In the first episode of our joint podcast with the ALLIANCE, Equally Valued, we spoke to a links worker concerned about the impact of fuel poverty on patients referred to her services. Following up with links worker, Samantha Hawkins and GPs working with the programme, healthandcare.scot learned of the critical support provided by these in-demand professionals.

Community links workers (CLWs) are based in GP practices, providing valuable, non-clinical support to patients most in need.

Early adopters of the CLW rollout across Scotland – an initiative run by the government, the ALLIANCE and WithYou – includes practices in Dundee, Glasgow, Inverclyde, Edinburgh and North Ayrshire.

What do links workers do?

Providing a connection between primary care teams and local support services, CLWs like Samantha Hawkins take referrals from the full team within their GP practice.

Ms Hawkins, one of around 59 CLWs employed by the ALLIANCE, explains that she does more than just offer a list of services:

“We’re there to help patients from a non-medical  view – I describe it as working with the social determinants of health. Everything around a person can filter down and affect their health.

“It’s a spectrum – from fuel, food, housing to relationships and mental health and then signposting or supporting people to access a specific service is key.

“Listening too, to what people feel they need
and finding services or support to help them is just invaluable as a links worker.”

In 2016, the Scottish government made a core manifesto commitment to recruit 250 more CLWs across its most deprived areas.

Dr Andrea Williamson, a Deep End GP specialising in Inclusion Health says CLWs are especially valuable in such areas:

“The input of CLWs has moved patient care on remarkably. One of the unifying things about CLWs is that they are interested in people and in supporting people.

“They do this through wider social prescribing – so, what other activities, groups, and socially orientated support can be offered? They have a really good knowledge of the local area and what’s available.”

Beyond individual interactions, healthcare professionals said in a Public Health Scotland (PHS) report that CLWs allowed GPs more time to attend to patients, with PHS noting that more data is needed.

A study found 78% of GPs had prescribed antidepressants when they would prefer an alternative. Social prescribing led by CLWs can support people to engage with their local community and find support from other non-clinical services, like money advice or food banks.

Where are they based in?

Earlier this year, healthandcare.scot reported that the government had fallen short of its CLW recruitment target, saying that services were not intended to be universal.

Dr Williamson says that every GP surgery would benefit from CLWs. She added:

“Deep End practices cover blanket socioeconomic deprivation – most of our patients will experience high socioeconomic deprivation and adversity. There are people experiencing that in any practice across Scotland and patients facing lower socioeconomic deprivation will still benefit from CLWs.

“But we would really like to stick to proportionate universalism – practices with larger numbers of Deep End patients should have proportionately more links workers.”

GPs across Scotland called for more CLWs in July of 2020, especially in the most deprived areas. By January 2022, they were still limited by funding, as under 60% of practices had CLWs. Ms Hawkins says some CLWs worked part-time across two or more practices in a community.

Challenges to links workers

We reported previously that some patients are unhappy being directed to alternative care pathways like CLWs, in part due to poor health literacy.

Ms Hawkins, a links worker in Glasgow, says that if the CLW role is well-explained, most people are accepting of their help.

Dr Williamson highlights the importance of trauma-informed practice, recognising people’s history, adverse childhood experiences, and acknowledging that some patients may then struggle with trust is key to effectively connecting patients with this additional support.

Even with well-established trust between the CLW and wider community, she explains that their help is ultimately limited by systemic problems:

“It’s important to recognise the impact of austerity and welfare reform has had on people. In some ways, as Deep End GPs and I imagine CLWs, what we’re doing is pushing a boulder up a steep hill.

“People do not have money to live a life that is safe and secure, to heat their home – we are trying to mitigate for the structural stuff that is policymakers and government’s role to change.”

Ms Hawkins agrees, saying the biggest struggle in her job are the lack of resources:

“More funding is needed to support people. A lot of local resources – churches and groups that are running – are invaluable as they are in touch with the community needs. If they don’t have enough funding to keep going, the support people need is gone.”

Food vouchers and free Wi-Fi access are also important offerings - one Ms Hawkins patients told her that, without these, they did not think they would have survived. She adds that travel vouchers are incredibly important among people seeking asylum in Scotland.

“It’s a shame because the services that could help people seeking asylum are not close by, they need to travel to them. There are people who have arrived themselves and are totally isolated. After everything they’ve gone through to get here, people are just left alone – it’s like they’re dumped.”

A motion to extend free bus travel to people living in Scotland who are seeking asylum was submitted this month. It has not yet achieved cross-party support.

A Glasgow-based GP healthandcare.scot spoke with recalled that patients housed in hotels in the city centre while they seek asylum are “really isolated, little-to-no contact with people or support systems.” After initial consultation for health concerns, the CLWs can provide vital links to community organisations.

The most rewarding part of the job according to Ms Hawkins, is how her CLW skills and growing knowledge can meaningfully improve to the lives of patients and their families – even if they did not believe it possible to begin with.

You can listen to all Equally Valued podcast episodes here.

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