As the social prescribing workforce is expanding in primary care, Dr Pipin Singh explains why the role is valuable for PCNs and how to make it work for your practice and patients
Why take on social prescribing link workers?
We have seen a big increase in austerity, childhood poverty and social deprivation over the past 10 years. It is widely recognised that a significant percentage of GP consultations are due to social problems such as housing, financial and employment issues.
Social prescribing allows patients to be directed down a path that takes into account all these social factors and formulate a holistic plan with the patient that can also have a positive impact on their physical and mental health, as well as their role in society.
NHS England’s winter plan, released in August 2022 announced the ‘rapid recruitment’ of up to 2,000 additional social prescribing link workers, health coaches and care coordinators.
Quarterly figures, published by NHS Digital in August showed that the number of social prescribing link workers hired through the ARRS grew by 135 in three months to bring the total to 2,662. This was the second largest increase after advanced practitioner hires.
Funding for social prescribing link workers was introduced in 2019 in the new five-year contract framework for general practice. This allowed each primay care network (PCN) to employ a link worker with full costs reimbursed.
The salaries are defined in line with the NHS Agenda for Change scale, with a social prescribing link worker for 2022/2023 paid ‘up to band 5’ with total costs of £36,428 reimbursable via the ARRS.
What are requirements of the role?
The social prescriber has to work within a GP practice and, with the help of clinicians and the administrative team, identify those who would benefit from a holistic overview of their care.
They should work within the MDT providing psychosocial interventions to patients such as setting goals, signposting to other organisations, agenda setting and setting boundaries and promotion of self-management.
They should be trained in promoting motivational change and recognise the stages of change that patients go through.
They also need to be empathetic, sensitive to patient needs and have good communication skills in order to extract information that will help manage the patient. They should be trained in safeguarding and be alert to information that may need to be passed back to the primary care team or escalated to the appropriate agency.
A social prescriber would also need to be knowledgeable of the area that they serve, work well within the primary care team and be comfortable attending meetings and sharing information as needed.
NHS England sets out the minimum requirements for a Social Prescribing Link Worker employed by PCNs in the NHS England Network Contract DES service specification.
What are the potential benefits?
Evidence on social prescribing is mixed. A recent study published in BMJ Open looked at the effectiveness and costs of the link worker model of social prescribing internationally. It looked at eight studies involving 6,500 people. Of the four studies reporting on primary healthcare use, one reported a reduction in primary care attendance in the intervention group. Of the remainder, two found no evidence of a change in use, while one US-based study found that attendance increased.
There is increasing evidence, however, that social prescribing does get people back into the workplace and improves mental health.[2,3]
The main expected benefits of social prescribing for patients can be summarised as:
- Assists with continuity of care
- Allows more time to address the social factors contributing to health problems
- Improves mental health, self-esteem and self confidence
- Leads to greater empowerment
- Can support with return to work (both through better self-care and practical help, such as with job applications)
- Improves physical health
- Increases motivation and thus engagement
- Can foster greater social inclusion.
As described above the evidence for any impact on healthcare use is mixed, but from my own experience and anecdotal reports, assigning a regular link worker to a complex patient with multiple chronic physical comorbidities and social needs results in the patient becoming more empowered and they are less likely to attend out-of-hours services and the GP surgery for problems related to their conditions.
Getting the best out of your link worker
Help them to help you. It is vital to invite your social prescribing link worker to regular MDT meetings. This is the best way for them to identify patients they can help. This will also help the social prescriber identify what other agencies are involved and whether their involvement may duplicate work or cause extra steps or inconvenience for patients.
Encourage regular communication. Presence at team meetings also encourages sharing of information and the likelihood that the service will be used, as it helps other healthcare professionals within the team identify needs and potential support available. It will also enhance relationships with other team members and break down any potential barriers to communication.
If you do not have a regular MDT, ensure you introduce the link worker to your team or directly to individual team members. It is really important all your team are aware that there is a link worker available, particularly any care navigators whose roles may partly overlap.
Co-ordinate with PCN colleagues. It is important to co-ordinate with other member practices where link workers are employed across a PCN. For example, if MDTs at different practices are held the same day, a link worker could be invited at least once a month, or where there are multiple link workers you can assign them to different practices.
A regular (monthly) newsletter via email, highlighting some positive outcome case examples, is also useful to keep up their profile, and share knowledge and information about the service.
Have clear referral pathways. This can be through email, task or referral form. It is also important to have a clear and formalised process by which the link worker can communicate back to the referring clinician easily. Also remember when referring to use the code ‘referred to social prescribing service’.
Make sure they feel supported. Some concerns have been raised about social prescribing link workers feeling undervalued and lacking support in their new roles in PCNs. One survey conducted in summer 2020 found 30% of link workers were considering quitting due to a lack of clinical supervision and/or support – most of them based in general practice.
I suspect much of this is likely down to poor understanding of the support and skill they can provide, such that teams are not referring patients appropriately. As outlined above, it is vital your link workers are invited to MDT meetings and kept in touch with the rest of the team.
This is all the more crucial at a time where face to face meetings are restricted. With the ongoing pandemic, practices need to come up with innovative ideas for integrating their allied healthcare professionals like social prescribers into the team.
It may not be necessary to have a formal supervision process, but it is important your link workers have a clinician they can speak to, or the practice manager, to discuss any queries or concerns. In addition, encourage link workers within a PCN to meet regularly to discuss cases and support each other – this could involve a group on social media, such as Facebook, WhatsApp or Twitter.
You could also encourage them to join an organisation such as the National Association for Link Workers, to network with other social prescribers to share experience, knowledge and training opportunities.
Dr Pipin Singh is a GP partner and trainer in Wallsend, Tyne and Wear
References
1. The King’s Fund. What is social prescribing? Originally published February 2017; updated November 2020. https://www.kingsfund.org.uk/publications/social-prescribing
2. Chatterjee HJ et al. Non-clinical community interventions: a systematised review of social prescribing schemes. Arts and Health 2018; 10: 97-123
3. Public Health England. Effectiveness of social prescribing. An evidence synthesis. Published July 2019
Further resources
National Association of Link Workers
NHS England. Social prescribing FAQs
NHS England. Supporting link workers in primary care networks
Health Education England. Accredited online training for social prescribing link workers
