A target to recruit an additional 250 community link workers to GP practice teams by the end of the last parliament was missed by the Scottish government, new figures have revealed.

The pledge to recruit the staff, who work alongside GPs to direct patients to non-medical support, was made in the SNP’s 2016 manifesto and reaffirmed in the 2020 programme for government.

But an update shows there were 218 community link workers (CLWs) in place in March 2021, equating to 189 whole time equivalent (WTE) staff.

The figures were published by the Scottish government in a progress update on the implementation of the 2018 GP contract, which sought to minimise GP workload by recruiting a wider range of professionals to practice teams and transferring some services to health boards.

The BMA has said the new community services are being “significantly held up” due to a lack of staff.

Some areas, such as Aberdeenshire and Forth Valley, had no CLWs recruited by March 2021. Others, such as Fife, had seen fewer than five extra staff. 

Across the country just under six in ten practices now have access to a link worker.

The government says their services are not intended to be universal but are allocated on basis of need. A spokesperson said the target was expected to be met “by the end of this financial year”.

The Health and Social Care Alliance employs around 50 CLWs supporting 65 practices in deprived areas in Glasgow and West Dunbartonshire.

Sara Redmond, Chief Officer – Development at the ALLIANCE, said: “Links Workers have continued to provide essential support to people during the pandemic and highlight the importance of investment into the third sector to ensure there are the necessary community based supports to connect people into.

"The success of the programme shows that investing upstream and early can avoid crisis situations further down the line. It’s disappointing the recruitment target has not been realised and we would urge Scottish Government to fulfil their commitment.”

The statistics suggested no additional link workers had been recruited in NHS Highland under the initiative by March 2021. Dr Iain Kennedy, medical director of the Highland local medical committee, told healthandcare.scot he expected 29 workers to be in place by April 2022.

The Inverness GP said: “There wasn’t enough government funding to provide a CLW for all practices, so we decided to allocate the resource to those practices with more deprived populations. NHS Highland has acted in good faith with the very limited resources provided and Highland LMC has been impressed by the work done to get this 2018 GP contract variation workstream in place.”

Under the 2018 GMS [GP] contract, responsibility for a number of tasks previously led by GPs will be delivered instead by NHS boards to reduce GPs’ workloads and allow their role to evolve into being ‘expert medical generalists’ supported by a multidisciplinary team of different clinical and non-clinical staff.

The pandemic has meant the timelines for the transfer of vaccination, pharmacotherapy services – the routine management of people’s medicines, and so-called ‘community treatment and care services’ – which includes management and monitoring of chronic conditions – will all cease to be led by GPs from the 1st April 2022.

GPs voted in December to consider alternatives to the contract amid concerns over slow progress, backing a motion stating they had “lost confidence” in the government’s handling of the changes.

This week’s government statistics show major increases in staffing to support six priority services set out in the contract.

This includes more than 400 WTE pharmacists and more than 200 WTE pharmacy technicians since 2018. More than 200 WTE mental health workers and 160 WTE musculoskeletal physiotherapists were in post at the time of the March 2021 snapshot.

However significant numbers of practices still do not have access to all of the services that were supposed to be provided by health boards.

This varies from 88% having partial access to pharmacotherapy services to less than half having some access to urgent care services.

The definition of “access” has been locally determined by HSCPs, the report notes, adding that work is underway to improve reporting consistency.

Dr Andrew Buist, chair of BMA Scotland’s GP committee, told healthandcare.scot: “Progress on the GMS contract implementations is happening but just not as fast as we would like, it continues to be made with steady but locally variable increases across a number of services including pharmacotherapy and the vaccination transformation programme .

“Workforce supply is a problem, the new community services have been significantly held up by a lack of available healthcare workforce…we urgently need a workable plan and to redouble our focus on delivering these staff to support our practices”.

The first phase of CLW recruitment focused on the most-deprived practices. A 2020 report found the support had been “unvaluable” during the pandemic.

A Scottish Government spokesperson said: “Throughout the pandemic, we have liaised with Health and Social Care Partnerships about the recruitment of Community Link Workers. We expect to meet the target of 250 additional CLWs by the end of this financial year.

“Community Link Worker programmes have been rolled out at different rates across Scotland as it is for local areas to decide which practices require support depending on local population needs.

Read more: Links workers "stop people falling through the cracks"; Charity calls for links worker in every GP practice; GP contract causing pharmacist "workforce drain"

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