The hidden cost of getting better. Why affordability is the barrier of social prescribing.

I have spent twelve years working in NHS roles across clinical, innovation, health tech uptake and commissioning. In that time I have watched the NHS invest significantly and sincerely in social prescribing — the idea of connecting people to community activities as an alternative to clinical intervention.

The investment is real. The intent is right. And there is growing evidence that it works. Social prescribing has generated a 42.2% reduction in GP appointments in some areas and up to a 39% reduction in A&E attendances among frequent users (National Academy for Social Prescribing, 2024). These are significant, meaningful outcomes.

But there is a barrier that the social prescribing literature acknowledges consistently and the policy conversation almost never addresses directly: the cost of participation from the patient's perspective.

Not the cost to the NHS. The cost to the person being referred. The hidden price of getting better.

What social prescribing actually costs the patient

When a social prescribing link worker refers someone to a community activity, the assumption built into the referral is that the person can get there and can afford to participate. For a significant proportion of the people most likely to receive a social prescribing referral, neither of these assumptions holds.

Research using the realist review methodology identified that costs of the activity itself, distance, and travel problems were all cited as key barriers to attendance in social prescribing programmes (Sturgiss et al., 2020). A study on community and cultural engagement for people with lived experience of mental health conditions found that participants' ability to engage was hampered by the expense, inaccessibility, and sometimes unstructured nature of activities (Chew-Graham et al., 2022). The same research identified that subsidising attendance, transport, and equipment costs was among the interventions that could address these barriers.

Transport inaccessibility was identified as one of the main barriers to social prescribing engagement in research using the COM-B model of behaviour change (Sadio et al., 2025). And yet transport subsidies, childcare support, and participation costs are almost never built into social prescribing referral pathways as standard. They are recognised as barriers. They are rarely removed.

Who bears this cost — and why it matters for health inequalities

Social prescribing is disproportionately used by people from socioeconomically deprived backgrounds. Analysis of over 160,000 social prescribing referrals found that 61% were female, and people referred were more likely to live in deprived areas (National Academy for Social Prescribing, 2024). The Lancet Public Health reported that the rollout of link workers has seen progress in reaching more deprived communities, though disparities in accessibility and uptake remain (Wilding et al., 2025).

This creates a specific and troubling pattern. Social prescribing is reaching the people who most need it. Those same people are often the least able to afford the transport, the participation fees, the equipment, and the time off work that attending a community activity requires. The referral reaches them. The activity does not.

This is not a marginal problem. Social determinants of health — the non-medical factors that influence health outcomes — account for between 30% and 55% of health variation according to the World Health Organisation (WHO, 2023). In the UK, life expectancy in the most deprived areas can be more than a decade lower than in the most affluent (Knexu, 2025). The financial barrier to participation in community health activities is not a separate issue from health inequality. It is one of its causes.

The referral reaches the people who need it most. The activity often does not. The cost of getting there is the gap nobody is filling.

The specific problem with current social prescribing activities

The activities most commonly available through social prescribing — art classes, cooking sessions, walking groups, gardening clubs — often carry costs that are invisible to the commissioning system but very visible to the patient. A ceramics class requires transport to a venue. A cooking session requires ingredients. An exercise class requires appropriate clothing and footwear.

These costs are individually small. Collectively, for someone on a low income or benefits, they represent a meaningful financial barrier. Research consistently finds that financial barriers to participation are highest among the populations most targeted by social prescribing — those in deprived areas, those with long-term health conditions, those who are socially isolated (Melam et al., 2025).

The system knows this. Recommendations to address it include long-term flexible funding for community organisations to subsidise attendance and transport (British Journal of Hospital Medicine, 2025). But these recommendations remain largely aspirational. The structural cost barrier persists.

What Nettie changes

Nettie does not solve the transport problem or the participation cost problem for every activity. But it does something specific and valuable: it makes grassroots women's sport — one of the most powerful community health activities available in England — genuinely free to attend and genuinely local.

A women's grassroots football match is free to attend in most cases. It takes place within the community, often within walking distance. It requires nothing from the attendee except their presence. There are no membership fees, no equipment costs, no participation charges.

A person referred via a Nettie-enabled social prescribing pathway does not need to budget for transport, clothing, equipment, or participation fees. They walk to the ground. They scan in. The club earns. They watch the game.

This is not a small thing. For someone on Universal Credit, the financial calculation of whether to attend a community activity is a real one. Removing that calculation entirely — making the activity genuinely free and genuinely accessible on foot — removes one of the most consistent barriers to sustained engagement that the social prescribing literature has identified.

The proximity principle

Nettie's discovery platform operates on a simple principle: find active women's sport clubs within your community, verified by real attendance data, within 30 seconds of entering a postcode.

This is not incidental to the health inequality argument. It is central to it. Research into physical activity and community health consistently finds that proximity is one of the strongest predictors of sustained participation. Where public transport was necessary, individuals were less likely to engage (Sturgiss et al., 2020). Distance and travel problems are not just inconveniences — they are structural barriers that reproduce health inequality by making community health activities less accessible to those who need them most.

Grassroots women's sport happens in communities. In the local parks, the school grounds, the municipal pitches that exist in every neighbourhood in England — including the most deprived ones. A women's football club is not a leisure centre that requires a bus journey. It is often the same postcode as the people who need it most.

Nettie makes that proximity visible. It turns a local asset that was invisible to the health system into a verified, discoverable, referrable community health resource.

The broader argument

The NHS spends significant resource commissioning activities for people who cannot always afford to attend them, in venues they cannot always reach, delivered by organisations that cannot always sustain themselves without long-term funding.

Grassroots women's sport is already there. Already funded by the communities that built it. Already attended by people who found their own way there without a referral. Already generating the social connection, the physical activity, the community belonging that social prescribing is trying to commission.

It just has not been connected to the health system. Because nobody could find it. Nobody could verify it. Nobody could prove it was there.

Nettie makes it findable, verifiable, and free. That combination — local, verified, and accessible to anyone who can walk there — is not an accident of product design. It is the point.

The most equitable health intervention is one that costs nothing to access and exists in the same postcode as the people who need it most.

If you work in social prescribing, health inequalities, or community health commissioning — and you think there is a conversation worth having here — I would love to talk.

Nic Vovk Founder, Nettie nettie.online