Health system lessons from community practice: a qualitative study rethinking the role of social prescribing for refugee populations.

Background: Social prescribing has become central to UK health policy, positioned as a mechanism for addressing social determinants of health through non-medical interventions. However, little is known about its relevance for refugee populations, whose experiences are shaped by poverty, legal precarity, and systemic exclusion. Limited evidence exists on which delivery models are used in health and refugee-serving initiatives. Consequently, this study explores how different delivery models of social prescribing and community-led refugee support projects intersect and how this could inform health systems. Methods: Twenty-three UK practitioners participated in semi-structured online interviews, including social prescribers, community project leads, health professionals, and volunteers. Participants represented diverse projects, including arts, sports, language learning, peer mentoring, health advocacy, and General Practitioner (GP)-based social prescribing. Data were analysed iteratively to generate conceptual insights into delivery models, resources, challenges, and practitioner perspectives on social prescribing by using reflexive thematic analysis informed by realist principles. Results: Practitioner accounts revealed diverse delivery models across community-led and NHS-commissioned settings, converging around trauma-informed, person-centred approaches. Community projects frequently evolved into multi-service community centres combining social, legal, and health-related activities, sustained through precarious funding and reliance on volunteers. Social prescribers described exceeding their short-term signposting remit to meet complex needs. Key challenges included systemic underfunding, workforce burnout, language and cultural barriers, immigration status-based exclusions, and hostile policy environments. Resources identified included dedicated staff, volunteers, and community partnerships. Practitioners identified relational trust, safety, and empowerment as key mechanisms of impact for refugees. While social prescribing delivery models were viewed as conceptually aligned with refugee-serving community organisations, practitioners identified several potential harms around capacity, accountability, and suitability of referral models. Conclusion: Based on practitioner perspectives, community-led refugee projects offer important lessons for social prescribing: the importance of trauma-informed practice, cultural safety, relational outcomes, and sustained accompaniment. Findings suggest that for social prescribing to be effective and safe for refugee populations, systemic adaptations may be needed, including: long-term funding, prescriber training in trauma and asylum contexts, improved service mapping, and evaluation frameworks valuing relational outcomes. These insights require validation through research with refugee populations to establish whether identified challenges and harms manifest as described.