Building capacity for NBSP within the healthcare system is important to introduce and develop NBSP programmes that support and improve health and wellbeing at a population level. Whether resulting directly from participation in NBSP or as an indirect result of these programmes, evidence suggests that participation in NBSP can improve both physical and mental health. A recent meta-analysis showed reductions in blood pressure as well as anxiety and depression scores among service users ((59) see also (60) for related findings), while another recent review suggested that NBSP can improve social connectedness and mental wellbeing (18). Regarding health service delivery, NBSP may lead to reductions in the use of health services (e.g., pharmaceutical use) with associated economic and environmental benefits. This is supported by previous research indicating, for example, that social prescribing results in fewer visits to the GP and has a positive social return on investment (61).

Challenges discussed by participants relating to current capacity to deliver NBSP were similar to those recently identified for social prescribing programmes in integrated care (62). Capacity building is needed within three main areas. Firstly, there is limited information and training for professionals who might deliver NBSP. Education and training are necessary to equip professionals with the knowledge, skills, and competencies to deliver quality care. Depending on the NBSP pathway used, the professionals involved may include primary and secondary care practitioners (e.g., nurses and GPs), and community workers (e.g., nature-based activity managers, volunteers delivering activities). Participants discussed how some of these (e.g., link workers and community connectors) may not necessarily need a medical qualification, but they should be trained in relevant skills and competencies (e.g., in behaviour change methods, motivational interviewing, health assessment, action planning, safeguarding individuals with mental health conditions, coping strategies for themselves), as their role is crucial to the success of the referral, with many service users opening up more to them than to other healthcare professionals. This could be achieved through formal education programmes, specialised and accredited training courses, and/or continuous professional development to stay updated with the latest developments. This is likely to be context-specific as different countries have different professional training requirements. In the UK, for example, training might be adapted from cognitive behavioural therapy, as these courses have previously been developed to train a non-professional workforce (63).

Secondly, there is need for workforce expansion. Increasing NBSP provision means more professionals will be necessary to meet the growing demand for services (e.g., currently there is unmet demand for NBSP in the UK) (17). This may involve the creation of new professional roles. Whilst in the UK, link workers connect service users with appropriate nature-based activities, this role could be taken by other staff in the healthcare system in other countries. In Germany, it might be taken by GPs or social workers, as was discussed by workshop participants. Other countries operate with equivalents to link workers, such as the Netherlands with wellbeing coaches, Singapore with wellbeing coordinators, and the Philippines with village health workers and nutrition scholars (12,64,65). Participants also discussed strategies to recruit and retain staff (e.g., the provision of appropriate training and support). In the UK, there is currently high turnover in some roles because, for example, staff feel unsupported when service users share difficult stories (66).

To address the needs of an expanding workforce for knowledge, it may help to foster a broader understanding of the benefits of nature through education on planetary and public health, including the links between the environment and health, and giving opportunities to experience nature (e.g., through school and medical university curricula). In Germany, planetary health is not mandatory in medical training and education. However, education options are growing: for example, the German NGO “KLUG” has introduced online courses that address these issues within their own “Planetary Health Academy” (67). Also, the Chair of Public Health and Health Services Research has developed an online planetary health course for students for the “Virtual University of Bavaria” (68). Both programmes were funded by the German Government via the German Environment Agency. There is the potential for further development in this area; for example, there are ongoing clinical studies investigating the efficacy of nature and forest therapy at different German institutions, which could contribute materials for dissemination. While planetary health and sustainability are taught by many medical schools in the UK, teaching does not necessarily reflect current knowledge in these fields and is not mandatory (69).

Thirdly, along with the development of the workforce, to enable the presence of staff such as link workers, there is a need for the development of infrastructure and processes to enable the provision of NBSP in all health and social care facilities. For example, the UK is ensuring that everyone can access social prescribing through their GP by employing a sufficient number of link workers (70). However, expansion of NBSP will require these professionals being aware of available NBHI in their communities as insufficient communication across sectors can be a barrier (see also Embedded and integrated networks and collaborations). Currently, policymakers tend to give NBSP and other public health prevention programmes insufficient priority as their potential health-related benefits and co-benefits (i.e., climate change mitigation and adaptation, social cohesion, and nature conservation) have not yet been communicated effectively or are difficult to communicate due to the long timeframes until effects are visible. Developing good communication campaigns about nature’s health benefits could facilitate this acceptance (e.g., by land owners), and facilitate capacity building and the development of infrastructure and processes.

Related to finding effective communication strategies for policy makers, knowledge dissemination could also lead to increased service user acceptance, as they may have limited trust in NBSP due to a lack of understanding of the benefits of social prescribing (71) and NBSP (17). In this context, potential stigma for attending NBSP was discussed. Expectations and knowledge of service users are important as the beneficial effects of social prescribing programmes can be hindered when the aims, expectations, and/or interest of service users do not meet those of link workers or other people involved in the programme (72). The use of social marketing strategies (e.g., with buzz words) might help raise awareness amongst key audiences (cf. (73,74)).