“More than medicine — but when?” A qualitative study of how general practitioners assess, negotiate, and apply social prescribing in clinical practice

Social prescribing (SP) addresses social determinants of health by linking patients in general practice to community-based, non-clinical services. Despite positive attitudes among general practitioners (GPs), uptake remains limited, and little is known about how SP is interpreted and applied in everyday clinical practice, particularly in contexts where SP is not yet formally embedded in routine primary care. The aim of this study was to explore how SP is understood, negotiated, and applied in general practice, and identify factors influencing its uptake. A qualitative exploratory study conducted in Danish general practice, embedded in a structured SP model implemented in a primary care setting. Data were generated through participant observations in GP cluster meetings, clinical consultations, and project meetings, as well as semi-structured interviews with 15 GPs conducted 1 year after implementation. Data were analysed using thematic analysis inspired by Graneheim and Lundman. Six themes were identified: (1) SP as a negotiated expansion of the medical mandate, (2) the target group as a product of clinical reasoning and moral judgement, (3) younger patients as a blind spot in GPs’ construction of SP candidacy, (4) relational access as a precondition for SP, (5) sustaining SP as a workable clinical practice, and (6) legitimacy of the SP approach is grounded in patient-centred ethics rather than system efficiency. SP is not enacted as a standardized model but as a mediated and negotiated practice. Uptake depends on how GPs construct candidacy, interpret needs, negotiate boundaries, and assess patients’ capacity to engage. These findings highlight SP as a situated practice embedded in primary care dynamics.