Abstract
Background: Social prescribing addresses non-medical factors affecting health and well-being. Link workers are
key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise
sector. Funding from the National Health Service means that link workers are becoming a common part of primary
care in England.
Objective: To explore and understand the implementation of link workers in primary care in England.
Design: A realist evaluation addressed the question – When implementing link workers in primary care to sustain
outcomes – what works, for whom, why and in what circumstances?
Setting: Link workers and staff associated with seven primary care sites across England.
Methods: Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact
with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition,
interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise
representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients
and with link workers 9–12 months later. Data were coded and developed into statements to identify how context
around the link worker triggers mechanisms that lead to intended and unintended outcomes.
Results: We found that link workers exercise micro-discretions in their role – actions and advice-giving based on
personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted
that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and
social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported
delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could
place link workers at risk of overstepping their remit.
Limitations: Our research focused on link workers attached to primary care; findings may not be applicable to
those working in other settings. Data were collected around seven link worker cases, who were selected purposively
for variation in terms of geographical spread and how/by whom link workers were employed. However, these link
workers were predominately white females.
Conclusions: Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient
needs but can result in uncertainty and to link workers feeling overstretched.
key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise
sector. Funding from the National Health Service means that link workers are becoming a common part of primary
care in England.
Objective: To explore and understand the implementation of link workers in primary care in England.
Design: A realist evaluation addressed the question – When implementing link workers in primary care to sustain
outcomes – what works, for whom, why and in what circumstances?
Setting: Link workers and staff associated with seven primary care sites across England.
Methods: Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact
with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition,
interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise
representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients
and with link workers 9–12 months later. Data were coded and developed into statements to identify how context
around the link worker triggers mechanisms that lead to intended and unintended outcomes.
Results: We found that link workers exercise micro-discretions in their role – actions and advice-giving based on
personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted
that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and
social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported
delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could
place link workers at risk of overstepping their remit.
Limitations: Our research focused on link workers attached to primary care; findings may not be applicable to
those working in other settings. Data were collected around seven link worker cases, who were selected purposively
for variation in terms of geographical spread and how/by whom link workers were employed. However, these link
workers were predominately white females.
Conclusions: Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient
needs but can result in uncertainty and to link workers feeling overstretched.
| Original language | English |
|---|---|
| Journal | Health Services and Delivery Research |
| DOIs | |
| Publication status | Published - 11 Sept 2024 |