When Doctors Look Beyond Medicine: How GPs Decide Who Gets Social Prescribing

Social prescribing has become one of the most talked-about ideas in modern primary care: the notion that a doctor might treat loneliness, isolation, or the slow grind of poverty not with a prescription pad, but with a referral to a walking group, a community kitchen, or a volunteer service. The logic is compelling. Many patients who fill general practice waiting rooms do not have problems that pills can solve. Yet a new qualitative study from Denmark, published in BMC Public Health, reveals just how complicated it is to turn that appealing idea into everyday clinical routine. The research, led by Jeanette Wassar Kirk of Copenhagen University Hospital and the National Institute of Public Health at the University of Southern Denmark, followed how general practitioners actually assessed, negotiated, and applied social prescribing in their consultations, and the findings suggest that the fate of such programs rests less on policy documents than on the minute-to-minute judgments of individual doctors.

The study was conducted in Danish general practice, a setting where social prescribing had not yet been formally embedded in routine primary care but where a structured social prescribing model had been implemented as part of a local initiative. The researchers embedded themselves in this environment using an ethnographic approach that is still relatively rare in health services research. Rather than relying solely on what doctors say they do, the team generated data through participant observations in general practitioner cluster meetings, clinical consultations, and project meetings. They then complemented these observations with semi-structured interviews with fifteen general practitioners, conducted one year after the implementation of the model. This combination of watching and asking allowed the researchers to capture both the lived texture of consultations and the reflective accounts doctors gave of their own decisions.

The data were analyzed using thematic analysis inspired by the approach of Graneheim and Lundman, a well-established qualitative method that moves from surface-level codes to deeper interpretive themes. From this analysis, six themes emerged, and together they paint a picture of social prescribing as something far messier and more human than a standardized referral pathway. Social prescribing, the authors conclude, is not enacted as a standardized model but as a mediated and negotiated practice, one whose uptake depends on how general practitioners construct candidacy, interpret needs, negotiate professional boundaries, and assess each patient’s capacity to engage with a non-clinical service.

The first theme describes social prescribing as a negotiated expansion of the medical mandate. This phrase captures a fundamental tension at the heart of the approach. General practitioners are trained, licensed, and paid to practice medicine, and every extension of that mandate into social territory must be actively justified in the moment. When a doctor considers referring a patient to a community-based, non-clinical service, they are in effect redrawing the boundary of what counts as a medical problem and what counts as a legitimate use of the consultation. The study shows that this redrawing is not automatic, even among doctors who hold positive attitudes toward social prescribing. The abstract notes that despite favorable attitudes, uptake remains limited, and the negotiation of the medical mandate helps explain why: enthusiasm alone does not dissolve the professional and organizational boundaries that keep clinical practice anchored to biomedical work.

The second and third themes concern who gets identified as a candidate for social prescribing, and here the findings become particularly striking. The researchers found that the target group for social prescribing was a product of both clinical reasoning and moral judgment. In other words, when a general practitioner decides whether a patient is suitable for a community referral, two kinds of assessment run in parallel. The first is clinical: does this person have needs that a non-clinical service could plausibly address? The second is moral: is this person the kind of patient for whom such a referral is appropriate? The interplay of these two assessments shapes the pool of patients who actually receive social prescribing, and it means that candidacy is constructed in the consultation rather than defined by any fixed eligibility criteria.

Within this construction of candidacy, the study identified a systematic blind spot: younger patients. The third theme reports that younger patients were largely absent from general practitioners’ mental model of who social prescribing is for. This finding matters because social determinants of health, such as loneliness, unemployment, and social disconnection, do not only affect older adults. If doctors instinctively associate social prescribing with elderly patients living alone, younger people with equally serious social needs may never be offered the option. The Danish study thus exposes how implicit assumptions about age and need can quietly filter access to services before any formal eligibility rule comes into play.

The fourth theme identifies relational access as a precondition for social prescribing. A referral to a community service is only meaningful if the patient can actually connect with that service, and the study found that general practitioners assessed whether each patient had the relational capacity to engage. This involves judging whether a person has the social skills, motivation, trust, and practical circumstances to walk into a community group and benefit from it. Social prescribing, in this light, is not a simple handoff. It is a clinical judgment about a patient’s ability to form new relationships and participate in non-clinical settings, and patients who lack this capacity, in the doctor’s assessment, may be screened out even when their social needs are greatest.

The fifth theme addresses whether social prescribing can be sustained as a workable clinical practice. Implementation research has long shown that interventions which add work to already overloaded primary care settings tend to stall, and the Danish study confirms that general practitioners weigh social prescribing against the practical realities of their working day. For social prescribing to survive beyond a pilot phase, it must fit into the rhythms of general practice: the length of consultations, the flow of patients, the availability of link workers who connect patients to community services, and the broader infrastructure of the primary care system. The study’s focus on sustainability signals that one year after implementation, doctors were still actively evaluating whether the model could be maintained as part of ordinary practice rather than remaining an exceptional, effortful addition.

Perhaps the most philosophically rich finding is the sixth theme: the legitimacy of the social prescribing approach is grounded in patient-centred ethics rather than system efficiency. General practitioners in the study did not primarily justify social prescribing by pointing to cost savings, reduced hospital admissions, or other system-level benefits, arguments that dominate much of the policy literature. Instead, they grounded the practice in what they judged to be good for the individual patient in front of them. This ethical grounding aligns with the core tradition of general practice, which has always prized continuity, personal knowledge, and attention to the whole person. It also suggests that attempts to scale social prescribing through efficiency arguments alone may miss the professional logic that actually sustains the practice at the front line.

Taken together, the six themes carry a clear message for health systems experimenting with social prescribing, from the United Kingdom, where the approach has been embedded in the National Health Service, to Denmark and beyond. The success of social prescribing does not hinge primarily on the design of referral forms, the size of community service catalogs, or the enthusiasm of policymakers. It hinges on the situated judgments of general practitioners: how they read a patient’s needs, how they weigh the boundaries of their role, how they judge a patient’s capacity to engage, and whether the model fits the daily realities of their work. The authors highlight social prescribing as a situated practice embedded in primary care dynamics, a formulation that should reshape how implementation efforts are designed. Programs that treat social prescribing as a standardized pathway to be rolled out may find uptake stubbornly limited, while programs that support doctors in negotiating candidacy, provide relational infrastructure such as link workers, and respect the patient-centred ethics that give the approach its legitimacy are more likely to see it become more than medicine in practice, and to answer the question the study’s title poses: not just whether, but when.

Subject of Research: How general practitioners assess, negotiate, and apply social prescribing in everyday clinical practice

Article Title: “More than medicine — but when?” A qualitative study of how general practitioners assess, negotiate, and apply social prescribing in clinical practice

Article References: Kirk, J. W., Oldrup, L. S., Andersen, O., Sommer, C., Broholm‑Holst, M., & Nilsen, P. (2026). “More than medicine — but when?” A qualitative study of how general practitioners assess, negotiate, and apply social prescribing in clinical practice. BMC Public Health. https://doi.org/10.1186/s12889-026-29639-5

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29639-5

Keywords: social prescribing, general practice, primary care, qualitative research, candidacy, social determinants of health, medical mandate, link worker, patient-centred ethics, implementation, Denmark, BMC Public Health