Nature Prescriptions: supporting the health of people and nature

Guide
Close up view of a robin perched on a snowy branch, adding colour against a bright white snowy background

We have never been more aware of how important nature is to our health and wellbeing with many of us turning to it for support, or just a change of scene, over the last two years. The direct links between exposure to nature and a range of health benefits inspired RSPB Scotland to create Nature Prescriptions, an initiative which provides an innovative way to support the health of people and nature.

Close up view of a robin perched on a snowy branch, adding colour against a bright white snowy background

Nature Prescriptions began as a collaboration with NHS Shetland in 2017 and we can now share the results from an Edinburgh pilot that tested the approach in an urban setting thanks to support from Edinburgh and Lothians Health Foundation.

For the first time, we can offer hard evidence of the value of Nature Prescriptions to both patients and healthcare professionals and provide guidance on how this approach can be effectively delivered in a primary care setting.

How does nature help health?

There is an ever-increasing body of evidence demonstrating direct links between exposure to nature and a range of health benefits, including reductions in anxiety, fatigue and depression, lower rates of inflammatory-based diseases, type 2 diabetes and obesity, improved concentration, enhanced immune function and reduced mortality. Nature also has positive impacts on levels of life satisfaction, vitality and happiness.

What is a Nature Prescription?

Nature Prescriptions are designed to support GPs and other healthcare professionals to formally prescribe connecting with nature so their patients can harness the benefits of nature for health and wellbeing. They use their medical knowledge to choose when a prescription is appropriate and then customise it to an individual patient’s needs and abilities as part of their treatment.

The prescription is supported by a leaflet and a calendar of local, seasonal activities produced by RSPB Scotland along with some information about local greenspaces and groups.

Some of the activities may include physical activity in nature (green exercise), but Nature Prescriptions is about more than being active outdoors, it’s about connecting in a personal and meaningful way. While the focus is very much on individual connections, it can also work in group settings or as part of social prescribing approaches.

As nature nurtures us, the connection we build can deepen our care and concern for nature. This reciprocal relationship is at the heart of Nature Prescriptions.

Where did Nature Prescriptions start?

Nature Prescriptions started in Shetland inspired by a report produced for the RSPB by Dr William Bird about the mutual benefits of connecting people with nature. The pilot started at Scalloway Health Centre in 2017 and, following its success there, was rolled out to all ten GP practices in Shetland in 2018.

View the leaflet and calendar produced for Shetland here:

“It’s a simple idea: get our most trusted health professionals (GPs), to recommend that people seek nature as a way of feeling better. As a result, people form deep connections to nature through an association with better health. The value placed on nature means more people are likely to step up to save it in the future.” Karen MacKelvie, RSPB Scotland

 

The Edinburgh Pilot

Media coverage of Nature Prescriptions in Shetland led to ongoing interest from healthcare professionals around the world. However, our ability to measure success was largely based on anecdotal evidence and we wanted to undertake more thorough research to investigate both the benefits of prescribing nature and how best to do it. We also wanted to test if it could work as well in an urban area.

So, with the support of Edinburgh and Lothians Health Foundation (the official charity of NHS Lothian) and start-up funding provided by the RSPB, an Edinburgh pilot of Nature Prescriptions was formed working with five GP practices across the city.

The pilot was due to begin in spring 2020 but was delayed due to the onset of the Covid-19 pandemic. It was restarted in November that year, despite ongoing pressures, as GPs were keen to begin with one saying that “Nature Prescriptions is needed now more than ever”.

View the leaflet and calendar produced for Edinburgh here:

Close up view of a branch in front of murky river in the background

The Edinburgh results

Nearly 350 patients across all age groups received a Nature Prescription. Prescriptions were given for 32 different conditions, most (69%) were given to support mental health, with 17% given to support physical health and 10% for both.

Nearly three-quarters of patients who provided feedback said they had benefited from their Nature Prescription, with most continuing to connect with nature each week, and 87% of them saying it was likely or very likely that they would continue using their prescription.

The formal prescription was liked because it gave patients the permission and motivation to engage with nature, it was a drug-free safe alternative and they thought it was working.

“I have lived in Edinburgh for over 10 years but honestly had no idea where to go for woodland walks, so the maps and suggestions were fantastic. It is so easy to forget how good nature makes you feel, especially in winter and throughout the pandemic. Thank you!” Patient

“I’ve been reminded of all that nature has to offer. I share my love of nature with friends and I’ve noticed how it has benefitted them as well. This prescription has shone a light on something that brings me a lot of joy and that’s always there no matter what. Being connected with nature calms me and makes me feel grounded. It gives me perspective and lifts my heart. Thank you so much for this inspired service. Absolutely brilliant!” Patient

Most patients did not experience any issues with using their nature prescription. The main challenges to helping patients get the benefit of a nature prescription were felt by the prescribers who mentioned that both time pressures and virtual appointments made it harder to have conversations with patients and ensure they understood the benefits connecting with nature could give them.

Despite this, by the end of the pilot nearly 90% were prescribing nature and they all said they would continue to do so. Before the pilot, only 39% of prescribers were recommending nature-based activities.

“It’s great to have something specific to offer to patients that isn’t medication.” GP, Leith Mount Surgery

In conclusion...

Nature Prescriptions is an effective, low-cost health intervention that has no negative side effects, is able to support a range of physical and mental health conditions and is entirely complimentary to traditional medicative treatments as well as social prescribing approaches. It could, and should, be extended to other locations – both rural and urban. With adequate funding and support, it could be part of toolkit for all healthcare professionals, providing benefits for them, their patients and nature itself.

Read the full report here  

Next steps

As a first step, we want to roll the Edinburgh Pilot out to more GP practices across the city to allow for continued assessment and evaluation of its efficacy, with a view to extending into other locations – both urban and rural across Scotland. We are seeking partners and potential funders to support this.

Get in touch with natureprescriptions@rspb.org.uk, to find out how you can support the next stages.