Skip to main content

Research Repository

Advanced Search

“She’s been a rock”: the function and importance of ‘holding’ by social prescribing link workers in primary care in England: findings from a realist evaluation.

Westlake, Debra; Wong, Geoffrey; Markham, Steven; Turk, Amadea; Gorenberg, Jordan; Pope, Catherine; Reeve, Joanne; Mitchell, Caroline; Husk, Kerryn; Redwood, Sabi; Meacock, Anthony; Mahtani, Kamal R.; Tierney, Stephanie


Debra Westlake

Geoffrey Wong

Steven Markham

Amadea Turk

Jordan Gorenberg

Catherine Pope

Caroline Mitchell

Kerryn Husk

Sabi Redwood

Anthony Meacock

Kamal R. Mahtani

Stephanie Tierney


Social prescribing link workers are new roles in English primary care. One of their intended functions is to address the increasing number of patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their non-medical needs. However, our research reveals that link workers provide not only connections, but also what we have described as ‘holding’ for patients who have complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context and its consequences.
As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a three-week period. We took field notes and interviewed 61 patients and 93 healthcare professionals. Nine to twelve months later we carried out follow-up interviews with 41 patients, seven link workers and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients’ distress. Holding appears to be a vital, but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become over-burdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers' primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support for them should be prioritized to ensure successful implementation and positive outcomes for patients, link workers and primary healthcare.


Westlake, D., Wong, G., Markham, S., Turk, A., Gorenberg, J., Pope, C., Reeve, J., Mitchell, C., Husk, K., Redwood, S., Meacock, A., Mahtani, K. R., & Tierney, S. (2024). “She’s been a rock”: the function and importance of ‘holding’ by social prescribing link workers in primary care in England: findings from a realist evaluation. Health and Social Care in the Community, Article 2479543.

Journal Article Type Article
Acceptance Date May 2, 2024
Online Publication Date Jun 21, 2024
Publication Date Jun 21, 2024
Deposit Date Jun 23, 2024
Publicly Available Date Jun 28, 2024
Journal Health and Social Care in the Community
Print ISSN 0966-0410
Publisher Wiley
Peer Reviewed Peer Reviewed
Article Number 2479543
Public URL


Published article (720 Kb)

Publisher Licence URL

Copyright Statement
Copyright © 2024 Debra Westlake et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

You might also like

Downloadable Citations