The review highlights that simply employing link workers within primary care will not necessarily magically reduce GP workload and increase patient benefits. The context in which link workers practice needs to be right. This includes acceptance from primary care staff that link workers can complement medical care, ensuring that patients understand how link workers might help them, and having a vibrant voluntary/community service to refer patients on to. Furthermore, link workers need appropriate training and support so they can help people to access relevant community assets and do not feel overwhelmed or isolated within this role.”
- Dr Stephanie Tierney
Link workers can help patients in primary care to develop a sense of belonging and confidence. They also act as an important source of advice and assistance, suggests research conducted by the Evidence Synthesis Working Group Service Redesign in Primary Care Workstream at the University of Oxford.
However, this is only likely to happen if patients, GPs and healthcare managers ‘buy-in’ to the link worker role and trust in the skills of the person undertaking it. There is evidence to indicate that in certain circumstances GPs are unclear about this role and that some patients feel they are being ‘fobbed off’ when referred to a link worker.
Social prescribing link workers are a key part of NHS England’s Long Term Plan to take pressure off GPs. They are employed to work with patients who have social, economic or environmental problems that affect how they feel. Link workers do this by connecting individuals to services and support in the community (e.g. groups, organisations, charities).
More and more link workers are being employed across GP practices in England to help address people’s ‘non-medical’ issues (e.g. loneliness, debt, housing problems). Funding for link workers is currently being channelled through the new GP contract.
The researchers, funded by the National Institute for Health Research, reviewed 118 documents to understand how, why and under what circumstances, patients can benefit from a link worker. Reviewed data suggested they should operate in an environment that allows connections to flourish. For example, link workers require time to spend with patients, so individuals feel listened to and open up about their unmet needs. The link worker can then propose community options that enable patients to develop other sources of support, aside from their GP.
Lead researcher, Dr Stephanie Tierney, stated: “The review highlights that simply employing link workers within primary care will not necessarily magically reduce GP workload and increase patient benefits. The context in which link workers practice needs to be right. This includes acceptance from primary care staff that link workers can complement medical care, ensuring that patients understand how link workers might help them, and having a vibrant voluntary/community service to refer patients on to. Furthermore, link workers need appropriate training and support so they can help people to access relevant community assets and do not feel overwhelmed or isolated within this role.”
Co-author, Dr Kamal Mahtani, a practicing GP and Associate Professor added: “Social prescribing is a consistent part of the NHS Long Term Plan, with link workers being key to facilitating patients to access this intervention. However, little evidence previously existed on how and why this service should be implemented in practice. Our research goes somewhere to supporting this, highlighting the need for patients and providers to ‘buy-in’ to the potential value of this new role.”
Dr Tierney and Dr Mahtani are based at the Centre for Evidence Based Medicine, Nuffield Department of Primary Health Sciences, University of Oxford. They are both members of the NIHR School for Primary Care Research Evidence Synthesis Working Group, a collaboration of 9 universities within England. Members of this group are developing a suite of reviews that address key issues facing primary care.
The authors have conducted their research with support from members of the public and have had discussions with NHS England about their findings.
Contact details: Dr Stephanie Tierney (stephanie.tierney@phc.ox.ac.uk) – 01865 289 324.
Publication
Supporting social prescribing in primary care by linking people to local assets: a realist review