Befriending, health and social prescribing
Social prescribing is the route by which a GP practice or another health professional refers a person to non-clinical support in their community rather than to a treatment, and the person who takes that referral and does the connecting is a social prescribing link worker.
A coordinator being offered a referral route from a GP practice, and a person told by their surgery that somebody will ring them about befriending.
The volunteer. A health referral means the person was referred because of a health need, and a scheme that accepts the referral without accepting the information has put an untrained person in a room with a problem nobody described.
The referral says “low mood, would benefit from social contact”. It does not say the person was discharged from a mental health team last month. The volunteer finds that out alone, on a Tuesday evening, in the person’s front room.
Befriending is one of the things people are most often connected to. The activity a volunteer does afterwards is identical to any other befriending match. The risk profile is not, and this page is about the difference.
What a social prescribing link worker actually does
A social prescribing link worker takes a referral from a GP practice, meets the person for a longer conversation than a clinical appointment allows, works out what would help, and connects them to it. The role is non-clinical: a link worker does not diagnose, prescribe or provide therapy. What they provide is time and local knowledge, and their involvement is usually short, a handful of contacts to get the person connected, then a handover.
People are referred for reasons social in origin and clinical in presentation: loneliness after bereavement, low mood without a diagnosis, long term conditions that have shrunk somebody’s world, money and housing worries, adults with learning disabilities whose support ended at a transition, and frequent attenders whose repeated appointments are the only conversation in their week. In England link worker posts sit in primary care networks and are funded through NHS arrangements for additional practice roles. Scotland, Wales and Northern Ireland run their own community link worker arrangements, with different names, employers and funding routes.
This site does not publish link worker salaries and does not list vacancies. Pay bands and job adverts are published by NHS employers, primary care networks and the voluntary sector organisations holding the contracts, and those are the accurate source.
Social prescribing in mental health, and where the boundary sits
Social prescribing in mental health works at the mild to moderate end and alongside treatment, never instead of it. A person with low mood driven by isolation is a good referral. A person in crisis, actively suicidal, or under the care of a secondary mental health team is not a referral a befriending scheme should take on its own, without an agreed plan and a named clinician who retains clinical responsibility, and a scheme that accepts them because the form said “needs company” has accepted a clinical risk with a volunteer as the only mitigation.
The distinction a coordinator has to enforce is between company and treatment. Befriending can reduce loneliness, and that evidence is real but modest, weaker and less consistent on depression and on use of health services. Befriending cannot treat a mental illness, cannot substitute for a mental health team, and cannot hold somebody between discharge and relapse. Where a referrer is using befriending to fill a gap in clinical provision, the coordinator names that out loud at the referral stage, in writing, and declines.
How the referral should arrive, and what the scheme must ask for
A referral should arrive with enough information for the scheme to assess risk and match sensibly, and a scheme is entitled to refuse an incomplete one. Ask for six things every time:
- State the reason for referral in plain terms, not a category on a dropdown.
- Confirm the person has consented and knows a volunteer will contact them.
- Describe any risk to the volunteer or the person, including anything known about aggression, alcohol, dogs, or the state of the property.
- Name the other services involved, and whether any are closing.
- Record communication needs, including a first language other than English, hearing or sight loss, and whether a telephone match would work better than a visit.
- Give a named professional and a working route to reach them, with what happens to that route when the link worker steps back.
The sixth is most often missing and matters most. A link worker’s involvement is short by design. If the escalation route disappears with them, the volunteer becomes the only person in regular contact with somebody the NHS referred because they were at risk of getting worse, and nobody has told the volunteer that is what happened.
The volunteer is the only person still in contact
The volunteer keeps the visit or the call and changes nothing about it, then tells the coordinator that the other services have gone. The coordinator goes back to the referring practice in writing, asks who now holds clinical responsibility, and records the answer. A befriending scheme can hold company indefinitely. It cannot hold clinical risk, and the point at which it is the last service standing is the point at which somebody has to say so.
What the NHS expects back
What the NHS expects back is smaller than most coordinators fear and more specific than most reporting produces. A commissioner or practice typically wants four things: confirmation the referral was received and acted on, whether the person actually engaged, a short outcome measure at the start and again later, commonly the Office for National Statistics personal wellbeing questions, and notification of anything that went wrong. What it does not want, and should not be given, is the content of the conversations.
Two warnings about outcome reporting. A scheme can reduce loneliness, which is how a person feels, without reducing isolation, which is how many contacts they have, and reporting one as the other misleads a commissioner into thinking a different intervention worked. And this site attributes no reduction in hospital admissions or appointments to befriending, because the evidence does not hold. A scheme that builds its funding case on avoided appointments has agreed to be judged on what it is least likely to deliver.
Why a health referral changes the risk profile of a volunteer scheme
A health referral raises the risk profile in four ways at once, even though the volunteer’s activity has not changed. The person is more likely to be unwell than a self referrer. The referrer holds information the scheme does not automatically receive. The person may understand the volunteer as part of the NHS, which has consequences when they mention a symptom instead of telling their GP. And the scheme has taken on an expectation of feedback to a statutory body, which is a data protection question as well as an operational one.
The consequences for scheme design are concrete: a heavier initial assessment, a home visit by staff before any volunteer attends, tighter supervision in the first three months, and a written statement that the volunteer is not a health worker and cannot pass messages to a doctor. Volunteers are checked through the route for their nation, a DBS check in England and Wales, PVG scheme membership in Scotland, an AccessNI check in Northern Ireland, and where the role meets the legal definition of regulated activity with adults, that check includes the adults’ barred list. Whether it does is decided against the definition, not against how serious the referral feels.
The befriender
- Keeps to company and conversation, and refers every clinical question back to the person’s GP
- Reports a change in the person’s health or mood the same day, describing what they saw
- Declines to carry messages, prescriptions, medication or money between the person and any service
- Says clearly, when asked, that they are a volunteer and not from the surgery
The person referred
- Consents to the referral before the scheme contacts them, and can withdraw it without affecting their care
- Is told what information came across from the practice, and what will go back
- Can choose a telephone match instead of a visit, or a different volunteer, at any point
- Keeps their GP as the route for anything clinical, and is told so at the first meeting
The scheme agrees in writing with the referring practice what information flows each way, on what lawful basis, and who holds clinical responsibility once the link worker steps back. It keeps records for a period it has written down, commonly 6 years after a match closes, because UK GDPR sets no fixed retention period and requires the scheme to justify the period it applies.