“She’s been a rock”: the function and importance of ‘holding’ by social prescribing link workers in primary care in England: findings from a realist evaluation.

Social prescribing link workers are new roles in English primary care. One of their intended functions is to address the increasing number of patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their non-medical needs. However, our research reveals that link workers provide not only connections, but also what we have described as ‘holding’ for patients who have complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context and its consequences.As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a three-week period. We took field notes and interviewed 61 patients and 93 healthcare professionals. Nine to twelve months later we carried out follow-up interviews with 41 patients, seven link workers and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients’ distress. Holding appears to be a vital, but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become over-burdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers' primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support for them should be prioritized to ensure successful implementation and positive outcomes for patients, link workers and primary healthcare

Global Developments in Social Prescribing

Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the ‘Beyond the Building Blocks’ framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs