Implementing social prescribing in primary care in areas of high socioeconomic deprivation: process evaluation of the 'Deep End' community Links Worker Programme

• Published in: British journal of general practice Vol. 71; no. 713; pp. e912 - e920
• Main Authors: Chng, Nai Rui, Hawkins, Katie, Fitzpatrick, Bridie, O'Donnell, Catherine A, Mackenzie, Mhairi, Wyke, Sally, Mercer, Stewart W
• Format: Journal Article
• Language: English
• Published: England Royal College of General Practitioners 01.12.2021
• Subjects: Family physicians; General Practice; Health care; Health Personnel; Humans; Leadership; Prescriptions; Primary care; Primary Health Care; Qualitative Research; Social networks; Socioeconomic Factors; healthcare inequalities; primary care; social prescribing; community link workers; complex interventions; general practice
• ISSN: 0960-1643; 1478-5242
• DOI: 10.3399/BJGP.2020.1153

Social prescribing involving primary care-based 'link workers' is a key UK health policy that aims to reduce health inequalities. However, the process of implementation of the link worker approach has received little attention despite this being central to the desired impact and outcomes. To explore the implementation process of such an approach in practice. Qualitative process evaluation of the 'Deep End' Links Worker Programme (LWP) over a 2-year period, in seven general practices in deprived areas of Glasgow. The study used thematic analysis to identify the extent of LWP integration in each practice and the key factors associated with implementation. Analysis was informed by normalisation process theory (NPT). Only three of the seven practices fully integrated the LWP into routine practice within 2 years, based on the NPT constructs of coherence, cognitive participation, and collective action. Compared with 'partially integrated practices', 'fully integrated practices' had better shared understanding of the programme among staff, higher staff engagement with the LWP, and were implementing all aspects of the LWP at patient, practice, and community levels of intervention. Successful implementation was associated with GP buy-in, collaborative leadership, good team dynamics, link worker support, and the absence of competing innovations. Even in a well-resourced government-funded programme, the majority of practices involved had not fully integrated the LWP within the first 2 years. Implementing social prescribing and link workers within primary care at scale is unlikely to be a 'quick fix' for mitigating health inequalities in deprived areas.