Social prescribing: understanding the new role of link workers

UK General practice is struggling. It is overwhelmed and underresourced. Patients, practitioners and policy makers alike feel frustrated. People are looking for new ideas. One idea introduced by NHSE in 2020/21 is the idea of Social Prescribing.

Social Prescribing recognises that many of the issues affecting people’s everyday health are not medical. If we want to improve the health of individuals and communities, we need to recognise and address the range of so-called social determinants of health. These include issues about housing, eating, social contacts, work and employment, environmental issues.

By introducing Social Prescribing, NHSE aimed to introduce new services to help connect people with local expertise and resources in their communities that can help with health related needs, but ones that don’t need medical care. The goal was to improve the health of local communities, and reduce the demand on formal health services.

Social Prescribing is nothing new – although the name has changed over many decades. GP practices have been working with their local communities for decades to support the extended health needs of their local populations. But the introduction of a formal Social Prescribing service into the primary healthcare setting has created some important opportunities and challenges for patients, clinicians, communities, and health service managers.

We have been involved in primary care research in this area for a long time. The Academy of Primary Care continues to support a range of Social Prescribing research projects as part of our broader focus on advanced medical generalist care, workforce development and primary care redesign.

Understanding the implementation of link workers in primary care networks: A realist evaluation to inform current and future policy

Many people have fulfilled the role of linking people with community based services that can help with their health. Including teachers, priests, GPs, practice receptionists, social workers, volunteers and charity workers.

As part of its 2021 Social Prescribing initiative, NHSE also introduced funding for a new role – the Link Worker. The roles of the Link Worker haven’t been clearly defined, delineated and designed and so are developing in multiple ways in different contexts. All of which creates challenges for patients, Link Workers, practices and health services.

So in this research, we support a team led by Dr Stephanie Tierney at the University of Oxford to understand how the roles are developing and what are the implications for sustaining the Social Prescribing initiative.

LINK WORKER study is now nearing completion with some important key findings emerging

• The study describes the complex work being undertaken by link workers in practice who often work with some of the most vulnerable people in primary care
• It highlights the challenges of implementing and integrating a complex new service into a complex and struggling healthcare setting
• The primary intention of health policy was perhaps to divert people away from NHS care and so reduce referrals and healthcare use. As with many similar work previously, our research suggests the work is recognising/generating new and additional need
• The work highlights the additional challenges for link workers and health services alike arising from the failure to fully define and delineate the role and purpose of the service (The findings resonate with other workforce planning challenges in today’s primary care setting)
• Our work is recognising challenges but also opportunities for creating sustainable services

Tierney, S., Wong, G., Roberts, N., Boylan, A. M., Park, S., Abrams, R., …Mahtani, K. R. (2020). Supporting social prescribing in primary care by linking people to local assets: A realist review. BMC medicine, 18(1), Article 49. https://doi.org/10.1186/s12916-020-1510-7

In review/progress:

“She’s been a rock”: the function and importance of ‘holding’ by social prescribing link workers in primary care in England: findings from a realist evaluation.

Micro-discretions and boundaries associated with the link worker role. Patient buy-in to support from a link worker - giving hope (connecting with), giving direction (connecting to) as part of person-centred care: Findings from a realist evaluation