Understanding the implementation of link workers in primary care: A realist evaluation to inform current and future policy

People’s health and well-being can be affected by many things, some of which may be ‘non-medical’; they may be social (e.g. loneliness), economic (e.g. debt or unemployment) and environmental (e.g. poor housing). Social prescribing has been introduced into the NHS to support patients with ‘non-medical’ problems that affect how they feel physically and mentally. People called link workers are being employed to help deliver social prescribing. They may be known by other titles, depending on where you live, like ‘community navigator’ or ‘well-being connector.’ They have time to talk with someone to find out about their health and well-being goals. They can then connect people to local groups, organisations, activities and charities that can help (e.g. a luncheon club, Citizen’s Advice, an exercise group).

The voluntary sector has an important role in providing activities for link workers to connect people to, along with cultural organisations like libraries, galleries and museums. This connecting work has been happening for a number of years in voluntary organisations, like charities, and the community but is quite new in GP surgeries. We have been funded by the National Institute for Health Research (NIHR) to explore how the link worker role is being delivered in primary care and how it is being used to support patients. 

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 link workers do their job at six different ‘sites’ throughout the country. These sites will be doctors’ surgeries in different parts of England. We will shadow a link worker for three weeks and interview patients, GPs, nurses and other practice staff about the link worker role. This will help us to build a complete picture of what the link worker does, how they do it and what patients and other healthcare staff feel about it. We will also collect some data about what might happen as a result of someone seeing a link worker – what activities patients go on to do and whether the link worker and the activities might make a difference to how they feel.

A protocol for the study can be found at Research Registry. 

Progress so far

We have successfully gained ethical approval to complete the study, which includes observing link workers, talking to patients and looking at data collected by the surgeries involved about social prescribing.

We have made contact with several link workers and GPs who are keen for us to do the research in their surgery and are completing the paperwork that allows us to do this.

The researchers are making plans for their visits to sites and gathering together all the materials we will need to start data collection. Fieldwork will commence in November 2021.

Who is involved in this study?

The study is being led by Stephanie Tierney and Kamal Mahtani. Researchers on the study are Amadea Turk, Jordan Gorenberg and Debra Westlake. There is also a wider project team (see box) who bring a range of expertise and knowledge to the project. For this first blog post, we would like to introduce our patient and public involvement (PPI) contributor Tony Meacock. We asked Tony why he wanted to be involved in this study and what interests him about social prescribing. 

Tony very much enjoyed working with Stephanie and Kamal on a previous project about the role of gardens, libraries and museums in social prescribing and respects their work. When Stephanie suggested he join the team on this study he was keen to be involved. He emphasises that he is a socially aware person who believes social prescribing can have health benefits for people in improving their self-care and confidence, and increasing their social contact. He saw the impact community activities had for his mother who was introduced to a ‘forget-me not’ dementia group by a voluntary sector organisation; it was a ‘turning point’.

He says the group ‘rebuilt her confidence and increased her engagement with society and with me’. But he cautions the research team to realise that many health care providers and citizens are not aware of what social prescribing is and what it can do. This is where he most wants to make a contribution, using his experience of working in business and the voluntary sector to bring focus on the ‘real world’ into our study. He emphasises the urgency of clarifying the link worker role and purpose so that the window of opportunity to make this shift into social solutions is not closed. He hopes the study will make focussed recommendations on how best to introduce link worker roles and is keen to offer his support to the research team to sort out some of the ‘messiness’ of social prescribing: ‘if we can unpick the bowl of spaghetti and make it into lasagne [..] it will be well worth it.’

Contact us

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. Please contact one of the following, who all work at the Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford.

Debra Westlake is a Health Services Researcher. 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. debra.westlake@phc.ox.ac.uk

Stephanie Tierney is a Departmental Lecturer and Senior Researcher. She co-leads a network of academics, clinicians, providers, policy makers and members of the public with an interest in social prescribing. stephanie.tierney@phc.ox.ac.uk

Kamal R. Mahtani is a GP and Associate Professor. He co-leads a programme of work to build the evidence base to support the redesign of primary care services including building the evidence base for social prescribing. kamal.mahtani@phc.ox.ac.uk

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.