Catterina Seia28 Nov 20259 min read

Link workers – building a personalised approach to public health

11:31

Social prescribing is transforming primary care in many countries, establishing links between healthcare, local resources and community. This approach promotes care pathways that incorporate cultural, social and natural resources, encouraging and supporting personal independence and helping to relieve pressure on healthcare services.
It is a paradigm shift that calls for new skill sets, new professional roles – such as that of link workers – and a shared vision of health as a collective asset.

A new person-focused vision

Placing the focus on people and their potentialities. Social prescribing is well on its way to gaining a seat at the table as an approach that is capable of forging alliances between sectors in order to create life contexts that are salutogenic, or health-promoting, and encourage their incorporation into care pathways, making it easier for people to access networks of local resources.

These pathways can include activities and services that meet practical, emotional and relational needs, helping to foster more equitable and sustainable access to good health. They form part of an holistic approach to care, one which takes the totality of the social determinants of health into consideration and extends to include nature-based therapies (green social prescribing) and arts and cultural activities (arts on prescription).

This vision forms part of an ongoing broader rethinking of primary care, whose purpose is to foster a personalised and accessible approach founded on low-threshold interventions, on local healthcare, and on developing and promoting the networks of relationships active within individual communities.

Creating connections and new professional roles

Nonetheless, in order to design truly integrated services, it is essential to build bridges. In a number of Anglo-Saxon countries where this approach is already well-established, link workers are key figures, formally recognised as integral parts of a multidisciplinary team operating in a primary care context, in which they play central roles in social prescribing pathways.

The Long Term Plan published by the National Health Service (NHS) of England in 2019 set out a strategic objective: to recruit 1,000 link workers by 2021 in order to expand the availability of social prescribing nationwide. This commitment was formalised by the Guidance Document for Primary Care Networks (PCNs) published in 2022 by NHS England, through its implementation of personalised care actions provided for in the Network Contract Directed Enhanced Service (DES), ensuring that every patient could have access to a link worker.

What does a link worker do?

Social prescribing link workers play an essential role in improving the health and wellbeing of people living with chronic illnesses, mental health issues and social isolation or with complex social needs. Patients can access services offered by link workers with a referral from a general practitioner or on their own initiative (self-referral).

Once contact has been made, the link worker works closely with each patient, identifying resources, activities and services available in the local area that can meet the patient’s individual needs in a targeted fashion and developing a pathway towards greater well-being.

The goals of social prescribing

According to the National Health Service of England, the expected outcomes of social prescribing are to foster significant change in patients’ daily lives, so that each person:

gains greater awareness and control in terms of managing their own health and wellbeing;
increases the amount of exercise they take;
is better equipped to deal with practical problems such as debt, housing or mobility issues;
feels more connected to others, reducing feelings of loneliness or isolation.

Professional skills and tools

The role and competencies of link workers are defined in two main documents: the Workforce Development Framework for Social Prescribing Link Workers and the Reference Guide for Primary Care Networks.

The relationship between link worker and patient is founded on a person-centred approach guided by the question, “What matters to you?” which directs the entire listening, support and guidance process.

Active listening and personalised planning

One of the three key functions of the link worker is to engage in personalised conversations, in which time and active listening are essential tools for exploring individual needs of a non-clinical nature. This sort of attentive and non-medicalised response often cannot be provided by a general practitioner due to time constraints and, in many cases, to a lack of training in whole-person care as opposed to in the treatment of the patient as a simple carrier of symptoms.

The initial listening session is essential for identifying the problems affecting a person's overall health and wellbeing. Based on that first conversation, the worker puts together a Personalised Care and Support Plan (PCSP) that fosters and develops the patient’s personal resources and takes into account their life goals, as well as the actual opportunities available in the local area.

One distinctive feature of a link worker’s role is the ability to build connections between the person and the community, helping them to access a wide range of services and activities, from art, sport and cultural groups, to nature-based activities, to specialised consultations about social, housing or financial issues.

As a part of their jobs, link workers make ample use of relational tools and coaching techniques, such as motivational interviewing, which strengthen a person's independence and mindfulness in how they manage their own health and choices.

What's more, link workers engage in wide-ranging collaborations, working hand-in-hand with not-for-profit organisations, local authorities, and health and social services, with the aim of growing community services to meet community needs.

In fact, link workers may receive referrals from a variety of sources, including general practitioners, pharmacies, social services, emergency services, job centres and volunteer organisations.

The pathway with the patient

From an operational standpoint, the link worker’s job generally involves cycles consisting of 6-12 meetings over three months, with regular follow-ups and checks.

Link workers are also responsible for monitoring the impacts of their activities, using recognised assessment tools, like the ONS4 (Office for National Statistics – 4 Indicators of Wellbeing) or other validated tools to measure progress and the overall efficacy of actions.

A quantitative assessment of the impact of link workers on population health

In terms of the effectiveness of the services offered by link workers in England, a recent large-scale study – funded by the National Institute for Health and Care Research (NIHR) and coordinated by a team from the University of Manchester, in partnership with the Universities of Edinburgh, Newcastle and Bristol – analysed the impact of introducing social prescribing link workers within primary care networks with the aim of assessing whether the roll-out had effectively helped to improve health outcomes in the population.

The study

The study was based on an analysis of data from over 4 million participants in the General Medicine Patient Survey, collected between 2018 and 2023, combined with information on workforce distribution within Primary Care Networks. In order to assess the association between the availability of link workers and patient-reported outcomes, the researchers used logistic regression models, statistical tools which make it possible to analyse if, and to what extent, an increase in a given variable (in this case, the presence of link workers) correlated with a change in the probability of certain outcomes, such as satisfaction with services received.

Link worker presence was calculated in terms of full-time equivalent (FTE) per 50,000 patients, for the purpose of comparing areas with a higher or lower availability of link workers in relation to users’ perceived and reported outcomes.

The results

The results of the study show that a greater availability of social prescribing link workers is associated with measurable improvements in patient experience, especially among respondents with chronic conditions or mental health issues. The increased presence of link workers translates into greater confidence in managing long-term conditions, a more positive perception of support received from local services, and an overall improvement in how patients rated their relationships with their general practitioners.

In quantitative terms, employing a full-time worker in an average-sized Primary Care Network was associated with 56 more people feeling adequately supported and 104 more people reporting a good experience of medical care.

Extending the model to a national level, the researchers estimate that adding one FTE link worker per 50,000 residents would lead approximately 47,000 people to report having greater confidence in managing their conditions and approximately 132,000 people to report having a good primary care experience.

Investing in social prescribing to strengthen public health

This evidence is supported by a recent report by the National Academy for Social Prescribing (NASP), entitled The Impact of Social Prescribing on Health Service Use and Costs: Examples of local evaluations in practice, published in 2024. The research highlights a solid and growing body of evidence in favour of social prescribing as a non-medical device that can help to significantly reduce use of healthcare services, in particular avoidable GP appointments, hospital admissions, and A&E visits.

Important findings emerged from an evaluation of nine areas across England. These include:

In Tameside and Glossop there was shown to be a 42.2% reduction in GP appointments among the 1,751 patients referred for social prescribing pathways.
In the county of Kent, of the 5,908 patients seen by link workers, there was a decrease of between 15.4% and 23.6% in A&E admissions.

A model for more sustainable healthcare

These results confirm the potential of social prescribing, not only for improving individual well-being, but also for easing the burdens on healthcare services, with positive knock-on effects in terms of system sustainability.

Overall, the evidence shows that the structured introduction of link workers within primary care pathways can generate tangible benefits both for individual patients in terms of perceived wellbeing and quality of the care experience, as well as for the healthcare system as a whole, thanks to the easing of pressure on traditional medical services. In light of these results, social prescribing increasingly appears to be a strategic public health tool, one that can identify and address complex needs through a personalised, preventive and community-based approach. It is therefore crucial to invest in its expansion and in strengthening the professional roles within it, in order to foster more sustainable and equitable models of care.

Confirming the growing need for educational and training courses for this new standard of care, the fifth iteration of the Culture and Health course, entitled “Doctors and Social Prescribing. Healing with sport, nature, culture and volunteering”, promoted by the Faculty of Biomedical Science at USI – Università della Svizzera italiana, in partnership with IBSA Foundation and the Culture Department of the City of Lugano, offers an opportunity for international and multidisciplinary analysis.
The course, which took place from 6 October to 24 November 2025, explored the many aspects of social prescribing, with contributions by academics and experts from Europe, the United States, Canada, Singapore, and Japan.