Social Prescriber (Link Worker)

Job description

Job responsibilities

Job Description Social Prescriber Link Worker

Primary Care Network: East PCN

Salary: Competitive salary depending on experience

Hours: 37.5

Reporting to: PCN Clinical Director, PCN Manager

Accountable to: Tracy Hutchinson, Sunderland East PCN Manager

Location: GP practices across East PCN

Job Purpose

The Social Prescriber, Link Worker will work as part of the East PCN multidisciplinary team to support people with non medical needs that affect their health and wellbeing. The role focuses on personalised care, addressing health inequalities, and supporting individuals to improve their quality of life by connecting them to community based services, activities, and support.

The postholder will contribute directly to the PCN DES personalised care requirements, supporting demand management in general practice and helping people to take greater control of their own health and wellbeing.

East PCN consists of 7 GP partnership practices: Ashburn, Deerness Park, New City, Park Lane, River View, Southlands, Villette.

You will become part of our well-established social prescribing team in supporting our patients to ensure they receive the best possible care.

Key Responsibilities

Personalised Care and Social Prescribing

Receive and manage referrals from GP practices, PCN MDTs, and other primary care professionals.

Undertake personalised conversations using a what matters to me approach.

Co produce personalised wellbeing plans with individuals.

Support individuals to access appropriate voluntary, community, faith and statutory services.

Empower people to build resilience, confidence, and self management skills.

Provide time limited support, reviewing progress and adjusting plans as needed.

Reducing Health Inequalities

Proactively support individuals experiencing health inequalities, social isolation, loneliness, or wider determinants of poor health.

Work with underserved groups, including those with long term conditions, mental health needs, carers, and people experiencing deprivation.

Ensure equitable access to social prescribing across East PCN practices.

PCN and MDT Working

Work closely with GPs, nurses, care coordinators, mental health practitioners, and other ARRS roles.

Participate in PCN MDT meetings, neighbourhood working, and integrated care approaches.

Support practices to embed social prescribing into routine workflows and referral pathways.

Contribute to PCN service development and continuous improvement.

Community Asset Mapping

Develop and maintain up to date knowledge of local community assets and services.

Build strong relationships with voluntary and community sector partners.

Support sustainable links between primary care and community services.

Identify gaps in provision and feedback intelligence to the PCN.

Data capture

Support referral agencies to provide appropriate information about the person they are referring, including demographic data and data on wider determinants, for example, caring status.

Provide appropriate and timely feedback to referral agencies about the people they referred.

Work sensitively with people, their families and carers to capture key information to measure impact of social prescribing on their health and wellbeing, using validated tools

Monitoring, Reporting and Governance

Maintain accurate records in line with PCN and host organisation policies.

Collect activity data and outcomes to support PCN DES assurance and reporting.

Contribute to evaluation of social prescribing impact at PCN level.

Work within safeguarding, information governance, and confidentiality frameworks.

Professional Development and Supervision

Engage in regular supervision and reflective practice.

Participate in relevant training, including personalised care and safeguarding.

Work within the scope of the role and escalate concerns appropriately.

Contribute to peer support and learning across the PCN social prescribing team.

Leadership

Be a system leader in the development, delivery and education of social prescribing, ensuring involvement where value can be added.

Provide role coaching and mentoring for all staff where appropriate.

Key Relationships

GP Practices within East PCN

PCN Clinical Director and PCN Management Team

Community and Voluntary Sector Organisations

Other ARRS roles and neighbourhood teams

Person Specification

Experience

Essential

• Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
• Experience of supporting people, their families and carers in a related role (including unpaid work)
• Experience of supporting people with their mental health, either
• in a paid, unpaid or informal capacity
• Experience of working with the VCSE sector (in a paid or
• unpaid capacity), including with volunteers and small community groups
• Experience of data collection and using tools to measure the impact of services
• Experience of partnership/collaborative working and of building
• relationships across a variety of organisations

Desirable

• Local knowledge of VCSE and community services
• Knowledge of how the NHS works, including primary care and MDT working

Qualifications

Essential

• Meets DBS reference standards and criminal record checks
• Willingness to work flexible hours when required to meet work demands
• Full UK driving licence with use of own car
• Access to transport and ability to travel across the locality on a regular basis, including to visit people in their own homes and support people to attend activities as appropriate.
• NVQ Level 3, Advanced level or equivalent qualifications or working towards
• Demonstrable commitment to professional and personal
• development

Desirable

• Training in motivational coaching and interviewing or equivalent experience

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Employer details

Employer name

Southlands Medical Group

Address

Black Road

Ryhope

Sunderland

SR2 0RY

Employer's website

http://www.southlandsmedicalgroup.nhs.uk/ (Opens in a new tab)