Talking about the research with stakeholders: Our third knowledge exchange meeting

As we come to the closing stages of our link worker implementation study, we are talking to people about what we have found. This has included running three in-person knowledge exchange events in different parts of England. The final one of these took place in November 2023 in Sheffield.

We started the meeting with lunch, which gave those present the opportunity to network and meet with other people delivering, running or researching social prescribing. We also welcomed three members of the public who shared their views during the event.

After providing an overview of what the study involved, I presented two key concepts - holding and discretion - that our research team has developed from the data we have collected over the past two years. 

Holding

We talked about how our data suggested that link workers often offer prolonged support to people or act as a container for their emotions; engaging with patients without a particular goal or without necessarily connecting them to other services. In these cases, link workers can be seen as an intervention. Those present were invited to discuss, in small groups, the implications of holding from link workers for various stakeholders in social prescribing. A range of positive and negative consequences were raised, which are displayed in the table below.

Discretion

The idea of how much discretion link workers had in their role, to act according to their judgement of different situations, was the second concept from the research covered in the meeting. Discretion means the flexibility people have to make decisions. It relates to the idea of boundaries, which can curtail what people are able to do. In small groups, those present were invited to discuss how much discretion they felt link workers should have within specific aspects of their role. Differing views were expressed in how long it was felt that link workers should be supporting patients for; this was seen as variable depending on the range and complexity of problems that needed to be addressed. Variation was also expressed about where patients should be seen. Some link workers at the meeting said they saw people at home, which enabled them to pick up issues that might not otherwise have come to light. However, this could mean going out in pairs. Not all link workers present had the flexibility to choose where to see patients and had to see them in a clinical setting.  

Discretion around training was debated. It was noted that link workers need to undertake specific, mandatory training but then other training should be shaped by an individual link worker’s knowledge or skills gaps and the type of problems they encountered on a regular basis based on patients seen. In terms of referrals, it was suggested that if a link worker was part of a specific service (e.g. working with a cardiovascular or diabetes service) or a specialist link worker (e.g. working with children or with people with a learning disability), this reduced the discretion they had around referrals. Some of those present said they co-produced referral criteria with primary care staff to help reduce inappropriate referrals. 

End comments

The meeting was a great opportunity to garner views and comments around our emerging thoughts on the data we have collected from people working in the field of social prescribing and from patients. It was reassuring that those present felt that these concepts - holding and discretion - resonated with their experiences. Those attending had the opportunity to provide some feedback on the event. They were positive about having the time and space to reflect and discuss what link workers do in primary care. The following is a selection of their comments.

The link worker study mentioned in this blog is funded by a grant from the National Institute for Health and Care Research (NIHR130247). The views expressed are those of the author and not necessarily those of the NIHR, the Department of Health and Social Care, or the author’s host institution.