Community Link Worker Service
About the Service
CVS Inverclyde is commissioned to provide GP-based Community Link Workers (CLWs) in every GP practice across Inverclyde. Our Community Link Workers are fully embedded within practices and work alongside patients to address the non-medical issues that can affect health and wellbeing.
These might include:
By supporting patients with these challenges, Community Link Workers help people improve their mental and physical wellbeing and allow GPs and clinical teams to focus on medical needs during appointments.
Patient confidentiality is central to our role. Community Link Workers are bound by the same confidentiality standards as the GP practice team.
Referrals
How to make a referral
Most referrals are made directly by GPs and practice staff to the Community Link Worker at the practice. However, we want to make sure there are no barriers to accessing support, so:
- Patients can refer themselves
- Some external partner organisations can also refer
- It is important to follow the correct process depending on who is referring, as direct patient referrals cannot be made through the partner referral route
Patients referring themselves
Any registered patient at an Inverclyde GP practice can refer themselves to their practice Community Link Worker by:
- Contacting the GP reception team
- Asking for their details to be passed on to the Community Link Worker
- A GP appointment is not required before making a referral
Patients can call the reception team at a time that suits them (we recommend avoiding early mornings, when lines are busiest for urgent GP appointments).
The reception team will pass on the information and the Community Link Worker will then get in touch with the patient directly.
Professional partner referrals
Partner organisations can refer a patient using the referral form CLW Referral Form for Partners and submitting it to our monitored inbox: clwreferrals@cvsinverclyde.org.uk.
Please ensure the referrals inbox is used exclusively for this purpose, as referrals should never be sent to the general CVS Inverclyde email address.
Before submitting a referral, it is essential that:
- The patient has consented to the referral
- The patient’s GP practice is clearly identified
- Any known risk information is included
Supporting Patients
Once a referral has been made, the appropriate Community Link Worker from the GP practice will contact the patient to introduce themselves, explain their role and agree next steps. We get in touch in the way that works best for the patient – for example by phone, text, email or letter.
Please note: Community Link Workers cannot make GP appointments, obtain fit notes or request prescriptions. These should be arranged directly with your GP practice reception team. Find out more.
Together we will:
Talk through what is happening and what matters to the patient
Agree a plan and follow-up actions
Explore local services, activities and resources that may help
Review and adapt support as needed
While we often signpost patients to other services, many people face complex issues that can feel difficult to navigate alone. Our team take time to be “alongside” the patient, helping to remove barriers and build confidence to access support.
Once a patient is appropriately “linked” to the right support, we will step back – but we can re-engage if new issues arise and another referral is made.
Community Link Workers may meet patients:
At the GP practice
At another service
In a community venue or café
On a walk-and-talk
Occasionally at home (only when necessary and safe to do so)
Partnership Working
Community Link Workers are often described as “social prescribers”. This means we:
Listen to the issues a patient is facing
Explore options and resources together
Support patients to make informed choices about their next steps
As part of CVS Inverclyde, Community Link Workers are impartial and can actively promote:
Third sector services and community groups
Statutory and public services
Specialist organisations
A “social prescription” might involve support to:
Access counselling or mental health support
Get financial or debt advice
Resolve housing issues
Join community groups or activities
Arrange aids and adaptations at home
To keep our knowledge up to date, we:
Maintain regular contact with local and national partners
Host service update sessions
Attend events and themed network meetings
"Not all heroes wear capes.”
-Anonymous patient
"Excellent service. The Community Link Workers are always at the forefront of the team’s minds regarding patients."
-Inverclyde-based GP Practice
“Working in collaboration with them means we are able to expand on support we give to individuals and families experiencing crisis situations. It is a partnership that has a lasting impact on service users who are utilising the life changing support.”
-Relational Mentoring Service, Wise Group
Our Community Link Worker Team
Our Community Link Workers bring a wide range of professional and lived experience, including finance and money advice, nursing and health, social work and social care, recovery and mental health, employability and carers’ support.
Training is a key part of the role. The team receive enhanced trauma training and regular updates on new issues and developments, so that support is informed, sensitive and person-centred.
We also take part in regular reflective practice sessions, sharing experience, knowledge and learning across the team to ensure high-quality, consistent support.
