Experiences of integrating social prescribing link workers into primary care in England — bolting on, fitting in, or belonging: a realist evaluation

Tierney, Stephanie; Westlake, Debra; Wong, Geoffrey; Turk, Amadea; Markham, Steven; Gorenberg, Jordan; Reeve, Joanne; Mitchell, Caroline; Husk, Kerryn; Redwood, Sabi; Pope, Catherine; Baird, Beccy; Mahtani, Kamal Ram

Abstract

Background Following the 2019 NHS Long Term Plan, link workers have been employed across primary care in England to deliver social prescribing. Aim To understand and explain how the link worker role is being implemented in primary care in England. Design and setting This was a realist evaluation undertaken in England, focusing on link workers based in primary care. Method The study used focused ethnographies around seven link workers from different parts of England. As part of this, we interviewed 61 patients and 93 professionals from health care and the voluntary, community, and social enterprise sector. We reinterviewed 41 patients, seven link workers, and a link worker manager 9–12 months after their first interview. Results We developed four concepts from the codes developed during the project on the topic around how link workers are integrated (or not) within primary care: (or not) within primary care: centralising or diffusing power; forging an identity in general practice; demonstrating effect; and building a facilitative infrastructure. These concepts informed the development of a programme theory around a continuum of integration of link workers into primary care — from being ‘bolted on’ to existing provision, without much consideration, to ‘fitting in’, shaping what is delivered to be accommodating, through to ‘belonging’, whereby they are accepted as a legitimate source of support, making a valued contribution to patients’ broader wellbeing. Conclusion Social prescribing was introduced into primary care to promote greater attention to the full range of factors affecting patients’ health and wellbeing, beyond biomedicine. For that to happen, our analysis highlights the need for a whole-system approach to defining, delivering, and maintaining this new part of practice.

Citation

Tierney, S., Westlake, D., Wong, G., Turk, A., Markham, S., Gorenberg, J., Reeve, J., Mitchell, C., Husk, K., Redwood, S., Pope, C., Baird, B., & Mahtani, K. R. (2025). Experiences of integrating social prescribing link workers into primary care in England — bolting on, fitting in, or belonging: a realist evaluation. The British journal of general practice : the journal of the Royal College of General Practitioners, 75(752), e195-e202. https://doi.org/10.3399/BJGP.2024.0279

• Journal Article Type: Article
• Acceptance Date: Aug 7, 2024
• Online Publication Date: Jan 27, 2025
• Publication Date: Mar 1, 2025
• Deposit Date: Aug 12, 2024
• Publicly Available Date: Jan 28, 2025
• Journal: British Journal of General Practice
• Print ISSN: 0960-1643
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Volume: 75
• Issue: 752
• Pages: e195-e202
• DOI: https://doi.org/10.3399/BJGP.2024.0279
• Public URL: https://hull-repository.worktribe.com/output/4664303