Supporting social prescribing in primary care by linking people to local assets: a realist review

Background context:

Social prescribing link workers are a key part of NHS England’s aim to deliver personalised care. Their long-term plan states that by 2023/24, at least 900,000 people will be referred to social prescribing. Link workers are employed to support patients with social, economic or environmental problems that can affect how they feel physically and psychologically. They 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).

Our research

To understand how link workers work, for whom, why and in what circumstances, we conducted a realist review. Reviewing the evidence on this type of service was warranted given the prominence and recent investment in link workers within the NHS, and the introduction of similar roles in other countries.

Key findings:

The review found that link workers can help patients in primary care to develop a sense of belonging and confidence, and to develop sources of advice and assistance. 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. Reviewed data also suggested that link workers 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 can open up about their unmet needs. The link worker is then able to propose community options that enable patients to develop other sources of support, aside from their GP.

Impact:

The study has been developed into an alert by NIHR (https://evidence.nihr.ac.uk/alert/social-prescribing-could-empower-patients-to-address-non-medical-problems-in-their-lives/). We have also been talking about the research with NHS England and the RCGP. 

“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.” 

Lead researcher, Dr Stephanie Tierney

Further reading:

Supporting social prescribing in primary care by linking people to local assets: a realist review