Potential harms of social prescribing: a global umbrella review and dark logic model

Clinical Snapshot

Key Findings

• Effect Size: Not applicable (qualitative synthesis)

• Primary Outcome: Identification of harm types associated with social prescribing interventions

• Nnt Or Sensitivity: Opportunity harms most frequently reported, followed by psychological, equity, and group/social harms. No physical harms identified.

• Confidence Interval: Not provided

Clinical Application

Findings applicable to existing social prescribing programs with need for enhanced safety monitoring and harm prevention strategies Highly relevant to Australian social prescribing initiatives supported by PHNs and integrated with RACGP guidelines. Aligns with TGA safety monitoring principles for healthcare interventions Healthcare providers, commissioners, and link workers involved in social prescribing across primary care and community settings

Abstract

OBJECTIVES: Social prescribing has provided a lifeline to people, capturing the importance of quality support offered via community connections. It has not been exempt from difficulties, resulting in low-quality evidence on effectiveness in part due to high drop-out rates and lack of controls. While these have been the focus of recent research, less attention has been paid to the safety implications of social prescribing. This review aims to understand safety implications of social prescribing interventions and to build a dark logic model of how harms are produced. DESIGN: Using review of review (umbrella) methodology, we searched nine databases to June 2024. DATA SOURCES: Medline/Ovid, Embase, PsycINFO, Cochrane Library/Wiley, Web of Science and Scopus) were searched from 1 January 2010 to 3 June 2024. ELIGIBILITY CRITERIA: Included reviews were systematic/scoping/narrative reviews or meta-analyses, which synthesised primary data collected from any person in receipt, involved in delivery or the commissioning of social prescribing interventions. The context of the review was social prescribing interventions/services based in primary healthcare (statutory) or third sector (non-statutory) in any country. Only reviews that were published in English and in peer-reviewed journals were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data from included reviews using the Typology of Harms Framework (which includes five categories of harms associated with interventions: physical, psychological, group/social, equity and opportunity harms) and to build a dark logic model to understand what contributes to these harms. RESULTS: Sixteen reviews were included, reporting on social prescribing research including a link worker. Of the identified harms, we found that opportunity harms (harm related to the cost, inappropriate or ineffective interventions) were most reported. There was also evidence extracted to suggest plausible psychological, equity (impact caused by inequity in provision, delivery or access) and group/social harms (impact that overly or inadvertently excludes a person). No physical harms were identified. CONCLUSIONS: Social prescribing, as with any delivery of care, has the potential to cause harm. We identified a range of potential harms (psychological, group/social, equity or opportunity harm) from social prescribing; however, it is unlikely to be an exhaustive list. We provide two clear outcomes: (1) the need for robust design of social prescribing research, including collection of data on the incidence and prevalence of harms, (2) recognition of the potential for harm from social prescribing and to address these where practicable.

References

1. 1.Cooper, M., Okeowo, D., Bennett, L., Aslam, E., Yahya, F., Lawson, L., Robinson-Barella, A., Nazar, H., & Scott, J. (2026). Potential harms of social prescribing: a global umbrella review and dark logic model. BMJ Open. https://doi.org/10.1136/bmjopen-2025-108998