Has the national rollout of social prescribing link workers in primary care been achieved?

In this blog Dr Anna Wilding, Research Fellow in Heath Economics at the University of Manchester, draws on the findings from her PhD and early analysis from the National Institute for Health and Care Research (NIHR) funded ‘Multi-region evaluation of the national roll out of social prescribing link workers in primary care’ (NIHR134066), to look at how social prescribing link workers have been employed across England.

Part of the NHS Long term plan announced in January 2019 was to employ 1,000 link workers by the end of 2020/21¹. This goal has been achieved and more. Data from NHS Digital on workforce across primary care networks² (PCN) and general practitioner (GP) practices³ within England indicates that there were 1,449 link workers employed (1,265 full-time equivalents (FTE)) at the end of 2020/21.

As of June 2019, the workforce data for GP practices reported link workers being employed. Since this point, there has been an increase in the employment of link workers across GP practices. However, most of the link workers have been employed as part of the PCNs.

PCNs were formally established in June 2019, with there being 1,295 networks serving around 30,000 to 50,000 patients each, with all but 55 GP practices joining one. The NHS aims to employ one link worker per PCN. Data on workforce for PCNs was first available from March 2020, meaning link workers could have been employed within these networks pre-2019. As of March 2020, 112 FTE link workers were employed across the PCNs.

The map of England shows employment of FTE link workers per 10,000 patients across integrated care boards (ICB), with darker outlines indicating the NHS regions. We show from March 2020 there are low employment levels of FTE link workers. Across all ICBs this increases, with the South West employing link workers at an increased rate compared to other regions of England. The North East and North Cumbria ICB have the highest number of link workers per 10,000 patients as of March 2023, with ICBs within the Midlands approaching those levels. However, there are distinct areas that are not fulfilling the NHS aims of link worker employment; those include the London region as a whole, Humber and Yorkshire ICBs and parts of the East of England.

Past evidence has highlighted that uptake of social prescribing activities is linked to individuals and areas of higher socio-economic status⁴. However, there are greater returns in participating for those individuals for their health and well-being⁵. These varying returns have been reflected in a social prescribing pilot in North East of England with greater cost reductions in health care across those non-white and with less complex health needs⁶.

This evidence needs to be incorporated into social prescribing policy to effectively improve individuals’ outcomes and not contribute to existing health inequalities. This will also improve the overall efficiency of the scheme in terms of whom to requires additional support from the link workers to uptake and engage with the services.                      

Future work, we will use this data on link worker employment to estimate the impact of the provision of services on patients’ health and well-being using the Annual Population Survey, and service satisfaction and use using the General Practice Patient Survey. This is alongside our analysis of administrative data from Clinical Practice Research Datalink looking into returns on social prescribing referrals on health, regarding disease onset and prescriptions, and service outcomes, in terms of primary and secondary care use. Then finally, estimate the cost-effectiveness of the scheme as a whole.”

The NIHR funded ‘Multi-region evaluation of the national roll out of social prescribing link workers in primary care’ is a three-year (2022 to 2025) research award, is using a multi-region mixed methods approach to map current provision and service configuration and to assess whether access, engagement and outcomes vary by delivery model, geography and population characteristics over time.

More information about the multi-regional evaluation is available from here

• References

  1.           NHS England. The NHS Long Term Plan (2019).

   

  2.           NHS Digital. Primary Care Network Workforce. 

   

  3.           NHS Digital. General Practice Workforce. 

   

  4.           Wilding, A., Munford, L. A. & Sutton, M. Predictors of social participation: evidence from repeated cross-sectional population surveys in England. Journal of Public Health (2022)

   

  5.           Wilding, A., Munford, L. & Sutton, M. Estimating the heterogeneous health and well-being returns to social participation. Health Economics n/a, (2023).

   

  6.           Wildman, J. & Wildman, J. M. Evaluation of a Community Health Worker Social Prescribing Program Among UK Patients With Type 2 Diabetes. JAMA Network Open 4, e2126236 (2021).