Making ‘Social prescribing’ work: The Links Worker Programme in ‘Deep End’ practices in Glasgow

The problem

Primary care professionals are often unable to support their patients who have problems rooted in social circumstances. One possible response is ‘social prescribing’, where practitioners refer patients to non-medical support or to resources available in their communities. But simple referral to local resources is unlikely to work. Many people living with multiple health and social problems need more intensive support to make links.The Links Worker Programme is designed to address these problems. Funded by Scottish Government and delivered through the third sector, Alliance for Health and Social Care, it is implemented in ‘Deep End’ practices serving the most socioeconomically deprived populations in Glasgow. Each practice has an attached links worker who offers one-to-one support, and builds links between practices and community resources. There is no population targeted and no prescribed ways of working for either Links Workers or practice staff. Practices have flexibility to be responsive to local circumstances.

The approach

We are conducting an evaluation of this programme. The evaluation is designed as a quasi-experiment with embedded process evaluation conducted in 2 phases. For phase 1 we conducted 19 interviews and focus group discussions with programme and practice staff in both Links Worker (7) and comparison (8) practices and with members of the Programme’s Executive and Management Group (4). All data were transcribed verbatim and anonymized for analysis. We also extracted data from programme documents included Links Worker practice produced reports.Using a comparative case study approach with practices as the case, we combined data from these three sources to describe how each practice was implementing the programme. We then compared and combined these descriptions of practice activities to results in an overarching ‘programme theory’ through which the programme is expected to operate.

Findings

We conducted 19 focus group discussions and interviews, and extracted data from over 50 documents. Preliminary analyses suggest the overall goal of Links Worker practices to support some of their patients in improving wellbeing through social prescription is being met. Members of practice staff are gradually becoming involved in the ‘Links approach’. They: a) refer individuals to Links Workers who operate almost as ‘case managers’ by helping access extra support for immediate material needs, b) directly signpost patients to a range of community resources, c) increase the availability of information for patients, d) run practice-based activities such as walking groups, visits to local resources or held ‘coffee mornings’ practices inviting patients and local organisations themselves.

Consequences

Preliminary analyses suggest that practices offer their patients some solutions to long-standing social problems and primary care team capacities seem to be improving in ways that help people make links: in their own lives, and in their communities, with the primary care team as a hub.

Credits

• Nai Rui Chng, University of Glasgow, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
• Catherine O'Donnell, University of Glasgow, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
• Mhairi Mackenzie, University of Glasgow, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
• Stewart Mercer, University of Glasgow, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
• Kathryn Skivington
• Sally Wyke, University of Glasgow, MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK