Implementing social prescribing in primary care in areas of high socioeconomic deprivation: process evaluation of the ‘Deep End’ community links worker programme

Background
Social prescribing involving primary care-based ‘link workers’ is a key UK health policy which aims to reduce health inequalities. However, the process of implementation of the link worker approach has received little attention despite this being central to desired impact and outcomes.
Aim
Our objective was to explore the implementation process of such an approach in practice.
Design and Setting
Qualitative process evaluation of the ‘Deep End’ Links Worker Programme (LWP) over a two-year period, in seven general practices in deprived areas of Glasgow.
Methods
We used thematic analysis to identify the extent of LWP integration in each practice and key factors associated with implementation. Analysis was informed by Normalisation Process Theory.
Results
Only three of the seven practices fully integrated the LWP into routine practice within two years, based on NPT constructs of coherence, cognitive participation, and collective action. Compared to ‘Partially Integrated Practices’, ‘Fully Integrated Practices’ had better shared understanding of the programme among staff, higher staff engagement with LWP, and were implementing all aspects of 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.
Conclusions
Even in a well-resourced government funded programme, the majority of practices involved had not fully integrated the LWP within the first two 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