ORCID
- Kerryn Husk: 0000-0001-5674-8673
Abstract
Background: Social prescribing addresses non-medical factors affecting health and well-being. Link workers arekey to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprisesector. Funding from the National Health Service means that link workers are becoming a common part of primarycare in England.Objective: To explore and understand the implementation of link workers in primary care in England.Design: A realist evaluation addressed the question – When implementing link workers in primary care to sustainoutcomes – what works, for whom, why and in what circumstances?Setting: Link workers and staff associated with seven primary care sites across England.Methods: Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interactwith patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition,interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterpriserepresentatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patientsand with link workers 9–12 months later. Data were coded and developed into statements to identify how contextaround the link worker triggers mechanisms that lead to intended and unintended outcomes.Results: We found that link workers exercise micro-discretions in their role – actions and advice-giving based onpersonal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlightedthat micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community andsocial enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supporteddelivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries couldplace link workers at risk of overstepping their remit.Limitations: Our research focused on link workers attached to primary care; findings may not be applicable tothose working in other settings. Data were collected around seven link worker cases, who were selected purposivelyfor variation in terms of geographical spread and how/by whom link workers were employed. However, these linkworkers were predominately white females.Conclusions: Enabling link workers to exercise micro-discretions allows for responsiveness to individual patientneeds but can result in uncertainty and to link workers feeling overstretched.
DOI
10.3310/JSQY9840
Publication Date
2024-09-11
Publication Title
Health Services and Delivery Research
ISSN
2050-4349
Recommended Citation
Tierney, S., Westlake, D., Wong, G., Turk, A., Markham, S., Gorenberg, J., Reeve, J., Mitchell, C., Husk, K., Redwood, S., Meacock, A., Pope, C., & Mahtani, K. (2024) 'The consequences of micro-discretions and boundaries in the social prescribing link worker role in England: a realist evaluation', Health Services and Delivery Research, . Available at: https://doi.org/10.3310/JSQY9840
