Written Evidence Submitted by the National Association of Link Workers (FGP0293)
National Association of Link Workers is the only professional body for Social Prescribing Link Workers (SPLWs) in the UK. We are committed to upholding confidence and integrity of the profession by ensuring patients and communities receive high quality social prescribing services. Our members commit to high quality social prescribing professional practices and standards by maintaining Continuing Professional Development (CPD) and adhering to our code of practice. We produce social impact activities to deliver our cause and social mission. As a social enterprise, our strengths lie in our memberships.
NALW submits the below evidence to help drive further engagement about the necessity of SPLWs, who play a substantial role in the future of General Practice.
The Role of Social Prescribing Link Workers
Many GPs face an impossible task: brief appointment times within which to assess and address a patient's health and increasing demand for appointments. Understandably, the immediate presenting medical complaint takes priority in scenarios where the clinician rarely is afforded time to adequately address any non-medical causes of illness. The SPLW serves a role whereby they can support GPs by uncovering and addressing the non-medical concerns of the patient.
The SPLW has access to the 'whole' person over a longer period. As a non-medical professional, the nature of the interaction between the individual and the SPLW focuses not only on the physical symptoms of their illness but also on the wider social determinants of health that might contribute to those symptoms.
Social prescribing link workers are leading a ground-breaking innovation that allows the NHS to deliver 360° care to meet the needs of local populations – reducing health inequalities, improving mental health and quality of life, increasing NHS workforce capacity, and joining up care. They are playing a fundamental role in reducing inequalities in health and levelling up.
By working closely with social prescribing link workers to deliver care, the health and care sector can prevent unnecessary medical interventions and reduce overprescribing, saving the NHS both time and resources.
Owing to the ever-increasing NHS workforce pressures, mental health, increased public demand for 360° care, and health inequality crises, we must empower Social Prescribing Link Workers. A national workforce strategy for Social Prescribing Link Workers and professional regulation is needed now more than ever. We must utilise their knowledge and intelligence to inform intelligence and service provision nationally and locally, recruit more across the entire health and social care landscape and deliver all-doors access to Social Prescribing Link Workers. COVID-19 has validated the role communities play in health and wellbeing. We need to ensure that every social prescribing programme has a capacity-building fund, to fill in the gaps, and to unleash community creativity.
Improving the current model of general practice to make it more sustainable
How social prescribing can help GPs and practice teams
Social Prescribing link workers enable General Practice and teams to offer holistic service to empower individuals and communities to help themselves. It also helps to bring general practice much closer to the community, highlighting that the GP is the glue that connects other services, rather than being the focal point where patients are over-reliant on their GP.
In one case study in the Wirral, a telephonic intervention made by an SPLW identified barriers to attending smear tests and markedly increased the uptake of cervical smears in a group of women over 40. Considering further that in the UK, cervical cancer rates are drastically higher in the most deprived quintiles, SPLW interventions that ensure and facilitate access to health services can significantly improve health outcomes for underserved and underrepresented communities.
Social prescribing link workers can provide non-medical support to vulnerable patients, helping to reduce inequalities, but also enabling self-care approaches, and connecting patients to community-based support. In a recent article, How social prescribing can help GPs and practice teams, NALW CEO Christiana Melam highlights the valuable role SPLWs play. She notes, “Social prescribing link workers have time to get to the root cause of problems, which enables patients’ problems to be addressed, reducing demand on GP appointments. Increased access to social prescribing has also expanded in some areas and PCNs are now able to recruit more link workers as the additional roles reimbursement scheme (ARRS) has expanded.”
GPs work closely in partnership with link workers can ensure real benefits for patients. A senior social prescriber explains: "My most significant achievement is being able to feedback to the doctors on what we have achieved together to improve the lives of the patients. Just as important, the chance to give them a safe space to share some of their own frustrations about the pressured and isolated way they are currently working. The reassurance that they are getting it right and are appreciated by their patients is a great help in getting through this difficult time.”
Enabling general practice to work in effective partnerships with other professions within primary care
Increasing recruitment and utilisation of SPLWs
Increasing resources and expanding the rollout of the number of SPLWs, will provide exponential return. SPLWs are a valuable resource that can help increase an already strained NHS’s capacity. Working alongside primary care and community services, SPLWs play a pivotal role.
Ensuring that SPLWs are meaningfully embedded within Primary Care opens new opportunities for Public Health and Healthcare to become more person and community-centered to meet the needs of local people.
NALW’s 2020 Care for the Carer report highlighted that 1 in 3 social prescribing link workers plan to resign within the year due to lack of support and clinical supervision. This issue of retention and poor supervisions is still an issue over a year later. The pandemic has certainly exacerbated key challenges. The ‘use it or lose it’ funding model means PCNs are perhaps rushing to employ but are not able to properly support new roles as they ‘bed in’, while remote working has added to isolation among staff who already work to a different model than ‘traditional’ members of the practice team. At the same time, the pandemic has highlighted how valuable link workers can be, with many examples of good practice.
Across many of the new roles, we are seeing similar challenges in helping practices understand the value of these roles, and the support they need to succeed. NALW has already produced resources which provide some of this (including a code of practice, and a guide to supporting link workers), so there is some work to do in simply signposting to these resources.
The biggest cultural shift in medicine for generations
Speaking at our #LinkWorkerDay2021 Conference in October, chair of the Royal College of General Practitioners, Professor Martin Marshall highlighted the importance of helping PCNs and practices to understand the potential of link workers more effectively than we've done so far. He said, “I think we need to be able to provide better induction, better support. Coming into general practice is quite a difficult environment for new people to work in at the moment because everybody's so rushed so we need to provide a more conducive environment.”
In a joint BMJ article, General practice and public health: fostering collaboration for better health for populations Maggie Rae, president of the Faculty of Public Health and Martin Marshall, chair of the Royal College of General Practitioners, highlight how GPs, working with practice staff such as social prescribers are powering up public health by identifying the root causes of ill-health not just treating illness.
Responding to increasing needs and reducing health inequalities
With figures indicating that referrals for mental health services will rise by 20% in the next two years, NHS Trusts should look for sustainable, realistic, and holistic non-clinical mental health support for communities. Why should people need to be at a crisis point before they can access support? There is a significant correlation between a lack of infrastructure of support around the person in recovery resulting in avoidable high-intensity usage of acute services. The role of Social Prescribing Link Workers is proactive and can help prevent the looming mental health crisis. Clinical and non-clinical mental health pathways need to be synchronised and coordinated to reduce health inequalities. For example, as NICE highlights in new draft guidance, people with depression should make the choice on what treatment option is right for them, in discussion with their healthcare professional.
A new report by the British Red Cross shows that high intensity use of A&E is fundamentally a health inequalities issue and called for investment to boost social prescribing. With some people having gone to A&E more than 300 times in one year, it is believed that this has cost the NHS £2.5bn per year. Overreliance on A&E. People who attend A&E frequently often make use of other health services too – for example frequent use of GP services can be an ‘early warning sign’ of high intensity use at A&E. BRC’s recommendation is to increase community-based support, including the use of SPLWs to better respond to those individuals and address the drivers of their over reliance on A&E.
Revolutionizing the future
With an ever-increasing evidence base for the success of social prescribing and its impact on reducing social inequality, more and more Primary care Networks, GPs and ICSss arare e embracing social prescribing and committing resources to it.
The RCGP-Oxford RSC recently published data from 2020-21 across England which highlighted around 15 million instances of individuals with social needs, linked to social determinants of health, presenting to primary care that could have benefited from personalised care. Use of personalised care is growing, but is uneven across England and across population groups. Recorded rates of social prescribing referrals vary greatly across England - from 0.23-6.01 per 10,000 population per week – an approximately 25-fold variation.
Empowering our SPLWs and leveraging their engagement in and understanding of communities to help identify gaps in services and need, can inform local planning and knowledge of key issues. In many ways, SPLWs are the eyes and ears of their communities, ensuring no one is left behind. By identifying and removing key barriers to health, social prescribing addresses issues of social justice and health inequalities. As flexible, mobile individuals working closely with their respective communities, SPLWs can empower people to tackle social determinants of health that the NHS cannot traditionally reach.
The Black Country and West Birmingham ICS training hub, for example, has created a social prescribing link worker ambassador role to ensure social prescribing link workers' voices feed into the system. Similarly, NALW’s SPLW Impact Report from 2020 highlights shared learning from link workers from across the UK.