To explore factors shaping social prescribing (SP) link workers (LWs) experiences of their job, and how they influence decisions about whether or not to leave it.

LWs support healthcare delivery by listening to patients’ non-medical concerns and social or relational difficulties, connecting them to ‘community assets’ (groups, organizations, charities) when relevant to help. LWs try to assist people with often complex emotional and/or social issues. This can affect how they feel in their job.

As part of a mixed methods project on LW retention, a qualitative study was conducted. It involved 20 LWs, purposively selected from respondents to a questionnaire; variation in the sample was sought in terms of self-efficacy in the role, length of time in it, intention to leave or not, employing organization, where they worked in the UK and gender. Semi-structured interviews, conducted via Microsoft Teams, were audio-recorded and transcribed verbatim. Prior to interviews, we asked participants to take photographs of: a typical part of their working day; something that gave them confidence in their role; an unexpected part of their role. These photographs were discussed at the start of the interview. Thematic analysis was used to interpret data (the computer programme NVIVO supported this); this involved coding and clustering codes to develop analytical themes.

We produced four themes from the data; 1) Disconnection through place and space: straddling different organizational spheres; 2) Delivery ambiguity: vagueness around the link worker role; 3) Job misalignment and realignment: navigating identity and boundaries; 4) Clouded by instability: uncertainty around career advancement and sustainability. This led to the development of an overarching theme of LWs inhabiting a liminal space as they entered and undertook the role. Findings highlight the importance of training, supervision and other support to ensure LWs do not experience a prolonged liminal state.

The pressures facing emergency medical services (EMS) in Wisconsin and their effects on the delivery of prehospital emergency medical care were not known by the Wisconsin EMS Board. In an effort to assess these pressures and the needs of the emergency medical services in the State as perceived by the services, the Board undertook a survey of the EMS providers in Wisconsin.

A survey instrument was developed and approved by the EMS Board and distributed to all of the licensed emergency medical services in Wisconsin.

Of the 453 survey instruments distributed, 323 (71.3%) were completed and returned. Intermediate- and paramedic-level services were more likely to respond than were the basic services, but 235 (72.8%) of the respondents identified their service levels as basic. In addition to providing information about the service characteristics, each responding service also rated the importance of their perceived needs. Lack of medical direction was perceived as the greatest need by all levels of service. However, the second greatest area of need for basic and intermediate services related to difficulty in recruiting new staff. For paramedic services, the second greastest need was associated with dispatching. When comparing services by rural versus urban, difficulty in recruiting new staff and collecting ambulance fees were seen as second and third to lack of a medical director by rural services, whereas urban services noted local training to be in the top three. In the assessment of educational needs, patient-care issues dominated. A review of written comments also demonstrated a difference between rural and urban services, but both noted Medicare and Medicaid reimbursement issues more commonly than any other problem.

In the restructuring of health care, it will be important to consider the various needs of prehospital providers and recognize that such needs may be unique to the providers' location and level of service.