Green social prescribing: nature-based activities, what NHS England piloted and what to expect

NHS England describes green social prescribing as the practice of supporting people to engage in nature-based interventions and activities to improve their mental and physical health. It sits within the wider social prescribing approach, where a link worker connects someone with community activities that suit them.

The programme covers both green and blue activities, meaning land-based and water-based. The activities named include local walking schemes, community gardening projects, conservation volunteering, green gyms, open water swimming, and outdoor arts and cultural activities. The common thread is time outdoors, usually with other people.

A cross-government initiative ran from April 2021 to March 2023 across seven integrated care systems in areas heavily affected by COVID-19 and health inequalities. The seven were Humber and North Yorkshire, South Yorkshire and Bassetlaw, Nottingham and Nottinghamshire, Joined Up Care Derbyshire, Greater Manchester, Surrey Heartlands, and Bristol, North Somerset and South Gloucestershire.

NHS England reports that over 8,500 people received green social prescribing referrals, that uptake was 85% when activities were offered, that mental health improvements were documented, and that green networks were established at all seven sites. It adds that programmes continue to operate at all of them. These are programme reports rather than controlled trials, so they show that people took part and tended to benefit, not exactly how much any one activity helped.

You do not need a referral to benefit from the idea. NHS inform suggests that being active makes the brain release hormones that boost energy and improve mood, and lists gardening, including community gardens and indoor plants, among varied ways of moving that do not feel like formal exercise. It also notes that group activity can reduce loneliness.

The NHS five steps to mental wellbeing include being active, connecting with others and giving to others, all of which a community garden or conservation group can combine. Learning a new skill, such as identifying plants or managing a plot, adds to a sense of purpose.

• Start with a short, regular outing rather than an ambitious plan.

• Choose an activity with other people if loneliness is part of the picture.

• Pick something that suits your mobility, whether a seated gardening session or a flat walking route.

Outdoor activity carries ordinary risks. Wear suitable footwear and clothing, take water, and tell someone where you are going, especially when walking in remote areas. Open water swimming carries cold-water and drowning risks, so join an organised group with safety cover rather than going alone.

People with heart conditions, breathing problems, mobility limits or other long-term conditions should check with their GP or specialist about the level of activity that suits them. Gardening and conservation work involve tools and lifting, so tell the organiser about any physical limits.

Ask your GP practice whether a social prescribing link worker is available, as described in NHS England's social prescribing guidance. Charities and local councils may also run walking, gardening and conservation groups, and NHS inform points Scottish readers to Scotland's Service Directory for local wellbeing groups.

Useful questions include whether the group is suitable for beginners, whether there is step-free access, how long sessions last, whether equipment is provided, what the group does in poor weather, and how to leave if it does not suit you.