About the Project
The Public Health Institute in the Faculty of Health at LJMU (https://www.ljmu.ac.uk/research/centres-and-institutes/public-health-institute) is offering one 3-year PhD studentship to undertake research to develop an outcomes framework to evaluate the impact of social prescribing on health, wellbeing and health inequalities in the Liverpool City Region.
Much of the UK population lives in situations that are detrimental to health. The impact of health inequalities has been exacerbated by the COVID-19 pandemic, which has disproportionately affected populations living in areas of deprivation, including the Liverpool City Region, due to structural inequalities in social determinants of health, such as housing and employment. With 20% of patients consulting their GPs about social rather than health issues and increasing social isolation, which is linked to morbidity and mortality and has been further exacerbated by COVID-19 non-clinical community-based support such as debt and welfare advice and activities to tackle social isolation is seen as integral to reducing demand on primary care, improving community health, wellbeing, and economic productivity, and tackling inequalities.
Social prescribing, involving the referral of individuals by a link worker or equivalent to community-based support and activities, has the potential to reduce isolation, increase activities, and address the mental and physical health needs of patients. Social prescribing is a key part of the personalised care element of NHS England’s Long-term Plan (NHS England, 2019), with a commitment to fund 1000 new social prescribing link workers (through Primary Care Networks (PCNs)) by 2020/21 and an ambition that at least 900,000 people will be referred to social prescribing by 2023/24. By Autumn 2020, over 1200 link workers were in post. Alongside this, the Department of Health and Social Care have provided £5 million to establish a National Academy of Social Prescribing that aims to raise the profile of social prescribing, standardise the quality and build evidence and best practice. A number of different models of social prescribing implementation exist: link workers might be based within a GP surgery, a PCN, or within the community (e.g. within a community organisation or hub). However, all share the same ethos: the link worker works collaboratively with the individual to identify their needs and develop a plan of activity to improve their health and wellbeing. Locally, the Liverpool City Region (LCR) utilises a range of commissioned and non-commissioned models of social prescribing.
Despite the wealth of support for social prescribing across the UK, evidence supporting the effectiveness of social prescribing is lacking, largely due to inconsistencies in the reporting and evaluation of social prescribing schemes. There is a need for robust and systematic evidence on the effectiveness of social prescribing, co-developed with key stakeholders and utilising a combination of existing routinely-collected data and both quantitative and qualitative outcome measures collected longitudinally. High quality studies are needed to determine the effectiveness and impact of social prescribing. Moreover, social prescribing and similar community-based interventions suffer from what is known as the ‘inverse care law’ – those who need the most healthcare are often the ones who receive the least.
Recent research recommends that a common outcomes framework needs to be developed in order to develop a robust evidence base for social prescribing. It is vital that outcomes capture the potential benefits to the individual’s mental, physical, and social wellbeing, and to wider beneficiaries such as social networks and the wider community, and that they are identified and defined based on an in-depth understanding of the needs of the local community. This will ensure that the evidence collected is meaningful for the community and feed directly into the priorities of policy makers and commissioners of health and social care services. Evaluation of complex interventions such as SP must incorporate understanding of the mechanisms of action, which are a key component of logic models and other evaluation frameworks provides a useful framework for understanding the function and mechanisms of action of behaviour change interventions for the individual and the wider community.
The supervisory team brings together complementary expertise from across the Faculty of Health. Their profiles can be accessed on the links in the Supervision section above. All three have worked closely with key stakeholders across the LCR involved in commissioning or providing social prescribing.
Outline plan of investigation
It is envisaged that this project will use mixed methods in three distinct phases.
Phase 1 – mapping the models of social prescribing across the Liverpool City Region (0-10 months)
Using existing contacts and a snowballing approach, the mapping exercise will involve two stages:
Stage 1: using existing links and a snowballing approach to collate quantitative data on the models of SP implemented across the LCR. This will be used to create a sample frame for stage 2.
Stage 2: Conduct semi-structured interviews with social prescribing providers to identify the qualities of the ‘link worker’ and elements of the SP implementation. Thematic and content analysis will be conducted to identify characteristics of the link worker and SP scheme that are associated with success, and define what ‘success’ looks like. The analysis will draw on the behaviour change wheel (Michie et al., 2011) and behaviour change techniques taxonomy (Michie et al., 2013) to map the key mechanisms that drive behaviour change.
Phase 2 – community and engagement and development of the outcomes framework (10-20 months)
Building on the findings from Phase 1, this phase will involve engaging with communities and stakeholders (patients, public, providers, healthcare professionals, commissioners, third sector organisations) across LCR to define social prescribing outcomes that are meaningful for communities. These outcomes will be placed into an evaluation framework, most likely using a logic model methodology, and incorporating a minimum data set of quantitative and qualitative data collection and routine data on health service use.
Phase 3 – testing the outcomes framework (20-30 months)
The evaluation framework developed in phase 2 will then be piloted within key social prescribing schemes within LCR.
The studentship includes a tax-free stipend of £15285 p.a. and the tuition fees for UK students only for three years. An additional £1,500 will be available for research costs. The student will initially formally register for the award within 3 months of enrolment and will be expected to transfer to PhD registration within 12 months (subject to satisfactory progress and approval of the transfer report).
Dr Hannah Timpson is the Director of studies (https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-health/public-health-institute/hannah-timpson) and the project will be co-supervised by Dr Caroline Brett (https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-health/school-of-psychology/caroline-brett) and Dr Tara Kidd (https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-health/school-of-psychology/tara-kidd)
We are seeking a highly motivated student, who also has personal skills that are conducive to accessing and conducting research with patient groups and service providers (with the support of the supervisory team).
Applicants must hold a first or upper-second class undergraduate, or a Master’s, degree in psychology or a related discipline and should have a general understanding of quantitative and qualitative methods, preferably experience of/interest in conducting research in primary care. An excellent standard of verbal and written English is essential as the successful student will be expected to publish from their PhD studies, contribute to relevant publications from the supervisory team as a co-author, and work towards presenting their findings in relevant fora.
For an informal discussion contact Caroline Brett on firstname.lastname@example.org.
Please submit by email your CV and a cover letter explaining your interests and skills relating to this opportunity to Caroline Brett on email@example.com
We are expecting to hold interviews online via zoom/teams w/c 31st May.
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