Many GP practices are exploring social prescribing, which is a way of linking patients to sources of support in the local community. Social prescribing addresses non-medical needs such as loneliness and financial difficulties. The NHS employs link workers to connect patients with local support networks. During the COVID-19 crisis, link workers may have an even greater role to play in supporting vulnerable patients who are isolated at home.
Researchers who are part of the NIHR Evidence Synthesis Working Group wanted to understand how these schemes work and in what circumstances they are most effective.
They found social prescribing schemes increase patients’ confidence, motivation and the skills to manage their own wellbeing. This may reduce their reliance on GPs. These positive outcomes were only achieved when patients, GPs and healthcare managers were clear about the value of social prescribing schemes and when link workers had sufficient time and resources to form a connection with patients, with the voluntary/community sector and with healthcare staff.
What’s the issue?
Many GPs report unmanageable workloads. But up to one in five patients seeing their doctor has difficulties which are not medical. These include poor housing, financial issues and loneliness. The question is whether the GP is best placed to deal with those concerns or if a different scheme might be more appropriate.
Social prescribing looks promising. Local agencies can refer patients to a link worker who takes a holistic approach to a person’s health and wellbeing. The link worker may suggest community groups, cultural activities or services which could provide emotional support.
The COVID-19 crisis is likely to lead to more patients reporting financial challenges, mental health problems and isolation. Good connections between primary care staff and link workers may be particularly necessary to help reduce additional GP workload and support vulnerable patients during this time.
The researchers reviewed 118 documents evaluating social prescribing schemes and the link worker role in the UK. Gathering this data included a search of bibliographic databases, Google alerts and Freedom of Information requests to all Clinical Commissioning Groups in England.
They found that link workers for social prescribing schemes can help patients in primary care develop a sense of belonging and confidence. These new-found skills could help them better manage their own well-being, reducing their reliance on the GP.
For schemes to thrive, link workers need to work in an environment that allows them to build a connection with the patient. That means having enough time to get to know the person, so the patient feels listened to and is able to fully open up about their unmet needs and concerns. It is important that the patient is referred to the most appropriate social prescribing options for them.
The researchers also found link workers need to have an extensive, up-to-date knowledge of local services and organisations that patients can access. This is particularly important during the pandemic as activities such as financial advice or befriending services may have to be delivered via telephone or video conference rather than face to face. Link workers will need to keep up to date with how different community assets are functioning in the current crisis.
Why is this important?
NHS England has produced guidelines for implementing social prescribing in primary care. These recommendations highlight the importance of link workers feeling supported in their role and developing the necessary skills. But this guidance may not go far enough. This research suggests more consideration of the time required to build a relationship between the link worker and patient. Additionally, GP practice staff and link workers should be supported to work together.
Social prescribing schemes are relatively new to the NHS and need the support of key stakeholders such as GPs, commissioners and primary care staff. Otherwise, patients may regard these services as a means of blocking them from seeing their doctor.
At the same time, healthcare professionals may see these schemes as a short-term gimmick, rather than something which could have value in the long term for both doctors and patients. This attitude should be challenged, especially as link workers have good knowledge of available community resources and how to access them during the COVID-19 pandemic. This role may provide support to patients in a difficult time.
Commissioners should explore how to optimise social prescribing in primary care and how to support connections between patients and link workers. Due to COVID-19, health and social care, and the voluntary/community sector, will have to learn to adapt to a new normal where face to face services may be limited. Research is needed into virtual social prescribing services and the circumstances in which they work best.
Further research projects should consider:
- the best ways to integrate link workers into primary care
- the most important skills required by link workers, including their requirements for training and support
- the role of volunteers in encouraging patients to use social prescribing
- the cost-effectiveness of social prescribing schemes
- the pros and cons of virtual community schemes
- how the link worker role should be amended during the COVID-19 crisis
You may be interested to read
The full paper: Tierney S et al. Supporting social prescribing in primary care by linking people to local assets: a realist review. BMC Medicine. 2020;18:49.
Bickerdike L and others. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017;7:e013384.
Drinkwater C and others. Social prescribing. BMJ. 2019;364:1285.
Funding: This review is part of a series of reviews being undertaken by the Evidence Synthesis Working Group, and is funded by the NIHR School for Primary Care Research.
Conflicts of Interest: None declared.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.