Drawing on testimony from frontline Social Prescribing Link workers (SPLWs) in England, this article analyses their perspectives and argues for increased resources at the community level, awareness of social determinants and stronger link worker identity. This ethically approved small-scale qualitative study undertook interviews with eight SPLWs, employed in two different locations across the North of England, that encompassed both urban and rural locations. The study produced rich testimony from their direct experience of SPLWs, which were mapped, against the regional determinants of health, incorporating Proportionate Universalism principles. Respondents felt that more could be done to support the development of a stronger identity for link workers. Importantly, the issue of resources, particularly in areas of deprivation where available services may be more limited, emerged as a strong theme. The analysis suggests that resourcing is crucial for the success or otherwise of SPLWs input. The adoption of Proportionate Universalism (Marmot) in social prescribing and beyond could improve the resource allocation link workers have to support people in communities and raise awareness of working on the wider determinants of health and wellbeing, thus contributing to the sustainability of Social Prescribing and the SPLWs role.
Purpose This study aims to explore innovation from the perspective of social prescribing. The model has been developed within the framework of the TRANSIS LAB (Transborder Living Lab on Social Innovation for Longevity) project, funded by the European Territorial Cooperation Programme Spain–France–Andorra (INTERREG POCTEFA programme), which is developing six pilot experiences in social innovation for longevity in four regions of Spain and France. Design/methodology/approach The conceptual and intervention model with social innovation in longevity for rural areas based on social prescribing has been developed using a combined methodology. On the one hand, a review of the specialised literature has been carried out, which has helped to define the social innovation model. On the other hand, this model has been developed into a tool that measures social fragility. This tool has been validated and tested through its application to 34 elderly people and 14 professionals involved in social intervention with older people in situations of fragility in rural environments. Findings The article offers two main results. The first is a conceptual model linking social innovation and social prescribing in rural areas. The second is a social innovation tool for developing pilot projects in rural areas based on social prescribing. The tool enables the measurement of social fragility and thus activates, structures and coordinates networks, resources and local actors to facilitate social inclusion and quality of life for frail older people living in rural areas. Research limitations/implications The conceptual model proposed in this article still requires empirical testing, which constitutes a limitation of this study, although the fragility tool developed has been validated through a participatory process involving professionals and users. Both the tool and the intervention model presented will be tested within the framework of the TRANSIS LAB project, which will launch six pilot experiences in four regions of Spain and France (2026). These pilot experiences will allow the empirical assessment of the model through a quasi-experimental design, based on an ex ante/ex post evaluation with an experimental group without random selection or control-group. Practical implications The model offers practical guidance for policymakers, practitioners and rural communities seeking to implement social prescribing within a broader social innovations approach. Social implications This model has implications for strengthening inclusive and community-based responses to ageing, reducing social isolation, and strengthening the role of social services in rural areas. Originality/value Social prescription has been a complementary strategy for health services to guide users towards community resources. The proposed conceptual model offers a social innovation perspective to connect social prescribing with social and community services in rural areas.
Purpose Emergency departments (EDs) increasingly operate at the interface between acute care, Hospital at Home (H@H) and community services for frail older adults. Despite this, frailty care in EDs often remains fragmented, time-pressured and insufficiently aligned with patient and carer priorities. This study aimed to co-design an integrated frailty care pathway for the ED that supports continuity across the ED, H@H and community services, incorporating patient, carer and multidisciplinary staff perspectives. Design/methodology/approach A mixed-methods service evaluation was conducted in a large UK tertiary hospital ED with established H@H services. Quantitative patient and carer surveys (n = 52) explored experiences of ED care, including communication, involvement, kindness and respect. Qualitative data were generated through staff co-design workshops and patient and carer engagement activities. Appreciative inquiry and co-design principles guided data analysis and pathway development. Findings Survey findings demonstrated consistently positive experiences overall, with kindness and involvement strongly associated with patient experience and kindness the strongest independent correlate in the multivariable model. Qualitative analysis identified four themes: challenges in current frailty care, what matters to patients and carers, co-designing a responsive frailty pathway and organisational learning and culture. Across data sources, participants prioritised clear communication, compassionate care, a calm environment, meeting basic needs and meaningful carer involvement. These convergent findings informed the co-design of a frailty pathway that explicitly addresses coordination among ED, H@H and community services, including communication across transitions, carer engagement and shared care planning. Practical implications The study demonstrates that co-design is feasible within a time-pressured ED and can support integrated frailty care across acute, H@H and community pathways. The resulting pathway offers a practical, transferable model to improve continuity, experience and person-centred care for frail older adults. Originality/value This study provides a pragmatic example of operationalising integrated care principles across ED and H@H interfaces through participatory service design.
Purpose This study explored barriers and facilitators to cross-sector collaboration from the perspectives of frontline workers who provided youth mental health services in the sectors of health, child/social services, education and schools, policing and community agencies in Alberta, Canada. The goal is to better serve youth and families and improve navigation across diverse service delivery sites and sectors. Design/methodology/approach A qualitative approach collected data from participants in social (child) services, policing, schools, healthcare and community organisations. Recruitment was guided by an advisory group of patients with lived experience (i.e. parents, caregivers, youth) and community organisation managers from rural and urban areas. One-on-one interviews were recorded and transcribed verbatim. Data analysis followed Interpretative Description methods to explore complex experiential questions and emerging phenomena to develop pragmatic recommendations for practice. Findings Of the 17 frontline professionals interviewed, 8 were in healthcare, 2 in social services, 2 in policing, 3 in education and 2 community members. The overarching concept (theme) of “Tensions and Opportunities Across Sectors” supported by three attributes (subthemes): (1) services for child and youth mental healthcare services in a state of incongruity (discordance), (2) seeking trust of services and providers and (3) creation of mental health service hub. Challenges and gaps identified “inconsistent and disconnected information”, “geographic isolation”, “individual agency mandates” and solutions proposed: “municipal/local level control”, “enhance communication” and “personalised pathways of care”. Originality/value Cross-sector collaboration requires youth and families, frontline workers and policymakers involved in designing an adaptive program to enhance service delivery.
Purpose Integrated care aims to improve continuity and coordination across health services. However, the interface between general practice, community services and hospital care remains challenging in many health systems. This study gathered Irish general practitioners' (GPs) perspectives on the current state of integrated care following recent health system reforms and identified priority areas for future research. Design/methodology/approach A mixed-methods sequential explanatory study was conducted involving a cross-sectional survey and semi-structured interviews with GPs practising in the Republic of Ireland. The survey captured data on practice characteristics, perceptions of primary–secondary care integration and the research priorities in primary care. Additionally, semi-structured interviews qualitatively explored experiences and suggestions on improving integration. Findings Fifty-seven GPs from 17 counties responded, with a median practice size of 5,000 patients; 72% reported a mixed public–private patient population. Most practices were in urban or mixed settings (87%). Nearly all GPs (93%) identified improving primary–secondary care integration as a research priority, though the majority perceived current integration with hospitals and community services as poor. Top research priorities included chronic disease management, population health, mental health, acute care, healthcare access and clinical trials. Qualitative analysis highlighted barriers in digital information exchange, unclear responsibilities, limited time for collaboration and the need for population health–focussed, patient-centred integrated care models. Originality/value This study provides the first geographically diverse post-reform examination of Irish GPs’ perspectives on integrated care and related research priorities following implementation of major health system reforms. The findings identify persistent implementation gaps between national policy objectives and frontline practice, while informing future integrated-care research and service development in Irish primary care.
