Observing the social prescribing link worker role: reflections from the front line

The study

Our research aims to answer the question: When implementing link workers in primary care to sustain outcomes – what works, for whom, why and in what circumstances? We will explore and compare how social prescribing link workers do their job at six different GP surgeries throughout the country. Details of this study were reported in a previous blog. Here, researcher Debra Westlake reflects on the first stages of data collection (which started in November 2021) for this study.

Reflections

I live in rural Devon and, because of the pandemic, have worked from my front room for 18 months so it was with much anticipation that I embarked on some ‘live’ field work at a GP practice in a large suburban housing estate adjacent to a major city. Pre-planning was essential to ensure that the field work was executed smoothly at a time of growing pressure on general practice due to the pandemic. When setting the date to start at the surgery, we did not realise that we had hit on a window of opportunity to collect data; a few weeks later a further wave of infections led to more restrictions and it is likely I would not have been able to carry out the work in person.

I decided to base myself in a bed and breakfast near the GP practice to understand the area better and see what it had to offer its residents. This turned out to be really helpful: not only because I was allocated the gold painted ‘royal’ room, usually reserved for tourists who are fans of the British monarchy, but also because I quickly picked up on local issues. These included a lack of community meeting areas and safe green spaces. Poor provision of public transport was also a problem, with a lack of connection to the much wider metropolitan offers of the city in terms of arts and culture.

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The doctors’ surgery was an important focus for the community and somewhere that the link worker felt was a safe space for their clients. However, it did seem incongruous to observe the link worker sitting in a clinical room, behind a desk, surrounded by medical supplies and an examination couch to talk about social problems. That said, there were few face-to-face consultations with the link worker, unless specifically requested; most interactions between a patient and the link worker were conducted by telephone. Some patients were glad they did not have to travel to the surgery and take time out of the working day, but others wanted the social contact and felt freer to speak in person as they did not have a space to talk confidentially where they lived.

The link worker, voluntary sector and practice staff - including doctors and other health care practitioners - were helpful and welcoming (as well as being very much converts to social prescribing). I was able to carry out a total of 14 practitioner interviews, as well as five patient interviews. I managed to conduct six observations of link worker appointments with patients. I also attended peer support meetings that were run for link workers in the area. These meetings were really interesting as I could compare the backgrounds and interests of different link workers and the type of work they did at different GP practices.

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I was surprised at the variety of difficult issues that the link worker had to deal with during their conversations with patients – including harrowing examples of racial and domestic abuse, drug and alcohol dependency and extreme poverty including homelessness and limited access to food. It was interesting that patients were broadly supportive of social prescribing and found the link worker empathetic and helpful. However, these patients had not heard of social prescribing prior to being referred and even after a few sessions were not very clear about what it really was or how you gained access to referral.

Field work was a really interesting experience, thanks to the permission to observe from patients, and the support of the link worker, their employing organisation and the GP practice; I thoroughly enjoyed my three weeks in their company. I am now looking forward to analysis meetings in which we will start to unravel some of the meanings in the rich data I collected at this first site. I then plan to collect further data at different practices later in the year – COVID restrictions permitting.

If you would like to know more about our project, or have any comments you would like to share, we very much look forward to hearing from you.

Study leads: 

Stephanie Tierney - stephanie.tierney@phc.ox.ac.uk

Kamal Mahtani - kamal.mahtani@phc.ox.ac.uk

About the author

Debra Westlake - debra.westlake@phc.ox.ac.uk

Debra Westlake is an applied health services researcher at the Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford. She specialises in research on person centred care and social prescribing and is interested in developing involvement of members of the public and practitioners in co-designing and interpreting research.

This research is funded by a grant from the National Institute for Health Research (NIHR130247). The views expressed are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care, or their host institution.