Fitting in or belonging: emerging findings from a realist evaluation of social prescribing link workers in primary care

BACKGROUND: Social prescribing link workers are being employed in primary care through the Additional Roles Reimbursement Scheme. AIM: To understand and explain how the link worker role is being implemented and sustained in primary care. METHOD: As part of a realist evaluation, we observed link workers in practices in different parts of England and interviewed patients and professionals. Data have been coded and are being developed into statements that explain how context interacts with mechanisms leading to intended and unintended outcomes. RESULTS: Our first work package (WP) involved data collection from seven sites in England. For this WP, we interviewed 61 patients and 94 professionals (link workers, GPs, and members of the voluntary-community sector). 'Boundaries' is a key concept within the data. It can describe whether and how link workers draw limits around their role. This can affect the breadth of their work, as they attempt to gain credibility and acceptance within a practice. Boundaries can shape how far link workers feel they belong rather than having to fit into a practice. This may shape their ability to support patients with their psychosocial needs. CONCLUSION: Dominance of a medical model approach to service delivery may not be conducive to uncovering and supporting people with their non-medical problems, or to promoting a wider understanding of health. Tensions between fitting into a setting dominated by medical discourse and practices, compared to feeling they belong, is something that link workers can encounter when providing social prescribing services in primary care.