benefit

People with Long-term Health Conditions

People with diabetes, asthma, heart conditions, or chronic pain often face added life challenges. These may be work difficulties, family stress, or low mood. Social prescribing can help them manage their condition in daily life, build confidence, and find support.

Those Experiencing Loneliness or Isolation

This could be older adults living alone, but it can also be younger people with poor support networks. Loneliness can harm both mental and physical health. Introducing them to social groups or befriending services can help.

Individuals with Mild to Moderate Mental Health Issues

People feeling low, stressed, or anxious (but not severely unwell or at risk) often benefit from community activities. This gives routine, purpose, and a boost to confidence. Peer support groups can also be very helpful.

Unpaid Carers

Those caring for relatives can feel overwhelmed, stressed, or socially cut off. They may benefit from carers’ support groups, respite services, or information about their rights and benefits.

People Coping with Major Life Changes

Divorce, bereavement, redundancy, or moving to a new area can have big effects. Social prescribing can offer ways to connect and adapt.

Individuals with Social or Practical Needs

Some people may need advice on housing, debt, food, or employment. These issues often cause worry and can impact health. Schemes may direct them to agencies for advice, food banks, or job clubs.

Using Person-Centred Approaches

Not everyone needs social prescribing, so listen and ask open questions. Some people may not want community activities or extra support.

Use these approaches:

Listen carefully to what the person says about their life
Use open questions: “How do you spend your days?”, “Do you see friends or family often?”
Notice signs of distress, boredom, or frustration
Ask gently about challenges with housing, money, or caring
Remember some people are embarrassed to ask for help
Check what matters to the person, not what you assume they want

How to Identify People in Different Settings

You might work in a GP surgery, care home, hospital, or in the community. Spotting those who could benefit may look different in each setting.

In Primary Care (GP Surgeries)

Many people visit the GP for issues that are social or emotional. If you notice frequent visits with little clinical cause, consider what might help outside a medical approach.

Clues:

Non-urgent appointments for sleep worries, general low mood, or loneliness
Missing social roles, hobbies, or jobs
Talking about financial stress or isolation

In Care Homes

Residents may feel lonely, bored, or cut off from previous interests. They could benefit from social activities, befriending, or links with community groups.

Watch for:

Withdrawal from group activities
Asking about visits or wishing for old hobbies
Mood changes

In Community Services

Home care workers or social workers may notice clients lack support. Help could come from local clubs, lunch groups, or advice services.

Signs include:

Few social contacts
Signs of carer burden
Managing complex life events alone

In Hospitals

Staff may notice inpatients or outpatients need social support, not just clinical care. Discharge teams often include social prescribing options to prevent readmission.

Possible indicators:

Difficulty coping outside hospital
Limited family or community support
Stress about home life or money

Limitations and Contraindications

Social prescribing is not for everyone. You must judge when another approach is needed.

Do not refer to social prescribing if:

The person has severe mental illness needing urgent specialist care (psychosis, high risk of suicide)
Immediate safeguarding issues are present
Medical investigation or treatment must come first

For some, social prescribing can be part of a wider solution, but urgent care must always take priority.

Equality and Diversity Considerations

Be fair and open. Avoid assumptions about who might benefit. Some groups face extra barriers, such as language, disability, or lack of transport. Others may feel anxious about group settings. Make adjustments and offer choices. Remember that inclusion is important.

Consider:

Cultural background: Does the service suit their beliefs and preferences?
Access: Can they physically get to groups or advice shops?
Communication: Are materials clear and easy to understand?
Support: Do they need help with confidence or anxiety before joining?

Referral Pathways

Once you identify an individual, you may need to guide them or refer them to a “link worker”. A link worker is someone supporting people to access social prescribing schemes. You could:

Give information about local services
Help them contact a link worker or community connector
Refer formally using your organisation’s procedure
Support the individual to self-refer if they can

Building Trust and Encouragement

Some people take time to accept support. Stigma, pride, or worry can make it hard to ask for help. Build trust by:

Explaining what social prescribing is, in plain language
Listening to their concerns
Offering encouragement but respecting their wishes
Giving reassurance about privacy, cost, and accessibility
Following up if they appear interested but get “stuck”

Skills for Health and Social Care Workers

Identifying who might benefit means you must:

Listen without judgement
Notice subtle signs of need
Ask open, gentle questions
Stay up to date about local resources
Respect the individual’s choice and consent
Understand when a medical or emergency referral is needed

Monitoring Outcomes

After referral, check in where possible. Ask if the support has helped. Notice changes in mood, confidence, activity, or social contact. Share concerns or successes with your team or supervisor.

Final Thoughts

Social prescribing can make a big difference to people dealing with loneliness, practical problems, or mild mental health needs. Your skill in identifying who could benefit is key. Listen, look for clues, and support people to get the right help at the right time. By doing this, you help improve health, wellbeing, and quality of life for those you care for.