Embedding a population health approach into health care at the local, regional and national level in England will require slow, incremental cultural shifts over the space of years, as suggested in our report, A vision for population health.
While researching how well the roles in the Additional Roles Reimbursement Scheme (ARRS) have integrated into primary care networks (PCNs), I began to understand first hand some of the challenges – and opportunities – the system has to contend with as it starts to make this tectonic shift.
Social prescribing has been around for many years, and link worker roles were one of the first to be funded through the ARRS scheme. These link workers represent a real investment in non-clinical roles and the social model of health care, in general practice. They support patients who attend primary care with challenges such as access to healthy food, poor housing and financial issues, which have been strongly linked to poor health and avoidable deaths.
'[Link workers] created bespoke resources for the people in their areas based on their needs and connected them to services in their community rather than generic nationally defined services.'
The link workers we spoke to as part of the ARRS project were passionate, dedicated and creative, and were well aware of their potential role in population health within their area. For example, they created bespoke resources for the people in their areas based on their needs and connected them to services in their community rather than generic nationally defined services.
At The King’s Fund, we have recently argued that tackling health inequalities should be ‘business as usual’ for the NHS. Some link workers are already making it their business by assessing their local population needs and creating community networks, groups and activities to tackle health inequalities head on, a priority for improving population health. For example, one link worker told us how they had developed a social prescribing clinic to accommodate and facilitate access for the large numbers of refugees and asylum seekers in their area.
Some link workers spoke of having supportive and enthusiastic teams around them who understood their vision and potential. But more frequently, we heard from link workers whose roles were misunderstood, misused, underutilised and unsupported.
“Everybody seems to have a different idea of what social prescribing is.
'There are people… using their social prescriber to book smear tests, and while there is a case for… you know, connecting and empowerment and all these things about access to healthcare, that’s not active social prescribing to me, that is an administrative task.”
With many link workers being hired just as the pandemic began, they were quickly enlisted to do work outside of their original remit and lacked consistent supervision or training. While wholly willing and capable to do these other tasks, with recovery underway they should now be supported to establish their original role and purpose.
'If the health and care system is serious about making this cultural shift towards addressing population health and promoting people to live more healthily within their communities... it needs to ensure key actors are given what they need to succeed in their work.'
In addition to a lack of understanding about their roles, link workers faced the same problems as other roles employed under ARRS – often working in isolation, not feeling part of the general practice team and with little understanding from others of the value of or how to embed such roles within primary care teams. Subsequently, in our recent report we call for adequate funding and time for those supervising, supporting and training ARRS roles and for PCNs to consider how to embed these roles as part of the strategy.
If the health and care system is serious about making this cultural shift towards addressing population health and promoting people to live more healthily within their communities – and indeed the recent British Social Attitudes survey suggests that the public think this should be one of the top priorities for the NHS – it needs to ensure key actors are given what they need to succeed in their work.