29% of Social Prescribing Link Workers plan to leave in the next year due to lack of clinical supervision and support according to NALW survey

Today, 8^th July marks the 1st anniversary of Link Worker Day. Lord Victor Adebowale (current Chair of NHS Confederation), in his keynote speech on Link Worker Day 2019 conference said, “our future relies on the success of social prescribing link workers”. 1 year on, findings from our recent study show that 29% of Social Prescribing Link Workers are considering resigning in the next year due to lack of Clinical Supervision and/or support; over three-quarters of these are based in General Practice (77%)¹.  A third of participants knew someone who had resigned (33%), while three-fifths had no clinical supervision (61%), and over a tenth has had no support at all (11%)². 279 Social Prescribing Link Workers responded to our survey in June 2020, 221 are based in England³.

I dread seeing some clients as I don’t know how to deal with them or help them to move forwards. I find it hard to keep their burdens from being my burdens. I sometimes wake up in the night thinking about difficult cases; this gets me down. I’d love to be able to talk things through with a professional. I work in a GP practice but don’t have anyone I can talk to about this, so on one level, I feel part of the team, but on another level, I feel very alone.

I feel that I cannot share my ideas and feel undervalued and isolated. I also become concerned that we are not working to the right quality if we are not looking to improve by talking about it. I start to think this may not be the right job as it is not set up properly.

The issues of lone working felt by Link Workers well before COVID-19, combined with remote working as a result of re-adjusting to new ways of offering support in COVID-19 times; have exacerbated the challenges that face Link Workers who are working with vulnerable people, dealing with complex cases of mental health, homelessness, domestic violence, and suicide.

There is anecdotal evidence from the National Association of Link Workers’ (NALW) previous research that many social prescribing link workers are struggling and feel unsupported⁴. Our recent survey establishes a clear narrative for urgency in addressing the lack of clinical supervision and support.

Jane Soothill, Social Prescribing Link Worker/NALW Board Member, said:  

Link workers support some of our most vulnerable and complex citizens. As this timely and powerful NALW report clarifies, they often do this with minimal support, supervision, or direction. If this new workforce is to be sustainable, every effort must be made to put in place structures that encourage link workers to feel confident and valued. The coronavirus pandemic has highlighted the key role link workers play in helping people with loneliness and social isolation. Given the post-COVID challenge that lies ahead, it is more important than ever that the loneliness and isolation felt by many link workers are acknowledged and addressed as soon as possible.

Kelly Austin, Social Prescribing Link Worker/ NALW Board member, said:

It is very disheartening to see these findings. As an established Social Prescribing Link Worker (SPLW) employed by a forward-thinking GP surgery, and NALW East of England Champion, I see the benefits to patients and the enthusiastic, amazingly diverse and innovative work my fellow SPLW’s achieve.  To hear SPLW’s are not being supported just when their potential is being realised needs addressing.

Christiana Melam, Chief Executive of National Association of Link Workers, said:

The findings of this study sadly are not surprising; it corroborates, the 1^st report highlighting social prescribing link workers support needs⁴ and ten things NHS need to get right to properly implement social prescribing nationally⁵ published by NALW in 2019. Key learnings from the National Association of Link Workers have not been acknowledged, and we risk relearning mistakes and wasting taxpayer’s money.  

We need to pay attention to retention and setting Link Workers up to succeed to realise the positive outcomes that social prescribing can provide for the person, their families, friends and community as well as the reduction in inappropriate use of health and social care services.

This report raises quality, safety, wellbeing, and sustainability risks, and the recommendations must be urgently implemented.

Dr Victoria Tzortziou Brown OBE, RCGP Joint Honorary Secretary, said:

GPs and our patients rely on the variety of skills provided by multi-disciplinary teams and it is important that all members of the practice team feel welcome, supported and valued.

General practice has remained open throughout the extraordinary challenges of the pandemic and has adapted quickly to new ways of working. Our social prescribers and extended teams have developed connections with local communities and support services in order to respond to our patients’ health and care needs during the crisis, and we are extremely grateful to them.

It is important that GPs and our extended primary care teams have the opportunity to reflect together on this very busy and fast-paced period so that we can learn how best to support each other going forward, and so that we can continue offering our patients the holistic care they need.

Ruth Rankine, director of the NHS Confederation’s PCN Network, said:

The role of social prescribing has been proven to be invaluable to PCNs and their patients, particularly during the Covid-19 pandemic. Now is the time to really embed social prescribing into primary care as part of the wider offer to patients. That means ensuring they get the right level of support and supervision to succeed, both personally and professionally; and that Clinical Directors and managers are given sufficient time to provide it.

Dr Nav Chana MBE, Clinical Director- National Association of Primary Care, said:

NAPC supports the findings in this important report and its recommendations. Team based care is an essential part of NAPC’s philosophy to care delivery and social prescribing link workers are a fundamental part of this.  Meaningfully engaging people is an important element of  great community orientated care. Link workers are a vital connection with individuals, people and the community and therefore play a really key role in making this happen.

There is a wider burden of care for link workers that their employers should be adhering to, and these are clearly outlined by NHS England⁶, NALW code of practice⁷ and are underpinned by the Health & Safety at Work Act (1974)⁸.

National Association of Link Workers is calling for clinical supervision, peer/professional supervision, and reflective practice to be embedded in the role and urgently made available. Employers, commissioners, RCGP, BMA, STPs, ICS, and other relevant stakeholders should urgently address the quality, safety, wellbeing and sustainability concerns raised in this report.

Notes to editors

1. When asked, have you or might you consider resigning in the next year or so due to a lack of supervision or support? 29% answered yes; over three-quarters of these are based in General Practice 77%
2. When asked, are you aware of any colleagues who have left their role as a result of lack of supervision and/or support? 33% answered yes. Three-fifths had no clinical supervision 61%, and over a tenth has had no support at all 11%
3. 279 Social Prescribing Link Workers responded to our survey from 1^st to 19th June 2020, 221 are based in England.

Reference materials

4. Link Worker Report 2019
5. Ten things
6. NHS England DES contract
7. Code of practice
8. Health & Safety at Work Act (1974)
9. Download Link Worker report 2020 Care for the Carer

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