Social Prescribing Link Workers Feel ‘Bolted-On’: Study

Social prescribing link workers often feel isolated and lack a sense of belonging, according to research led by the University of Oxford. 

Working in primary care settings across England, link workers address non-medical factors affecting patient health. They connect patients to services such as community groups and housing support, helping to ease pressure on GPs. 

Social prescribing is part of the NHS Long Term Plan and an important part of delivering universal personalised care. The 2019 GP contract enabled social prescribing link workers to be employed and funded in primary care networks (PCNs). By 2023, more than 3600 had been appointed, according to the National Academy for Social Prescribing. NHS England has estimated that this will rise to 9000 by 2036-2037.

“Generally, patient feedback on link workers is very positive,” according to Azeem Majeed, professor of primary care and public health at Imperial College London. “Patients appreciate the time, empathy, and practical support they receive,” he told Medscape News UK.

Workplace Isolation

Despite their generally positive public reception, the new research, published in the British Journal of General Practice, highlighted tensions that could lead to link workers feeling isolated and overwhelmed, potentially prompting them consider leaving their jobs.

“Our analysis highlights the need for a whole-system approach to defining, delivering, and maintaining this new part of practice,” the study authors concluded. 

The researchers built focused ethnographies with seven link workers from different areas of England. They interviewed 61 patients and 93 professionals, including link workers, GPs, care coordinators, reception staff, and allied health professionals. This process yielded a continuum  reflecting how well link workers were integrated into primary care. 

“At one end of the continuum, link workers are ‘bolted on’ – brought into primary care without consideration of how the role will work alongside existing provision, how their skills and knowledge will be used, or what additional support and training they require,” the authors wrote. 

The second point on the continuum is termed ‘fitting in’. Here, some structure exists, yet link workers still feel their roles are misunderstood and under-appreciated. The final stage, ‘belonging’, sees practices collaborating with link workers, who in turn feel they are making a positive contribution to primary care. 

Vague Job Descriptions 

Among the key challenges for link workers identified in the study were difficulties in forging an identity in the workplace owing to vague job descriptions, stakeholders’ lack of understanding of their role, and a lack of professional qualification. 

A social prescribing link worker in Cambridgeshire, who asked to remain anonymous, told Medscape News UK: “There is no one job description across the board, causing frustration and worse between primary care networks, when one PCN will do one thing and the others refuse to.” 

She added that a lack of understanding of the role across stakeholders resulted in GPs making inappropriate referrals, and patients expecting them to authorise repeat prescriptions of medications, which is out of their job scope. 

She called for “a national job description” and “better communication and understanding from GPs and other agencies” to address these issues. 

Supervision and Guidance

Centralising or defusing power emerged as a key issue. The study noted that link workers often feel uncertain about where to seek supervision and guidance. They may be funded by PCNs but employed by voluntary, community and social enterprise (VCSE) organisations. 

This lack of centralisation leaves link workers feeling caught between organisations with different expectations and requirements, according to the researchers’ field notes.

Tracking success was identified as another major challenge. Although collecting data is vital for improving service quality and demonstrating the value of social prescribing, the study found these systems were inadequate.

The researchers recommended “a feedback loop” so that GPs could appreciate the contribution made to patient care by link workers. Also, data collected should be “regarded as relevant by link workers to the assistance they give to patients”.

Being Part of a Team

A lack of team building, such as not being invited to multidisciplinary meetings, was also frequently mentioned across interviews.

“The link worker role is relational and relies on a strong, positive rapport between key stakeholders. […] This should be a two-way process, with practices taking steps to ensure that link workers feel welcomed and supported in primary care,” the researchers wrote.

The study found that link workers reported varying levels of readiness to integrate their services across different sites. Some recalled having to set up social prescribing provisions on their own. 

While the study did not directly address funding and resource issues, it highlighted the need for a robust VCSE sector for patient referrals.

Shorna, a social prescribing link worker in London, told Medscape News UK that a major challenge for her was “the limited availability of community services”. “There are significant gaps in the provision of essential support services, limiting the options available to patients,” she noted. 

Better funding “would enable us to signpost and refer individuals to a broader range of support options,” Shorna added. 

Recommendations

Majeed recommended several initiatives to improve link workers’ effectiveness and job satisfaction. He noted that standardised training programmes and qualifications could enhance their professional identity and ensure consistent service quality. He also urged the establishment of peer networks to help link workers share experiences, best practices and access supervision, along with more opportunities for career development. 

Majeed stressed that contextual factors are key. “Active support and referrals from GPs and other members of the primary care team are crucial, [alongside] a good understanding of local community resources is essential for effective referrals,” he said.

“Regular supervision and support from managers are vital,” Majeed said. “To apply these factors more uniformly, national guidance and best practice sharing across the UK are needed. This could involve developing toolkits, organising workshops, and creating online platforms for sharing resources and experiences,” he added. 

None of the contributors to this article disclosed any relevant financial relationships. 

Annie Lennon is a medical journalist. Her writing appears on Medscape, Medical News Today, and Psych Central, among other outlets.