Social prescribing is the referral of patients to non-clinical treatments – often for mental health needs and long-term health conditions. In 2019, the NHS Long Term Plan embedded the role of link workers to coordinate and refer patients from Primary Care Networks. But are the right areas getting the support they need – and how sustainable is social prescribing for both primary care and VCSE organisations? Here, Paul Wilson discusses the rollout of the link worker programme, and what is needed from policymakers to ensure the longevity of social prescribing.

• Referrals are made through GPs to link workers, who connect patients in primary care with sources of support within the community.
• Research has found fewer link workers in areas with the highest need – generally urban and deprived communities of lower socio-economic status.
• Public health policymakers at local, national, and regional levels must ensure link worker recruitment is targeted where it can have the greatest impact.
• There is also a need to comprehensively map, fund, and integrate VCSE organisations into primary care, to ensure the sustainability of social prescribing.

Link workers are non-clinical staff who, over several sessions, work with people referred from primary care (and other routes) to identify the issues that affect an individual’s health and wellbeing. Depending on need, link workers can then refer people on to a range of services such as legal and benefits advice, outdoor and physical activities, volunteering, or social support.

Although many social prescribing services predate the 2019 NHS Long Term Plan, the policy funded a rapid expansion of link worker provision across England. The goal was to ensure that every person in England could access a social prescribing service through their GP practice, facilitated by the introduction of 1,000 new roles to work across groups of GP practices known as primary care networks (PCNs).

What impact is social prescribing having?

We have a good understanding of how the link worker role could work to support access and engagement with community-based services. Research at The University of Manchester has previously shown that engagement with community-based activities, groups and services can improve health and well-being. This is particularly true for those on low income, with lower educational attainment, and who live alone or with no children. However, we also know that not all people who are referred actually go on to engage with support and activities provided in the community. We do not know how people become engaged, or if the link worker model promotes engagement or enhances access and equity.

To address this gap, The University of Manchester is leading a national team to evaluate the impact of the national roll out of social prescribing link-workers. We are looking at how link worker services are organised and delivered, who does and doesn’t get referred, and with what effect. The policy evaluation is funded by NIHR and will run until March 2025.

So far, our work has focused on the impact of expansion of link worker provision. We have combined workforce, population, survey, and area-level data to assess if rollout reflected need. We found that the areas with highest need have had lower resource allocation, with regard to both the number of link workers employed in that area, and the community-based services to refer people to. The areas with the largest disparity between need and resource allocation were more deprived and urban areas, typically in the North West and London.

Also notable was the lack of support reported in PCNs with larger proportions of patients of Black and Asian ethnicity. These PCNs reported higher rates of patients who said they receive “no support” from local services. This emphasises the need for a more targeted approach to future expansion of the workforce, achieved through better understanding of local PCN needs and the barriers to employing link workers. Given their intended role in meeting place-based health and care needs, the 42 Integrated Care Systems in England should coordinate with PCNs to identify which areas would most benefit from additional link workers, and direct funding and resources accordingly.

Ensuring sustainability

Funding link workers is only one part of the issue. For an optimal social prescribing pathway to function, the VCSE organisations taking referrals must have the capacity to meet the demand being placed on them. PCNs need to work closely with the local community to identify sources of support and services that match patients’ needs. These onward referral destinations also need to be funded, not only to meet the demand for services, but to ensure the long-term economic sustainability of social prescribing as a whole.

Better integration of VCSE organisations into Integrated Care Boards is essential in both helping link workers to map the assets available to them, and in creating a communication pathway for these organisations to raise concerns around their capacity and sustainability.

Social prescribing has a clear potential in prevention of ill-health. Through better management of chronic conditions, as well as alleviation of social isolation, this joined-up approach between primary care and the VCSE sector can ultimately reduce pressure on the NHS in other areas, saving both money and time for patients and staff. But the evidence so far suggests that those communities who would most benefit from this programme are being left behind.

Paul Wilson, Anna Wilding, Efundem Agboraw, Luke Munford and Matt Sutton are all part of Health Organisation, Policy and Economics at The University of Manchester.

This research is funded by the National Institute for Health and Care Research (NIHR) (grant number 134066). The team is also in receipt of funding from the NIHR Applied Research Collaboration Greater Manchester. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.