Summary

The purpose of the social prescribing link worker (SPLW) workforce development framework is to: 

• provide clear and consistent standards for SPLW practice, including their knowledge, skills and behaviours 
• provide guidance on the support, supervision, and learning and development offer required from employers to support SPLWs 
• promote the development of a strong and capable workforce of SPLWs and their future development
• support improved quality and consistency of social prescribing and reduced variation in outcome and access standards. 
• demonstrate the benefits of SPLWs working as part of a multi-disciplinary team (MDT).

The framework includes core competencies for the role and links to resources to support employers to recruit and embed SPLWs in services. Organisations employing SPLWs, including primary care networks, can use this framework to support recruitment and retention. It will help them develop a greater understanding of the role, its scope of practice and the training and development SPLWs need to enable them to practice safely and effectively.

SPLWs give people time over several sessions to offer a person-centred conversation based around asking, “what matters to you?”. They work with people to connect them with community-based services, groups and activities that meet practical, social, and emotional needs that affect their health and wellbeing.  

SPLW may be employed by primary care networks, or by a host organisation that provides SP services, such as a local voluntary, community and social enterprise sector (VCSE) organisations that have existing links and relationships within communities.

As with any role in a health, care or community setting, SPLWs need to be supported and enabled to succeed in their role. Before employing a SPLW, employers should be clear on the purpose of the role and how it can contribute to meeting people’s needs and neighbourhood/place/system priorities, and that they have the capacity to manage and support the roles.

SPLW will be recruited with relevant skills and experience, and they will complete the Link Worker Learning e-learning programme and other initial training as set out by the Personalised Care Institute (PCI). Employers are responsible for funding any necessary training, and for ensuring the SPLW workplan includes time for training and for community outreach activities, reporting, case work and research, as well as face to face client work.

Good supervision arrangements for SPLWs are crucial to ensure they practice safely and effectively. SPLWs should have an initial point of contact within a PCN, a GP supervisor, and monthly clinical supervision with a relevant professional, to manage any emotional issues and to develop their SPLW practice. They may also have a day to day line manager. Supervisors should have relevant experience of SPLW role, and be supported in their own development as supervisors.

SPLW manage their own caseload. The maximum safe caseload is 200-250 per year and may be less, based on the complexity of cases and the maturity of the social prescribing service. Workloads should be set based on this maximum rather than other targets.

Employers should support SPLW in their continuous professional development (CPD), giving them dedicated time, and where necessary funding, for training and CPD. Regular supervision sessions, appraisals and personal development planning should all be used as opportunities to focus on specific needs to progress and/or meet the competencies for the role, as well as future career aspirations. SPLWs themselves, their supervisors and employers have collective responsibility for CPD.

Personalised care is uniquely placed to help tackle growing health and wellbeing needs, including complex or multiple long-term conditions and unmet health needs. SPLW play a key role in empowering individuals and communities to improve health and wellbeing, and social prescribing is an important part of tackling health inequalities and responding to issues caused by the social determinants of health.

1. Introduction

The workforce development framework for social prescribing link workers (SPLWs) has been developed to support SPLWs and their employers to maximise impact of the role.

Organisations employing SPLWs, including primary care networks, can use this framework to support recruitment and retention. It will help them develop a greater understanding of the role, its scope of practice and the training and development SPLWs need to enable them to practice safely and effectively.

It is intended as a useful resource for organisations across the health and care sector including the NHS, voluntary, community and social enterprise (VCSE) partners, and local authorities. The framework also includes specific information for primary care network (PCN) SPLWs that are funded through the Additional Roles Reimbursement Scheme (ARRS). 

The framework has been developed by NHS England in collaboration with range of stakeholders (full list at item 13). 

It focuses on the core functions, skills and competencies of the SPLW role, alongside the professional support and development SPLWs need to enable them to practice safely, work effectively, and support improved outcomes for people and communities. The framework purpose is to: 

• Provide clear and consistent standards for SPLW practice, including their knowledge, skills and behaviours 
• Provide information about the training, support, supervision and continuous professional development (CPD) needed to enable them to succeed. Provide guidance on the support, supervision, and learning and development offer required from employers to support SPLWs 
• Promote the development of a strong and capable workforce of SPLWs and their future development
• Support improved quality and consistency of social prescribing and reduced variation in outcome and access standards. 
• Demonstrate the benefits of SPLWs working as part of a multi-disciplinary team (MDT).

This document brings together, simplifies and clarifies key information about employing, supporting and getting the best out of social prescribing link work.

2. Context

Social prescribing and community-based support is part of the NHS Long Term Plan commitment to make personalised care business as usual across the health and care system.

SPLWs, along with health and wellbeing coaches and care co-ordinators are dedicated to providing personalised care. SPLWs are important members of a PCN’s multidisciplinary team (MDT) and wider multiagency integrated teams. They work in partnership with other personalised care roles and health and care professionals to optimise health outcomes for people and populations, and reduce health inequalities. They can also contribute to community outcomes, including strengthening resilience and building connections and empowering community action (Marmott, 2018). 

The SPLW workforce development framework has been created alongside similar frameworks for health and wellbeing coaches and care co-ordinators.

3. What is a social prescribing link worker?

People’s physical and mental health and wellbeing is influenced by a range of factors, including their housing, finances, personal relationships, and existing health conditions. Not all the factors that affect health and wellbeing can be resolved through conventional health services, and up to 20% of people who go to see their GP present with an issue that is primarily a social problem (University of Westminster, 2017). 

Social prescribing is a way to connect people with community-based services, groups and activities that meet practical, social, and emotional needs that affect their health and wellbeing, and increase people’s active involvement with their health and their community. Social prescribing works for a wide range of people, particularly those with one or more long-term conditions, people who need support with their mental health, people who are lonely or isolated and those with complex social needs.

3.1 Role of a social prescribing link worker

SPLWs give people time over several sessions to offer a person-centred conversation based around asking, “what matters to you?”. They: 

• Are part of an all-age, whole population social prescribing approach and work with people who are lonely, have complex social needs, low level mental health needs and long-term conditions
• Help people to identify issues that affect their health & wellbeing, and coproduce a simple personalised care and support plan
• Support people by connecting them to non-medical community-based activities, groups and services that meet practical, social and emotional needs, including specialist advice services and the arts, physical activity, and nature
• Use coaching and motivational interviewing techniques to support people to take control of their own health and wellbeing
• Support accessible and sustainable community offers by working with VCSE organisations, local authorities and others to identify gaps in provision and deliver activities and groups to meet population needs. 

SPLWs provide support to tackle issues caused by the wider determinants of health, alongside colleagues providing conventional medical interventions. SPLWs and their PCN work in partnership with local agencies to proactively reach out to populations who might benefit from social prescribing, taking a preventative approach. People can be referred to SPLWs from a wide range of local agencies including NHS services, local authority services, pharmacies, emergency services, job centres, housing associates, VCSE organisations and self-referral. 

4. Employing social prescribing link workers

4.1 Employment

PCNs may directly employ SPLWs or sub-contract provision of the service to another provider in accordance with this Network Contract DES specification. 

SPLWs employed by VCSE host organisations are well-connected to wider agencies that support health and wellbeing, including statutory services, VCSE-led activities and groups, and hyper-local support offerings and opportunities such as volunteering. 

While primary care staff are not on the NHS Agenda for Change (AfC) pay scale, the SPLW role in PCNs is designed to be equivalent to AfC Band 5 in terms of responsibilities and remuneration. This reflects the complexity of the situations people present with, the level of autonomy SPLWs work with, and the need for a significant level of multi-agency working, including supporting community groups to receive referrals.

PCNs are responsible for ensuring SPLWs is included in the PCN wider team and are supported appropriately within surgeries. Where SPLWs are employed by a host organisation this will involve working together on supporting SPLWs.  

Considerations for setting up a social prescribing service are set out in the PCN reference guide for social prescribing and includes a checklist, SP planning, recruitment support including sample job description and advert, induction checklist. 

Employers should be confident that they have the necessary resources and support in place to embed the SPLW in the team. This includes having appropriate supervision arrangements in place, which is essential, and provision for training and ongoing CPD.

Where a PCN employs or engages one or more social prescribing link workers under the Additional Roles Reimbursement Scheme or sub-contracts provision of the social prescribing service to another provider, the PCN must ensure that each social prescribing link worker providing the service has the following key responsibilities in delivering the service to patients:

1. as members of the PCN’s team of health professionals, take referrals from the PCN’s core network practices and from a wide range of agencies* to support the health and wellbeing of patients;
2. assess how far a patient’s health and wellbeing needs can be met by services and other opportunities available in the community
3. co-produce a simple personalised care and support plan to address the patient’s health and wellbeing needs by introducing or reconnecting people to community groups and statutory services, and signposting where appropriate and as it matters to the person
4. evaluate how far the actions in the care and support plan are meeting the patient’s health and wellbeing needs**
5. provide personalised support to patients, their families and carers to take control of their health and wellbeing, live independently, improve their health outcomes and maintain a healthy lifestyle (including, where appropriate, by referral to weight management services)
6. develop trusting relationships by giving people time and focus on ‘what matters to them’
7. take a holistic approach, based on the patient’s priorities and the wider determinants of health, including supporting people to take up employment, training and welfare support
8. explore and support access to a personal health budget where appropriate
9. manage and prioritise their own caseload, in accordance with the health and wellbeing needs of their population
10. where required and as appropriate, refer patients back to other health professionals within the PCN.

*These agencies include but are not limited to: the PCN’s members, pharmacies, multi-disciplinary teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations.

**Including considering if the persons needs are met (for example, reasonable adjustments, interpreter).

A PCN’s Core Network Practices must identify a first point of contact for general advice and support and (if different) a member of staff with relevant competencies, as described in the Workforce Development Framework to provide supervision for the Social Prescribing Link Worker(s). This could be provided by one or more named individuals within the PCN. A PCN’s Core Network Practices must provide monthly access to clinical supervision with a relevant health professional.

A PCN will ensure the social prescribing link worker(s) can discuss patient related concerns and be supported to follow appropriate safeguarding procedures (e.g. abuse, domestic violence and support with mental health) with a relevant GP.

A PCN must ensure referrals to the social prescribing link worker(s) are recorded within GP clinical systems using the new national SNOMED codes.

Where a PCN employs or engages one or more social prescribing link workers under the Additional Roles Reimbursement Scheme or sub-contracts provision of the social prescribing service to another provider, the PCN must ensure that each social prescribing link worker has the following key wider responsibilities:

1. draw on and increase the strength and capacity of local communities, enabling local Voluntary, Community and Social Enterprise (VCSE) organisations and community groups to receive social prescribing referrals from the social prescribing link worker
2. work collaboratively with all local partners to contribute towards supporting the local VCSE organisations and community groups to become sustainable and that community assets are nurtured, through sharing intelligence regarding any gaps or problems identified in local provision with commissioners, local authorities and (where appropriate) VCSE infrastructure organisations
3. have a role in educating non-clinical and clinical staff within the PCN through verbal or written advice or guidance on what other services available within the community and how and when patients can access them

A PCN must be satisfied that organisations and groups to whom the social prescribing link workers(s) directs patients:

1. have basic safeguarding processes in place for vulnerable individuals
2. provide opportunities for the patient to develop friendships and a sense of belonging, as well as to build knowledge, skills and confidence.

A PCN must ensure that all staff working in practices that are members of the PCN are aware of the identity of the social prescribing link worker(s) and the process for referrals.

A PCN must work in partnership with commissioners, social prescribing schemes, Local Authorities and voluntary sector leaders to create a shared plan for social prescribing which must include how the organisations will build on existing schemes and work collaboratively to recruit additional social prescribing link workers to embed one in every PCN and direct referrals to the voluntary sector.

4.2 Caseload

SPLWs tend to support people for an average of 6-12 contacts over a three-month period, but this will be flexible, depending on the support the person needs. A full time SPLW can have a typical annual caseload up to a maximum of up to 200-250. This may be lower depending on the complexity of peoples’ needs, the maturity of the social prescribing scheme and wider work they may be undertaking, such as community development activities or outreach.

Other case number targets, such as the Investment and Innovation Fund (IIF) should be viewed in the context of this maximum caseload per SPLW, and staffing levels set accordingly. 

SPLWs should manage their own caseload to work with people in a format that works for them, including face to face appointments, home visits and community-based activity. 

5. Training and development in post

Investing in learning and development is one way that employers can support the delivery of excellent healthcare and health improvement, along with quality supervision and management support. It helps ensure that the workforce has the right skills, knowledge and behaviours to do their role effectively.

SPLWs should complete training and any on-going development to support their role. It is the responsibility of the employer to ensure that SPLWs have the appropriate level of training, and/or to support their training needs by funding and allowing time to attend training.

In primary care, while the ARRS funds relate to the salary costs of the SPLW (and a contribution to hosting costs, where SPLWs are employed by a VCSE organisation), there are a range of other funding streams already available to PCNs and to Systems for the development and management of PCNs and their workforce, including SPLW, employed through the ARRS.  

As the background skills and experience of SPLWs will be varied, the training or development needs at each stage of employment as a link worker needs to be led by the individual’s needs, based on a joint understanding by supervisor and staff member, and knowledge of needs of the local community. The Portfolio of Evidence template tools at Annex B, will help with this understanding, and section 6 on Supervision sets out expectations around the supervisory relationship, with recommendations on supervisor skills and training resources in Annex C. 

The broad phases we have set out below are a general guide, and decisions need to be made by the employer about readiness to work independently, and with the link worker about individual training and development needs. 

While all link workers will go through the first two phases, it is not necessarily expected that they will move on to specialise or become managers, as this will depend on individual career aspirations (see Career Pathways).

5.1 New SPLWs

Before SPLWs can work independently with people, they should complete an induction and onboarding and training process. This will ensure that SPLWs understand their role, have basic skills to start working with people, and can keep themselves and the people they work with safe. It will also help SPLWs to prepare for the challenges of the role and identify their base skills, knowledge and competencies.

5.1.1 Induction

PCNs as employers will want to ensure that all staff are valued and are treated with dignity and respect. Local induction is necessary for onboarding of new SPLWs, and this should promote good working relationships within the PCN, and with other areas of the NHS and external agencies, to help SPLWs feel supported and valued at work. Local induction should also include information for the wider workforce about the SPLW role and appropriate referrals and allow SPLWs to work as part of the MDT effectively.  

Employers may wish to include shadowing colleagues, being observed and receiving feedback, and establishing peer support relationships with other SPLWs as part of the onboarding process. It may also be helpful to establish reflective practice at the outset, and employers should think about the learning environment for SPLWs, as with all staff. 

Sole SPLWs working in PCNs may need additional support during induction to establish peer support relationships across organisational boundaries. Employers are encouraged to support SPLWs to connect with regional networks and to provide protected time to attend peer support sessions.

The PCN guide and technical annex includes an induction checklist.

5.1.2 Initial training

In line with the Network Contract DES, SPLWs employed in or by Primary Care Networks (PCNs) must provide to the PCN’s patients access to a social prescribing service. To comply with this, a PCN may:

• Directly employ SPLWs; or
• Sub-contract provision of the service to another provider in accordance with this Network Contract DES Specification.
• Enrol in, undertake or qualify from appropriate training as defined by the UK Government
• Complete the mandatory NHSE e-learning programme, found and be accessed at: Personalised Care Roles and  NHS England e-Learning for healthcare
• Attend the peer support networks delivered at place or system by the ICS and/or NHS England in the region

Where a PCN employs or engages a SPLW under the Additional Roles Reimbursement Scheme, the PCN must ensure that the Social Prescribing Link Worker:

1. has completed the NHS England and online learning programme accessed via the Personalised Care Institute website; and
2. attends the peer support networks delivered at place or system by the ICS in the region.

Additionally, where the SPLW does not already have a level 3 qualification (for example, A level or other equivalent post-16 education), the PCN should ensure that they are enrolled in or, undertaking appropriate training for social prescribing link workers.

Appropriate training includes a level 3 apprenticeship or level 3 training from the Personalised Care Institute approved list.

For those workers who already have a qualification at level 3, a level 3 social prescribing course is recommended but not mandatory.

In order to deliver the key responsibilities outlined above a PCN can claim reimbursement for the time Social Prescribing Link Workers spend out of practice undertaking these activities, noting the provisos for level 3 training, i.e. that reimbursement is for those who do not already hold an equivalent qualification.

The e-learning programme provides a brief overview of the role, expectations, evidencing impact, and a range of population- or issue-specific modules. Further initial training expectations for SPLWs are set out on the Personalised Care Institute website, that includes the PCI’s Core Skills and Personalised Care and Support Planning eLearning modules, which will allow SPLWs to understand working in a personalised way.

Peer support networks are delivered in local areas in a range of ways, such as regional peer support meetings, local communities of practice and group peer supervision sessions. For information about these, contact your ICS. 

NHS England regional training hubs provide information about primary care workforce, education and development, based local needs, bringing together education and training resources from a range of providers. They support every practice and PCN with access to information, resources, apps and contacts as well as national and local networks that can offer practical guidance, support and advice.

All new staff will do their mandatory and statutory training including safeguarding and data protection. This is a good time to introduce new team members to outcomes measurement tools used and ensure familiarity with case management systems and any reporting needed.

5.2 Continuing Professional Development

Following induction SPLWs will begin working independently, using and developing the skills, knowledge and behaviours in the Competency Framework to support clients. 

SPLWs and supervisors are expected to work together to undertake continuing personal and professional development, taking an active part in reviewing and developing their roles and responsibilities. 

Professional development planning takes place through clinical supervision, using experiential learning and workplace feedback as opportunities to engage in reflective practice, provide feedback to SPLW. It is a key part of ensuring patient safety and positive outcomes. SPLWs should be offered supervision on a frequent basis and at least monthly. Supervision expectations are set out in section 6 and supervisor standards in Annex C. 

We recommend using the Competency Framework (Annex A) and Portfolio of Evidence (Annex B) to provide structure for conversations about CPD during supervision sessions. 

CPD can be undertaken through a range of methods, including through formal or  training from PCI approved list, but also as part of the PCN or host organisation learning environment. For example, shadowing with colleagues, reflective practice, group supervision or case discussions, pair reflection sessions, community-based projects, independent reading and research are all valid forms of CPD. SPLWs need appropriate protected time in their work schedule for CPD in any format.

A wide range of other training is available for SPLWs. For example, the Personalised Institutes ‘PCI Plus’ offer. Many local authorities also provide training for community and care workers that may be appropriate for SPLWs. This will also provide learning in a local context and allow for relationship building with colleagues in other sectors. 

National learning offers are outlined in the Resources section.

6. Supervision

Supervision is a process by which individual SPLWs work with another person to meet their professional, organisational and personal objectives, which together promote best outcomes for the patient. 

Supervision covers the various types of support a SPLW will need to practise safely and effectively. It includes day to day management and clinical and professional expertise. Supervisors should have a good understanding of the level of skills and competencies a SPLW has, where they are now, and what they need to do to progress. They are enablers that support good working relationships and help to address issues and celebrate achievements. They encourage reflection and ongoing development and improvement.

Health and care providers regulated by the Care Quality Commission (CQC) are expected to offer staff regular supervision to ensure staff are competent and confident to do their role. 

SPLWs starting in role will already bring knowledge and skills and will continue to develop these through formal learning and CPD after identifying training and development needs through supervision. They will also gain support from their peers through formal and informal peer support networks, and from the wider team within the practice, PCN, wider NHS, host organisation or other organisations.

Across England, SPLWs are employed by a variety of different host organisations:

• Voluntary, Community and Social Enterprise organisations (VCSE) including faith organisations
• Local Authorities (LA)
• PCNs
• Other organisations, such as hospitals and agencies supporting discharge from hospital

All SPLWs will need supervision, which should be provided by their employer.  Regardless of which host organisation employs the SPLW, if the role is funded through the Network Contract DES the PCN contractual obligations regarding supervision are the same, and are set out below. However, in practice, SPLWs may be supported by a number of people depending on who the host organisation is. 

6.1 Supervision of SPLWs in PCNs

The Network Contract DES requirements on supervision are in the boxes below, accompanied by advice for implementation.  

6.1.1 First point of contact in each GP practice

The PCN’s member GP practices must each identify a first point of contact for general advice and support for the SPLW.

The role of the first point of contact will be to enable the SPLW to develop effective working arrangements with all staff within the member practices and to ensure that all staff can support the link worker role. This role could become a designated ‘social prescribing champion’ within each member practice.

6.1.2 GP supervisor

The PCN must appoint a GP supervisor, if different to the first point of contact, to provide supervision for the SPLW. This could be provided by one or more named individuals within the PCN.

SPLWs may also have a non-GP supervisor to line manage their work on a day to day basis. 

The supervisor(s) should meet regularly with the link worker to provide line management and supervision, discuss address any issues or concerns and ensure the link worker can succeed in the role. This will include patient-related concerns, for example, abuse, domestic violence, or other safeguarding issues, and refer individuals back to other health professionals as relevant, for further support, review or monitoring. 

Where the social prescribing link worker is employed by a host organisation, the GP supervisor is still required. In this arrangement, the GP supervisor may find it helpful to involve the partner organisation in regular progress updates about the link worker role, to enable clear lines of accountability, seamless joint working and problem-solving challenges together. 

6.1.3 ‘Clinical’ or non-managerial supervision

The PCNs must provide monthly access to clinical supervision with a relevant health professional.

‘Clinical’ or non-managerial supervision will enable the link worker to manage the emotional impact of their work and be guided by clinicians on dealing effectively with patient risk factors.

Clinical supervision supports continued professional development to enable a social prescribing link worker to develop in their role, ensure patient safety and high-quality care, by identifying training and development needs and supporting reflective practice. It is important that the supervisor possesses the skills and competencies needed to offer a constructive supervisory relationship and environment.  

How is clinical supervision different to workplace supervision?

Workplace supervision: includes the day to day oversight of the SPLW role by the GP supervisor and line manager. It is a space to discuss how you’re getting on with referrals, discuss issues relating to your schedule and contract. It is also a place to access emergency support (that is, the named GP when there are concerns over specific cases, particularly in relation to safety and safeguarding).

Clinical supervision: is the space to reflect more deeply on professional practice with a supervisor, ideally independent from the immediate work area. They will be skilled in supporting SPLWs to work through and develop their practice, themselves and the relationship with clients and the wider service. It is a place to discuss where the boundaries of practice are tested and explore options and solutions.

6.2 Supervisor roles and skills

The Personalised Care Institute have developed supervision recommendations for staff supervising SPLWs, exploring how the different types of supervision are delivered, and the skills needed by supervisors (Annex C). It aims to describe the supervisors’ roles in working with their staff member to use a structured approach to orientate and embed skills in the workplace. 

Alongside the competency framework (Annex A), the PCI’s supervision recommendations are designed to create a partnership between SPLW and supervisor, to promote safe and effective practice. It provides a foundation for personal and professional training and development for supervisors as well as giving a framework for support for the SPLW. 

7. Ways of working: professional framework

7.1 Working with people

SPLWs will support a wide variety of people from diverse backgrounds, including people with a range of conditions and disabilities. They should be able to adapt their communication approach to individual needs, including using plain language and culturally appropriate communication. SPLWs should ensure the people they support are able to say:  

• I am listened to and understood, and ‘what matters to me’ is central to all our work together. 
• I am respected and treated with dignity as an individual. 
• My human rights are protected, and I do not experience discrimination. 
• I experience warm, compassionate, personalised care and support. 
• If I raise a concern or make a complaint, it is acted on quickly. 

SPLWs should work with people to set clear expectations around their expertise and knowledge and how they can support the individual. This includes establishing boundaries and being clear on issues around confidentiality and safeguarding. 

7.2 Multidisciplinary Teams

A multidisciplinary team (MDT) is a group of professionals working together with the person at the heart. MDTs can be in place in primary, secondary and community settings. Working this way allows a wrap-around, holistic approach to supporting individuals, looking at everything that affects their health and wellbeing, and allows professionals to work together to explore problems and reach shared solutions. The MDT allows a wide range of experts to work with an individual, including those from health services, social care and the VCSE sector.

In line with the Network Contract DES, SPLWs must be embedded within the PCN’s core network practices and be fully integrated within the MDT. They must have access to other healthcare professionals, to electronic ‘live’ and paper-based record systems of the PCN’s Core Network Practices, as well as access to admin/office support and training and development as appropriate (Network Contract DES 7.4.1). 

SPLWs are not responsible for leading or convening MDT meetings, but they may present a patient in the same way other colleagues do.

SPLWs should attend MDT meetings to offer expertise on where SPLW support or community support would be beneficial to a patient, and enable the MDT to support patients with their social, emotional and practical needs through community support as well clinical treatments.

Considering care from this perspective will also enable patients to make the most of clinical treatment available, by building support networks and connections and reducing barriers to accessing care to enable the best outcomes. Where there is doubt, or the clinical situation is complex, SPLWs should ensure that the goals and plan have been checked with a clinician involved in that individual’s care. This level of MDT working helps to secure patient safety and can provide case-based learning for the SPLW’s portfolio.

SPLWs will need an induction to MDT working and the range of roles within the MDT, and likewise MDT colleagues also require an introduction to the SPLW role, their offer to patients, and the process for referrals (Network Contract DES B3.9). This could be done through regular practice team training, mutual job shadowing, or share and learn sessions. 

SPLWs also work closely with a range of community agencies. SPLWs need protected time to build strong working relationships with these services to work effectively and bring external colleagues to the MDT where this adds value. .  

7.3 Personalised Care roles

SPLWs also work closely with other personalised care roles, including health and wellbeing coaches and care co-ordinators. 

Diagram 2 – Personalised care roles in primary care

All three of these roles have expertise in personalised care approaches and working with people to understand their situation and needs, but each has a distinct role and skills. Information about the roles of health and wellbeing coaches and care co-ordinators can be found on the NHS England website.   

8. Professional values and behaviours

SPLWs should believe in and be committed to the values set out in the NHS constitution, along with the principles of personalised care and focusing on what matters to the person. 

There are 6 NHS values that all staff are expected to demonstrate:

As SPLWs sit in both the health and community worlds, and are not uniquely employed within PCNs, employers may have their own set of values and professional behaviours that they expect of all staff. It is the responsibility of the employer to communicate their values and expectations around these to SPLWs during recruitment, induction and supervision.  

There are also existing voluntary codes of practice which SPLWs and employing organisations can sign up to if they choose to be members of support organisations.

9. Competency framework

The Competency framework (Annex A) sets out the core competencies that all SPLWs working in or with PCNs need in order to deliver their role, and is designed to assist those who employ or direct the activities of SPLWs to understand the competencies for practicing safely and effectively in their role, and how these competencies can be achieved.

It should be used to ensure that people with the right skills and abilities are being recruited to the SPLW role, and as a tool to support continuing professional development (CPD).

Thee competencies are aligned to the NHS England sample Job Description for SPLWs and the Core Curriculum for Personalised Care published by the Personalised Care Institute (PCI).

The framework is divided into four areas: 

• competencies to engage and connect with people
• competencies to enable and support people 
• competencies to enable community development  
• competencies for safe and effective practice 

For those in specialist roles or working with specific population groups, these core competencies will still apply.  Specialist SPLW will also need appropriate skills, experience or qualifications in working with specific client groups. 

Recruitment, induction and supervision of SPLWs should include consideration of the competencies and plan how SPLWs will be supported to demonstrate and develop their skills. The competency framework can be used in combination with the Portfolio of Evidence (Annex B). 

10. Portfolio of evidence

The Portfolio of evidence (Annex B) enables SPLWs and clinical supervisors to evidence the depth of their knowledge, skills and behaviours. The Portfolio of Evidence is not a formal assessment tool, but a supportive toolkit for SPLWs to build their reflective practice. 

It provides tools to:

• evidence and reflect on practice 
• identify CPD needs and opportunities 
• demonstrate the impact of social prescribing
• demonstrate how SPLWs can work as part of the MDT
• support supervisors to understand the SPLW role

The Portfolio of evidence includes:

• observation sheet and a pre observation guidance sheet
• reflective practice tool
• case study template
• patient feedback survey

The Portfolio provides suggestions on how and when to use each tool, but SPLWs and employers are encouraged to use the Portfolio in the way that works best for them, including agreeing frequency of use and format.  SPLWs may find protected time to use the tools and reflect on their practice useful. 

The Portfolio of evidence has been developed by the National Academy of Social Prescribing (NASP) on behalf of NHS England.

11. Career pathways

11.1 Entry into the SPLW role

There is no single route into being a SPLW, and the wide range of backgrounds is a strength given the wide range of issues that SPLWs support people with, and when building teams of link workers and working with a range of population groups. 

Research by National Association of Link Workers (NALW) shows a wide range of entry routes, previous experience, existing qualifications of SPLWs, and an equally wide range of progression routes (see Annex D). This research shows a wide range of prior professional roles and levels of academic qualification which provide a potentially large pool of skilled and experienced candidates for recruitment into SPLW roles. 

As the SPLW profession grows, further work on developing career pathways and progression routes would be welcome. 

Informal routes into employment and tackling inequality

In addition to entry routes based on prior professional experience, social prescribing can offer a route into employment for those who may have lived experience, but few formal qualifications, given the emphasis on personal qualities and life experience in the sample job description and competency framework. 

A community health and wellbeing worker apprenticeship is one route into the role of SPLW. The purpose of a community health and wellbeing worker is to work in partnership with individuals and their communities to identify and address health and wellbeing needs, improve health, prevent ill-health and reduce inequalities. After completing the apprenticeship people may choose a career as a SPLW. However, they would still need to demonstrate the necessary competencies, be committed to personalised care and have the necessary SPLW training set out in earlier sections.

Similarly, those who take a route to employment through volunteering in community services may find that this experience offers a route into SPLW and other similar roles. In this way, social prescribing can be a powerful force in tackling inequity in employment opportunities as well as health inequalities.

11.2 Career development

The competency framework, the portfolio of evidence and clinical supervision will help SPLW to identify how their skills and experience can be transferrable to new roles. 

For example, the core personalised care skills essential to working with people may lead SPLWs into careers in coaching, counselling or to other clinical roles in the NHS, such as occupational therapy; skills of managing and reporting on data may lead to a route into evidence and service development; ability to manage multiple relationships and support link worker colleagues may lead to managerial roles within social prescribing services. 

As well as progression into senior, specialist or managerial SPLW roles, or moving to SPLW roles in other organisations, the NALW research shows SPLWs moving on to community development roles, Allied Health Professional (AHP) roles, or assistant AHP roles such as dietetic assistant, OT or psychology, and to lifestyle roles such as coaching or counselling. 

11.3 Progression into specialist roles

Developing SPLW specialisms may be important for the PCN in response to local health needs identified through the SPLW service or through Population Health Management analysis or development of the local proactive social prescribing plan. 

SPLWs may also be interested in developing specialisms related to their personal interests and strengths identified through their ongoing supervision. Specialisation is an emerging career pathway which enables retention of skilled and experienced SPLWs within PCNs. 

Specialties that are emerging include supporting:

• children and young people
• mental health
• financial inclusion and advice 
• refugees and asylum seekers 
• secondary care, including hospital discharge

The approach to developing specialist roles should be tailored to local needs. Models that are emerging include: 

• matrix approaches that develops theme lead roles within a team, where SPLWs have specialist knowledge but also take generalist cases
• individual SPLWs specialising exclusively or primarily on a specific population cohort
• specialist SPLWs acting as advisors on SPLW colleagues’ cases 

Specialist roles can be developed as part of plans to proactively expand the local social prescribing offer. This could include increasing the number of SPLWs working in a service and providing both specialist and generalist support, building teams of SPLWs who complement each other. 

While the SPLW Competency Framework describes core competencies for all SPLW, employers should ensure that SPLWs moving into specialist roles are appropriately skilled, experienced and qualified, especially where they involve working with children and young people or vulnerable populations.

In addition, employers should ensure supervisors have the skills and experience to provide appropriate supervision for specialist roles. 

11.4 SP management and leadership roles

Line management of social prescribing teams may be a natural progression for experienced SPLWs, and effective management can improve retention of the workforce.  

Management is necessary to deliver high-quality social prescribing services, including elements outlined in this document on supervision and line management. Service managers may also have a service development function, working to ensure social prescribing is understood across the PCN and partners, building strategic or relationships across organisations, creating a supportive and empowering environment for SPLWs to thrive, and using population health management data and developing proactive social prescribing services. 

The template SPLW job description for PCNs is intentionally broad and includes elements that PCNs or employers may choose to separate out into a social prescribing managerial role. 

As there is a growing workforce of skilled and ambitious professionals within systems, and organisations that wish to invest in the roles and maximise the benefit, it is natural that there are already programmes to enable link workers to develop and lead and we expect to see more similar programmes develop in the future. 

12. Useful resources

Resources about social prescribing

• Welcome and Induction Pack for link workers in PCNs
• Making Sense of Social Prescribing – University of Westminster Report
• What is social prescribing? – The King’s Fund explainer

Training and CPD related resources

• PCI website
• Social Prescribing – Learning for Link Workers e-learning modules
• NHS England Social Prescribing Webinar Series

Personalised care focused resources

• Personalised care and support planning
• Shared decision making
• Health and wellbeing coaches
• Care co-ordination
• Supported self-management summary guide
• Measuring supported self-management

Primary care specific resources

• DES Specification
• DES Guidance
• Further DES links

Support for SPLWs working in the NHS

• Looking after you: free confidential coaching and support for the primary care workforce
• Supporting our NHS people
• Staff mental health and wellbeing hubs

13. Design group members

• Health Education England
• Office of Health Improvement and Disparities
• Personalised Care Institute
• National Academy of Social Prescribing (NASP)
• National Association of Link Workers (NALW) 
• Social Prescribing Network (SPN)
• University of Salford
• Regional advisors from range of NHS regions, systems, PCNs
• VCSE organisations
• NHS England Primary Care Workforce team
• PMA (formerly Practice Managers’ Association)

14. Annex A – SPLW Competency Framework

Overview

This competency framework has been designed to outline competencies for working in or with PCNs. This framework is aligned to the NHS England & NHS Improvement Sample Job Description for SPLWs (Annex A, Summary Guide). This framework is also aligned to the Core Curriculum for Personalised Care published by the Personalised Care Institute (PCI), which acts as the foundational framework for both Personalised Care and specific Personalised Care roles in primary care.

The Framework is divided into 4 competency areas:

1. Competencies to engage and connect with people
2. Competencies to enable and support people
3. Competencies to enable community development
4. Competencies for safe and effective practice

The content is designed to assist those who employ or direct the activities of SPLWs working in or with PCNs to understand the competencies for practicing safely and effectively in their role, and how these competencies can be achieved.

These competencies are applicable to all SPLWs working in or with PCNs.

This Competency Framework was co-produced by NHS England & Improvement with stakeholders including the Personalised Care Institute, employers of SPLWs, and SPLWs. The template SPLW job description for PCNs is intentionally broad and includes elements that PCNs or employers may choose to separate out into a social prescribing managerial role. 

16. Annex C – Supervisor roles and skills

Personalised Care Institute recommendations for supervision of SPLWs

Supervision is a process by which individual SPLWs work with another person to meet their professional, organisational and personal objectives, which together promote best outcomes for the patient.

Workplace supervision means supervising SPLWs in their day-to-day practice to ensure that they have opportunities to develop their role within the limits of patient safety service provision, their scope of practice and their professional and personal competence.

Supervision should be readily accessible on a daily basis, and flexible according to the needs of the individual, working context, and complexity of their role.

Clinical supervision refers to monitoring and supporting the professional progress of individual SPLWs over time. It aligns learning needs with curriculum and competency framework learning outcomes. Clinical supervision uses experiential learning and workplace feedback as opportunities to engage in reflective practice, provide feedback and undertake professional development planning. 

The delivery of clinical supervision is more formalised, usually external to the workplace, and planned at regular intervals, and at least monthly.

Group supervision refers to providing peer support through a small group or learning set as an additional or alternative format to individual clinical supervision of SPLWs. It provides opportunities for shared experience, peer learning, and a supportive environment. It is organised and facilitated by a suitably trained and experienced professional and is planned at regular intervals.

On the following pages we set out how the different types of supervision are delivered, and by whom, and what the supervisors own training needs may be.

Workplace supervision

Clinical supervision

Group supervision

Training and supporting SPLW supervisors

Workplace supervisors

Clinical supervisors

Group supervisors

17 Annex D – Career pathways research

Undertaken by National Association of Link Workers on behalf of NHS England in Jan-March 2022

Publication reference: PR1569