Chantelle Fatania is a Consultant in Public Health at Haringey Council and a DPhil researcher at the University of Oxford. Her research examines leadership development for social prescribing link workers and comparable community-based roles through a global scoping review and empirical studies. The views expressed in this blog are her own and not necessarily those of her employer or academic institution.
Why It’s Time to Rethink Leadership for Social Prescribing Link Workers and Community-Based Roles
Health systems globally are investing in community-based roles to deliver prevention, reduce inequalities and improve population health. Whether known as social prescribing link workers, community health workers, care navigators, local area coordinators or community connectors, these practitioners form a diverse but increasingly significant workforce. Considerable attention has been devoted to expanding these roles and understanding their impact. Far less has been paid to the leadership required within them.
This is a striking gap. Leadership is frequently identified as important in policy, research and workforce development, and established health professions benefit from defined frameworks, development programmes and career pathways. For community-based practitioners, however, there remains little consensus about what leadership means or how it should be understood in practice. Leadership is acknowledged but rarely translated into a clear account of the capabilities these roles require.
My interest in this issue stems from both professional experience and academic inquiry. Before beginning my DPhil at the University of Oxford, I completed an MSc in Global Healthcare Leadership at this institution, where I explored how leadership theory has evolved in response to increasingly complex societal and healthcare challenges. Earlier in my public health career, I line managed a team of Local Area Coordinators, a community-based role sharing many characteristics with contemporary social prescribing, and I supported the model’s local expansion. These experiences exposed a disconnect between how leadership is discussed in theory and recognised in practice. Capabilities that would readily be identified as leadership in other professions were integral to the work but seldom named as such.
This observation led me to undertake a global scoping review examining leadership development for social prescribing link workers and comparable community-based roles; I am currently writing this up for publication. A notable evidence gap soon became apparent. I identified only a small number of relevant studies internationally, most concerning comparable roles rather than social prescribing link workers themselves. The literature I reviewed higlights that leadership is often presented as desirable without explaining how it develops, how practitioners experience it, or which approaches might support it effectively. Expectations of these roles are growing faster than our understanding of the leadership needed to fulfil them.
Why Traditional Leadership Frameworks Fall Short
Part of the difficulty may be that we have been looking for leadership in the wrong places. Traditional frameworks were largely developed within professional and organisational hierarchies. They commonly assume formal authority, designated positions and clear structures of accountability. Community-based practitioners often lead differently. They may have little positional power, but must still exercise judgement, build credibility and create alignment among people whose responsibilities and priorities do not neatly coincide. If leadership is defined primarily by seniority or control, these forms of influence will remain overlooked.
A micro, meso and macro lens offers a more useful way to understand this leadership. The distinction is not simply theoretical. It reflects how community-based practitioners work from day to day, moving between people’s immediate circumstances, local organisational relationships and wider system priorities. Leadership at these levels is interconnected; what is learned through individual relationships can reveal service gaps, shape partnerships and ultimately inform broader change. This framing makes visible both the range of leadership involved and the connections between its different forms.
Understanding Leadership at the Micro, Meso and Macro Levels
At the micro level, leadership is relational. Practitioners work alongside individuals facing interconnected health and social challenges, supporting them to identify priorities, exercise agency and pursue change on their own terms. This is not leadership based on instruction. It depends on trust, empathy, careful judgement and the ability to create the conditions in which another person can act.
At the meso level, leadership becomes organisational and collaborative. Practitioners work across professional and institutional boundaries, where fragmented provision, competing priorities and unclear responsibilities can impede progress. They connect people and organisations, create shared understanding and help partners move towards coordinated action. Because they seldom hold authority over those involved, their effectiveness depends on influence and buy-in to the role rather than control, a defining feature of leadership in complex systems.
At the macro level, community-based practitioners contribute to wider ambitions for prevention, health equity, community resilience and population health. Having a position close to communities gives them insight into how policy is experienced, where systems fail to connect and which assets remain underused. This means that they can do more than implement policy; they can inform it, challenge assumptions and help translate strategic ambitions into approaches that are meaningful within local contexts. Recognising this contribution is essential if community knowledge is to shape system change rather than simply respond to it.
Supporting Leadership Development for Link Workers
This multilevel perspective changes the central question. Rather than asking whether community-based practitioners are leaders, we should ask whether existing theories, frameworks and development opportunities reflect the leadership they need to exercise across these settings. My emerging view, informed by research and practice, is that they frequently do not. A model designed around formal organisational authority cannot fully account for leadership that is relational, boundary-spanning and rooted in communities.
The consequences are practical as well as conceptual. How leadership is defined determines whose capabilities are recognised, whose development is prioritised and whose contribution is valued. Without clearer articulation, leadership development risks being generic, inaccessible or disconnected from the realities of community-based practice. A more appropriate approach would begin with the distinctive conditions of the work and consider how practitioners can be supported to lead at each level, move effectively between them and understand themselves as legitimate contributors to change.
This also requires others to see them differently. Employers, policymakers, educators, researchers and established professionals must recognise that leadership does not begin only when someone acquires a management title. Community-based practitioners need the language and confidence to identify their own leadership, but recognition cannot rest solely on them. Systems must create opportunities for their knowledge to influence decisions, for their capabilities to develop and for leadership pathways to reflect the value of relational and community-grounded expertise.
The Future of Community-Based Leadership
The international relevance extends well beyond social prescribing or England. Health systems use different titles and delivery models, but many are strengthening community-based approaches in response to chronic disease, mental ill-health, social isolation and persistent inequalities. Their success will depend partly on practitioners who can connect lived experience with services, institutions and policy. Although context will shape how leadership is expressed, the need to understand and develop it is shared across settings.
As my global scoping review progresses towards publication, I hope it stimulates a wider conversation about what leadership means for these varied roles and who gets recognised as a leader. If prevention, community-centred care and population health are to realise their potential, leadership cannot remain confined to traditional hierarchies or established professions. We need an account of leadership that reflects the everyday movement between individuals, organisations and systems, and development approaches that equip practitioners to act across all three. The leadership is already being exercised. The task now is to define it more clearly, develop it purposefully and give it the place it deserves in the future of health and care.
