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

Stephanie Tierney, Kamal R. Mahtani, Catherine Pope, Kerryn Husk, Beccy Baird, Tony Meacock, Sabi Redwood, Geoff Wong, Amadea Turk, Dr Caroline Mitchell, Jordan Gorenberg, Debra Westlake, Prof Joanne Reeve, Steven Markham

Smiling woman using laptop at kitchen table

Background:

Social prescribing supports people with problems that are not necessarily physical but can affect how they feel; things like loneliness, money worries and housing difficulties. Link workers help to deliver social prescribing in GP practices and elsewhere (e.g. community settings). They do this by assisting people to identify their ‘non-medical’ needs. They can then connect individuals to resources or activities in their local area that might help to address these needs (e.g. social groups, organisations that give advice on housing or debt, cultural activities). In the NHS in England, primary care has received funding to employ link workers. How the link worker role is set up and carried out varies across the country, and it is evolving in response to contextual changes such as the COVID-19 pandemic. We wanted to develop an in-depth understanding of the role to generate evidence-based recommendations on how to optimise the implementation of link workers in primary care. We were awarded funding from the National Institute for Health Research to explore this topic.

Research question:

When implementing link workers in primary care to sustain outcomes – what works, for whom, why and in what circumstances?

Study design: A realist evaluation, composed of two work packages (WPs), will be undertaken. It will build on a programme theory we developed from a previous realist review.

WP1 will explore the implementation of link workers in different settings. A purposive sample of 6 cases (link workers) within 6 sites (geographical areas) across England will be selected. Each case site will be examined in-depth for 3 months. Data collection will be in-person and remote (via Microsoft Teams or telephone). It will involve talking to link workers and people they work with (GPs, practice mangers, voluntary-community sector staff) and to patients.
WP2 will consist of follow-up semi-structured interviews with patients from WP1. These interviews will take place 9-12 months after the initial interview. The interviews will seek to understand how patients benefitted (or not) from seeing a link worker in the longer term.

Sample:

There will be approximately 102 participants involved across the 6 sites; 60 patients and 42 other participants (link workers, healthcare professionals and voluntary-community sector staff).