Insights into social prescribing link worker roles in primary care

Over the last few years, there has been a drive to introduce social prescribing link workers across NHS primary care in England. These employees support patients with non-medical issues affecting their health and well-being; issues such as lack of social connections or housing problems. However, as this was a new role, there were growing uncertainties on how this role could be optimally implemented. In November 2021, we started collecting data for a 30 months study that set out to address the question: When implementing link workers in primary care to sustain outcomes – what works, for whom, why and in what circumstances? Our research involved spending time with seven link workers across England, watching what they did and collecting data around them. This included talking to people they worked with in primary care and with patients.

Knowledge exchange event

In October 2024, we brought together 24 stakeholders (members of the public, policy makers, practitioners, link workers, social prescribing organisations, researchers) for a knowledge exchange event. Its purpose was to consider how findings from our study could help to optimise the link worker role in primary care. The event was an opportunity to tell people about the research but there was also plenty of time to discuss with others how findings could inform practice and policy. At this meeting, we were able to share with those present the report we developed from the study. We have now launched this report on our website. 

The report

In this report, we provide an overview of the study and focus on the following key findings:

1. Holding – data suggested that often link workers became the intervention; this was because they provided ongoing support to patients due to: a) a lack of community provision to refer patients to, b) waiting for patients to be at a stage when they were ready/had capacity to connect to community support, c) wanting to protect healthcare staff from having to support people with non-medical needs, d) it not being possible to ‘fix’ problems that some patients were experiencing.  
2. Micro-discretions – relate to the flexibility link workers were afforded in their job to impact outcomes. It highlights actions that link workers took based on personal judgment; ‘micro’ was used because this discretion related to interpersonal interactions – with patients and primary care staff.
3. Being an anchor point – link workers’ ability to prompt patients to take steps towards change, which centred on their skills in putting people at ease, creating an atmosphere in which patients felt able to open up. They gave patients the space and permission to consider their non-medical needs.
4. A continuum of embeddedness – based on our data, we proposed a broad continuum of how integrated link workers were within primary care. At one end of the continuum, link workers were ‘bolted on’ – brought into primary care without much consideration of how the role would work alongside existing provision. In a central position within the continuum was ‘fitting in’. This is when there was some attempt to bring link workers into a practice but this could be uncomfortable if they felt their role was not really understood or appreciated. At the other end of the continuum was ‘belonging’, which involved some negotiation and potential adjustment by the link worker and the practice as they worked together to offer the best support possible to patients.

To find out more about this research, you can read the full report Understanding the implementation of link workers in primary care in England. 

Other outputs from the research

Alongside the report, we have also produced from the study:

• Five papers – four based on the four concepts listed above and an opinion piece in the British Medical Journal. These academic articles are listed in the table below.
• A video about what social prescribing means, based on interviews we conducted with 61 patients who had engaged with a link worker.
• An infographic that summarises essential infrastructure-related factors to consider in primary care to ensure that link workers feel they belong and are making a useful contribution to patient care.

Journal articles produced that are associated with the study

• Tierney S et al. Experiences of integrating social prescribing link workers into primary care in England: Bolting on, fitting in or belonging.
• Tierney S et al. Patient buy-in to social prescribing through link workers as part of person-centred care: A realist evaluation.
• Tierney S et al. The consequences of micro-discretions and boundaries in the social prescribing link worker role in England: A realist evaluation.
• Westlake D et al. 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.
• Westlake D, Tierney S, Wong G, Mahtani KR. Social prescribing in the NHS—is it too soon to judge its value?

We would like to thank the patients and professionals who took part in the research, especially the seven link workers who acted as our study cases. We would also like to thank our patient-public involvement group, our study advisory group and the project’s steering committee; all played an essential role in helping us to produce the findings listed above.

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The study referred to in this blog was funded by a grant from the National Institute for Health and Care Research (NIHR130247). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care, or the authors’ host institution.