Discussing factors that affect the retention of social prescribing link workers with our PPI group

Our study explores the challenges facing social prescribing link workers and their intention to quit their role. We are now in the process of analysing interviews we conducted with 20 link workers and identifying specific ways they describe why they are thinking of leaving or staying in their role.

PPI group meeting

Members of our PPI group were part of an earlier project on the link worker role in primary care in England. Five people attended our PPI meeting in July 2024, at which we talked about early findings from the interviews. First, we shared some anonymised extracts from the interviews and how link workers described their everyday work, and whether this aligned with their expectations, beliefs and values of the role or conversely when there were discrepancies and challenges associated with their work.

Discussing developing findings from the interviews

Discussion with the PPI group considered how interviewees described transitioning into the role to become a link worker; bringing past experiences from their previous work and building their confidence and knowledge through support from managers and colleagues. However, link workers we interviewed also described ambiguities and uncertainties related to their working environment; whether they were located in community settings or GP practices, how they were employed - through voluntary sector organisations or Primary Care Networks (PCNs), the inaccessibility of managers and when their role was misunderstood and they were given inappropriate patient/client referrals.

Discussing liminality

In the second part of our meeting, we discussed the concept of liminality. It originates from the social anthropologist Van Gennep (1960) who described the rites of passage or rituals of transition for individuals or groups (ancient practices at harvest time to New Year or during marriage ceremonies). Turner (1966) delineated this process of transitioning as the ‘betwixt and between’. He described ‘threshold people’ who slip through assigned networks of cultural spaces, remaining invisible or lacking a distinct identity (1969).

In our PPI meeting we applied the concept of liminality to the link worker role; interviewees described feeling stuck in the role, confused about where they belonged and what they should be doing. At this stage their identity as a link worker faltered and this pushed them into a liminal state. Yet our data suggested that they can transition out of this state with support from managers, colleagues and training. They are then able to cope with uncertainty (e.g. complex patient/client referrals) or disruption to their work setting or role.

Our PPI group felt that this idea of liminality associated with the link worker role made sense and was a good way to depict the ‘betwixt and between’ state that interviewees described. We discussed how some link workers stayed stuck in this liminal state whilst others passed through this confused, ambiguous state to create a clear role for themselves that enabled them to play to their strengths. They can then feel good about their work and their sense of self and identity.

Members of the PPI group developed the diagram shown at the bottom of this page to reflect this idea of link workers inhabiting a liminal state upon entry into the role. They felt that moving out of this liminal state put link workers in a position to cope with uncertainty (e.g. what patients will present with) and disruptions in their work setting. One of the group said this reminded her of a dragonfly, which will spend a lot of its time hovering and darting in all directions and then, with luck, get to a safe landing – however, this is not necessarily the case.

The PPI group members suggested it may help to develop a management tool to support staff responsible for supervising link workers and to emphasise the importance of peer and other support systems. This could highlight to new link workers that they may feel confusion, ambiguity and uncertainty but they can get through this stage and move on from those feelings to a realistic perspective of their role.

The study mentioned in this blog is funded by a grant from NIHR School for Primary Care Research (Award 678). The views expressed are those of the author and not necessarily those of the funder or the author’s host institution.