Social prescribing: migrant health guide
Advice and guidance for healthcare practitioners on the health needs of migrant patients.
Main messages
Social prescribing approaches for migrants in the UK vary widely.
Migrants may require a greater range of prescribed interventions or activities than the general population to holistically address their health and wellbeing needs (for example, language support, healthcare navigation, immigration support).
Supporting migrants to access mainstream healthcare services (PDF, 2.3MB) and preventive care can be an important outcome of social prescribing for migrants. Identify and establish referral pathways between healthcare services and voluntary and community sector organisations to ensure migrants can access healthcare (for example, GP registration, specialist care) and other services.
Social prescribing services should be responsive to the needs of individuals, including their preferences for language, culture, the sex of the link worker, and format of service delivery.
Link workers providing social prescribing services to migrants should be provided with adequate training to understand and address the wider determinants of health and wellbeing for migrants.
Robust evaluation and rigorous data collection should be built into social prescribing programmes to improve understanding of how social prescribing works and for whom.
Background
Social prescribing is a major component of the NHS Long Term Plan and universal personalised care.
There is a lack of high-quality research and evaluation on the effects of social prescribing for migrant populations in the UK. However, the available evidence shows that social prescribing can help migrants to access mainstream healthcare services through support for language and cross-cultural communication (for example, interpreting and bilingual advocacy), GP registration and system navigation. Improved self-esteem, confidence, empowerment and social connectivity is also reported frequently as an outcome of social prescribing for migrants.
Social prescribing approaches for migrants in the UK vary widely. To holistically address migrants’ health needs and the wider determinants of health and wellbeing, social prescribing may involve a greater range of prescribed interventions or activities than for the general population (for example, language support, healthcare navigation, immigration support). Services are commissioned locally and there is no standardised service model for social prescribing delivery, including for migrant populations.
Social prescribing programmes for migrants are successful when they are responsive to the preferences of migrants in relation to language, culture, gender and service delivery format.
Recommendations for referrers to social prescribing programmes
Those who refer migrants to social prescribing programmes should:
1. Be aware that migrants may require a greater range of prescribed interventions or activities than the general population to holistically address their health and wellbeing needs (for example, language support, healthcare navigation, immigration support).
2. Record social prescribing referrals and activities in electronic health records for routine monitoring and evaluation (see ‘Monitoring and evaluation’ section below).
Recommendations for link workers
Before providing social prescribing services to migrants, link workers should develop knowledge in:
1. Migrants’ entitlements to healthcare and other public services.
2. How to support migrants to access mainstream healthcare services (PDF, 2.3MB) and preventative care.
3. How to identify the health needs of migrants and when they require referral to specialist health services.
4. Wider determinants of migrant health.
5. Trauma-informed approaches to service provision.
6. How risk of communicable diseases and non-communicable diseases in migrants’ country of origin affect their health and wellbeing.
7. Safeguarding children and adults.
8. Looking after their own health and wellbeing as a service provider.
When providing social prescribing services to migrants, link workers should:
1. Ensure that services are culturally responsive and tailored to the needs of individuals, including their preferences for:
- language (for example, interpreting or translation and other bilingual support in social prescribing sessions like working with a bilingual advocate)
- culture (for example, as much as possible allowing the individual to choose a link worker from the same or different ethnic and religious background)
- sex (for example, link workers of the same sex, and same or mixed-sex groups)
- service delivery format (for example, individual or group sessions)
- personalised care (for example, some individuals may want personalised conversations about their health and wellbeing while others prefer quick signposting)
2. Clearly define link worker role boundaries, including whether they may need to take on additional responsibilities and support roles when providing services to migrants. The evidence shows that social prescribing link workers delivering services to migrants often provide the prescribed interventions or activities themselves and/or play additional support roles not typically defined within the scope of the link worker role. Link workers should recognise when an individual requires support that is outside of the scope of the link worker role and refer on to an appropriate service.
3. Consider whether access to healthcare and preventive health services is an important part of a migrant’s health needs, and provide appropriate support for migrants to understand the healthcare system and access healthcare services
4. Identify ‘windows of opportunity’ for service provision and be prepared to problem-solve any changes to migrants’ housing, legal status, location, and readiness to engage with services.
Recommendations for monitoring and evaluation
To improve the understanding of how social prescribing works and for whom, those who commission, plan, deliver and manage social prescribing services should ensure that:
1. Programmes are adequately funded to allow robust evaluation of implementation and outcomes.
2. Evaluations use comparative designs and prospective data collection where possible.
3. Data collection is standardised to include sociocultural and demographic characteristics of social prescribing recipients. This can include collection of data on country of birth, languages spoken, migration history, type of migrant (for example, labour migrant, refugee or asylum seeker) and ethnicity. It is important to note that some migrants may be hesitant to disclose details about their immigration history, so it is important to build trust and help them to understand why you are asking these questions, what you will do with the information, and the circumstances in which health services share non-clinical information with the Home Office.
4. Measurement of a range of social prescribing outcomes follows a framework (for example, NHS England and NHS Improvement Social Prescribing Common Outcomes Framework), and considers the effect of social prescribing on migrants’:
- physical health
- mental health
- healthcare utilisation
- confidence, self-esteem, empowerment
- knowledge and skill development
- social connectivity
5. Provider- and patient-reported measures are synthesised together with routine data from sources like electronic health records, particularly to capture referrals and measures of effect for outcomes like healthcare utilisation.
6. Patient-reported outcome tools for health and wellbeing outcomes in migrants are assessed for cultural and linguistic appropriateness.
Recommendations for researchers
Future research on social prescribing for migrant populations in the UK could consider:
1. Validating measurements tools in social prescribing settings for migrant populations.
2. Assessing why link workers take on additional roles when providing services to migrants, and whether migrants’ holistic health and wellbeing needs are better addressed through single-function link worker roles, transdisciplinary support roles, or other types of support.
Resources
Doctors of the World UK with the support of the Mayor of London has developed a toolkit for social prescribing link workers (PDF, 2.3MB) to support migrants’ access to healthcare, which also includes a poster (PDF, 127KB) for link workers.
Doctors of the World UK provides resources and training on migrant’s entitlement to healthcare to GP practice staff including frontline and social prescribing link workers as part of the Safe Surgeries Initiative.
The migrant health guide contains advice and guidance that can help link workers and other healthcare professionals to understand migrants’ entitlements to NHS care, how to assess migrant patients, considerations regarding vulnerable migrants, and communicable diseases and non-communicable health concerns relevant to migrant health.
NHS England:
- produced a social prescribing and community-based support: summary guide, which includes a Common Outcomes Framework (Annex D) to support a more standardised approach to evaluating social prescribing
- produced a reference guide for primary care networks (PCNs) to support PCNs to embed social prescribing and community approaches
- coordinates an online social prescribing community of practice