Improving the retention of social prescribing link workers in their role

Our research on the role of social prescribing link workers has highlighted that these employees face several challenges in their role. These challenges may include:

• Working across more than one practice
• Receiving more and more referrals to support
• Being presented with increasingly complex patient cases
• Not being invited to team meetings in primary care
• Lacking adequate supervision

This can have an impact on link workers in terms of burnout and a decision to quit their job. We wanted to understand this topic in more detail. Hence, we conducted an explanatory sequential mixed methods study to address the question: How do occupational self-efficacy and job discrepancy affect social prescribing link workers’ experiences of and intention to leave their role, and what can be done to support their retention?

The research involved collecting data via a questionnaire, which was completed by 342 link workers, from across the United Kingdom, at the end of 2023. Findings suggested that greater job discrepancy (the difference between what people believe a job will be like with what it is like in reality) was associated with people thinking about leaving their role in the past 6 months and the next 6 months. Lower occupational self-efficacy (confidence in being a link worker) was associated with people thinking about leaving their job in the past 6 months but not in the next 6 months. We followed the questionnaire, in 2024, with a series of qualitative interviews, undertaken with a subset of 20 questionnaire respondents.

What did interview data suggest about improving retention of link workers in their role?

Interview data from link workers suggested that having the following in place could help support them in their role and with retention.

• An alignment between job descriptions and what the role of a link worker actually entails (e.g. in terms of the emotional support they provide to patients, the severity/complexity of cases and the salary received) – we have produced a gallery of photographs, taken by link workers we interviewed, which provide a realistic insight into the role for those interested in an insider’s view of it
• A mixed caseload in terms of complexity of patient problems
• A responsive line manager, who builds confidence (which can be difficult if this individual is responsible for an increasingly large number of staff members)
• A peer support forum where they can exchange knowledge and experiences with colleagues (including via WhatsApp)
• A regular pattern of supervision to talk about patient cases and about the emotional toil the job can take day-to-day
• A supportive team in place within primary care
• A celebration of successes (e.g. a patient is rehoused or starts attending a group) – to help feel the job is making a difference to people’s lives
• A moment in the working week to reflect on what has happened in their job (positive and negative)
• An ability to access training that is not just mandatory but meets the individual needs of a link worker (e.g. in how to have conversations with people who have been bereaved, on young mental health)
• An opportunity to shadow primary care team members to understand their roles better
• A time set aside each week or at least each month to develop connections within the community (with groups or charities or services or activities that could form part of someone's social prescription)
• A greater sense of job security – rather than working to short-term contracts
• A chance to undertake career development and progression
• An appropriate space in primary care to see patients in and to discuss their difficult life circumstances (e.g. not in the waiting room or a room without natural light that feels like a broom cupboard)

Some people we interviewed did mention wanting tighter guidelines around what support they could and could not provide to patients; this relates to earlier research we produced on the discretion link workers have within their role. 

Further reading

Findings from the quantitative research have been published in the British Journal of General Practice Open. Findings from the qualitative research have been submitted to a journal and will hopefully be published later in 2025.

For further details about the research, please contact Stephanie Tierney who led the study (stephanie.tierney@phc.ox.ac.uk).

The study mentioned in this blog was 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.