Beyond referral: social prescribing as an access-producing system

Social prescribing is commonly represented as a referral from healthcare to non-clinical community resources, but referral does not ensure use. This perspective argues that social prescribing should be designed and evaluated as an access-producing system. Drawing primarily on food-access interventions as an analytic case, it distinguishes financial, geographic, and relational access as dimensions of practical access that can function as intermediate implementation mechanisms when strategies change them. They are not the antecedent barriers themselves or the downstream outcome of participation; they are the conditions linking a strategy to use. The added value of this framing is therefore not a new taxonomy of familiar barriers, but a more explicit causal question: what changed that made a prescribed resource affordable, reachable, legitimate, and sufficiently trustworthy to use? The three access pathways may interact as complements or bottlenecks, and participation may occur only after each necessary pathway reaches a context-dependent threshold. This parsimonious framing directs evaluation toward proximal evidence of access before distal health outcomes are attributed to social prescribing and offers propositions for prospective testing rather than a validated comprehensive theory.