Job summary
The post-holder works alongside a team within the PCN and empowers people to take control of their health and well-being.
The post-holder will be an integral part of the PCN team, working across our seven practices, as well as part of a wider community groups and their multidisciplinary teams.
A referral to a non-medical link worker is designed to support patients to be able to take a holistic approach, connecting people to community groups and statutory services for practical and emotional support.
Social prescribing/Health and well being can help to strengthen community resilience and personal resilience while reducing health inequalities by addressing the wider determinants of health such as debt, poor housing and physical inactivity by increasing peoples active involvement with their local communities.
This role can be particularly beneficial to patients with long-term conditions, those with mental health issues and those who are lonely or isolated or who have complex social needs which affect their wellbeing.
Main duties of the job
To support patients in our local community to take control of their health and wellbeing by:
Promoting prevention & lifestyle changes
Engaging patients and connecting them with the wide range of groups and services
Working with the wider health, social care and voluntary network
Encouraging a holistic approach for patients with chronic diseases
Building a relationship in the journey of patients towards mental health services
Supporting the practices in attaining their referral targets
Promoting and raising awareness of the social prescribing service within the practices and partner agencies
The post holder will Provide care within own competence and seek advice or refer to colleagues when appropriate, ensuring that practice is effective, relevant, evidence-based and of a high standard.
About us
Our PCN has a patient population of approximately 50,000 across 7 practices. The PCN team currently has 40 staff delivering 11 centralised services, we have our own office base providing an excellent working environment for staff, this office is very close to our Lead Practice. We have a very motivated work-force always striving to provide excellent care for our patient population. All staff are valued and have opportunity to share ideas for future developments. We have just incorporated our new Limited Company and will be submitting our CQC application soon.
All staff are encouraged to develop, with study time supported, plus we have a robust PLT programme to support all staff. We are currently developing Clinical Supervision Groups across the whole PCN.
Job description
Job responsibilities
- Promoting social prescribing, its role in self-management, and the wider determinants of health.
- Build relationships with key staff in GP practices within the local Primary Care Network, attending relevant meetings, becoming part of the wider network team, giving information and feedback on social prescribing.
- Be proactive in developing strong links with all local agencies to encourage referrals, recognising what they need to be confident in the service to make appropriate referrals.
- Work in partnership with all local agencies to raise awareness of social prescribing and how partnership working can reduce pressure on statutory services, improve health outcomes and enable a holistic approach to care.
- Provide referral agencies with regular updates about social prescribing, including training for their staff and how to access information to encourage appropriate referrals.
- Seek regular feedback about the quality of service and impact of social prescribing on referral agencies.
- Be proactive in encouraging self-referrals and connecting with all local communities, particularly those communities that statutory agencies may find hard to reach.
- Provide personalised support: Meet people on a one-to-one basis, making home visits where appropriate within organisations policies and procedures. Give people time to tell their stories and focus on what matters to me. Build trust with the person, providing non- judgmental support, respecting diversity and lifestyle choices. Work from a strength-based approach focusing on a persons assets.
- Be a friendly source of information about wellbeing and prevention approaches.
- Help people identify the wider issues that impact on their health and wellbeing, such as debt, poor housing, being unemployed, loneliness and caring responsibilities.Work with the person, their families and carers and consider how they can all be supported through social prescribing.
- Help people maintain or regain independence through living skills, adaptations, enablement approaches and simple safeguards.
- Work with individuals to co-produce a simple personalised support plan based on the persons priorities, interests, values and motivations including what they can expect from the groups, activities and services they are being connected to and what the person can do for themselves to improve their health and wellbeing.
- Where appropriate, physically introduce people to community, groups, activities and statutory services, ensuring they are comfortable. Follow up to ensure they are happy, able to engage, included and receiving good support.
- Where people may be eligible for a personal health budget, help them to explore this option as a way of providing funded, personalised support to be independent, including helping people to gain skills for meaningful employment, where appropriate.
- Support community groups and organisations to receive referrals, forge strong links with local organisations, community and neighborhood level groups, utilising their networks and building on whats already available to create a map or menu of community groups and assets. Use these opportunities to promote micro-commissioning or small grants if available.
- Develop supportive relationships with local organisations, community groups and statutory services, to make timely, appropriate and supported referrals for the person being introduced.
- Ensure that local community groups and organisations being referred to have basic procedures in place for ensuring that vulnerable individuals are safe and, where there are safeguarding concerns, work with all partners to deal appropriately with issues. Where such policies and procedures are not in place, support groups to work towards this standard before referrals are made to them.
- Check that community groups and organisations meet in insured premises and that health and safety requirements are in place. Where such policies and procedures are not in place, support groups to work towards this standard before referrals are made to them.
- Support local groups to act in accordance with information governance policies and procedures, ensuring compliance with the Data Protection Act.
- Work collectively with all local partners to ensure community groups are strong and sustainable.
- Work with commissioners and local partners to identify unmet needs within the community and gaps in community provision.
- Support local partners and commissioners to develop new groups and services where needed, through small grants for community groups, micro-commissioning and development support.
- Encourage people who have been connected to community support through social prescribing to volunteer and give their time freely to others, in order to build their skills and confidence, and strengthen community resilience.
- Develop a team of volunteers within your service to provide buddying support for people, starting new groups and finding creative community solutions to local issues.
- Encourage people, their families and carers to provide peer support and to do things together, such as setting up new community groups or volunteering.
- Provide a regular confidence survey to community groups receiving referrals, to ensure that they are strong, sustained and have the support they need to be part of social prescribing.
- Adhere to organisational policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety.
Knowledge, Training and Experience
- Proven ability to work effectively in a team.
- Experience of working with a variety of different stakeholders.
- Ability to work with clinicians and other health and social care professionals.
- Evidence of ongoing training and personal development.
Planning and Organisational Skills
- To be able to plan, organise and prioritise a busy caseload with conflicting demands on time.
- To take an active role in identifying service development initiatives.
- Determine the patients holistic support needs accurately over the telephone or face-to-face and work with the patient proactively to support a positive outcome.
- Support patients to access appropriate support for important financial matters (i.e. personal budgets and benefits).
- Implement and follow up key action points from the MDT meetings on to the agreed care plan which is clear and concise contemporaneous.
- Effectively communicate a patients needs within a multidisciplinary team meeting environment
Job description
Job responsibilities
- Promoting social prescribing, its role in self-management, and the wider determinants of health.
- Build relationships with key staff in GP practices within the local Primary Care Network, attending relevant meetings, becoming part of the wider network team, giving information and feedback on social prescribing.
- Be proactive in developing strong links with all local agencies to encourage referrals, recognising what they need to be confident in the service to make appropriate referrals.
- Work in partnership with all local agencies to raise awareness of social prescribing and how partnership working can reduce pressure on statutory services, improve health outcomes and enable a holistic approach to care.
- Provide referral agencies with regular updates about social prescribing, including training for their staff and how to access information to encourage appropriate referrals.
- Seek regular feedback about the quality of service and impact of social prescribing on referral agencies.
- Be proactive in encouraging self-referrals and connecting with all local communities, particularly those communities that statutory agencies may find hard to reach.
- Provide personalised support: Meet people on a one-to-one basis, making home visits where appropriate within organisations policies and procedures. Give people time to tell their stories and focus on what matters to me. Build trust with the person, providing non- judgmental support, respecting diversity and lifestyle choices. Work from a strength-based approach focusing on a persons assets.
- Be a friendly source of information about wellbeing and prevention approaches.
- Help people identify the wider issues that impact on their health and wellbeing, such as debt, poor housing, being unemployed, loneliness and caring responsibilities.Work with the person, their families and carers and consider how they can all be supported through social prescribing.
- Help people maintain or regain independence through living skills, adaptations, enablement approaches and simple safeguards.
- Work with individuals to co-produce a simple personalised support plan based on the persons priorities, interests, values and motivations including what they can expect from the groups, activities and services they are being connected to and what the person can do for themselves to improve their health and wellbeing.
- Where appropriate, physically introduce people to community, groups, activities and statutory services, ensuring they are comfortable. Follow up to ensure they are happy, able to engage, included and receiving good support.
- Where people may be eligible for a personal health budget, help them to explore this option as a way of providing funded, personalised support to be independent, including helping people to gain skills for meaningful employment, where appropriate.
- Support community groups and organisations to receive referrals, forge strong links with local organisations, community and neighborhood level groups, utilising their networks and building on whats already available to create a map or menu of community groups and assets. Use these opportunities to promote micro-commissioning or small grants if available.
- Develop supportive relationships with local organisations, community groups and statutory services, to make timely, appropriate and supported referrals for the person being introduced.
- Ensure that local community groups and organisations being referred to have basic procedures in place for ensuring that vulnerable individuals are safe and, where there are safeguarding concerns, work with all partners to deal appropriately with issues. Where such policies and procedures are not in place, support groups to work towards this standard before referrals are made to them.
- Check that community groups and organisations meet in insured premises and that health and safety requirements are in place. Where such policies and procedures are not in place, support groups to work towards this standard before referrals are made to them.
- Support local groups to act in accordance with information governance policies and procedures, ensuring compliance with the Data Protection Act.
- Work collectively with all local partners to ensure community groups are strong and sustainable.
- Work with commissioners and local partners to identify unmet needs within the community and gaps in community provision.
- Support local partners and commissioners to develop new groups and services where needed, through small grants for community groups, micro-commissioning and development support.
- Encourage people who have been connected to community support through social prescribing to volunteer and give their time freely to others, in order to build their skills and confidence, and strengthen community resilience.
- Develop a team of volunteers within your service to provide buddying support for people, starting new groups and finding creative community solutions to local issues.
- Encourage people, their families and carers to provide peer support and to do things together, such as setting up new community groups or volunteering.
- Provide a regular confidence survey to community groups receiving referrals, to ensure that they are strong, sustained and have the support they need to be part of social prescribing.
- Adhere to organisational policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety.
Knowledge, Training and Experience
- Proven ability to work effectively in a team.
- Experience of working with a variety of different stakeholders.
- Ability to work with clinicians and other health and social care professionals.
- Evidence of ongoing training and personal development.
Planning and Organisational Skills
- To be able to plan, organise and prioritise a busy caseload with conflicting demands on time.
- To take an active role in identifying service development initiatives.
- Determine the patients holistic support needs accurately over the telephone or face-to-face and work with the patient proactively to support a positive outcome.
- Support patients to access appropriate support for important financial matters (i.e. personal budgets and benefits).
- Implement and follow up key action points from the MDT meetings on to the agreed care plan which is clear and concise contemporaneous.
- Effectively communicate a patients needs within a multidisciplinary team meeting environment
Person Specification
Knowledge and Understanding
Essential
- Good knowledge and understanding of Primary Care and the Local System
- Knowledge of health and social care terminology.
- Knowledge of health and social care pathways.
- Awareness of the local resources available in the community.
- Knowledge of the safeguarding interventions.
- Knowledge of Self-Directed Support.
- Awareness of the Mental Capacity Act.
- Awareness of data protection and confidentiality issues.
- Awareness of legislation relating to Equal Opportunities and KCC and NHS equality and diversity policies, procedures and legislation.
- Knowledge of assessment processes or willingness to undertake
- Effective communicator at all levels
Desirable
- Knowledge of QOF and Enhanced Services
Experience
Essential
- Experience of supporting people, their families and carers in a related role (including unpaid work)
- Experience of partnership/collaborative working and of building relationships across a variety of organisations.
- Experience of data collection and providing monitoring information to assess the impact of services
- Full driving license and access to a car. Ability to travel across the locality on a regular basis, including to visit people in their own homes
Qualifications
Essential
- GCSE grade A* to C (9-4) in English and Maths or equivalent
- Demonstrable commitment to professional and personal development
- Willingness to work towards further educational qualifications required for the role
Desirable
- NVQ Level 3, Advanced level or equivalent qualifications
Person Specification
Knowledge and Understanding
Essential
- Good knowledge and understanding of Primary Care and the Local System
- Knowledge of health and social care terminology.
- Knowledge of health and social care pathways.
- Awareness of the local resources available in the community.
- Knowledge of the safeguarding interventions.
- Knowledge of Self-Directed Support.
- Awareness of the Mental Capacity Act.
- Awareness of data protection and confidentiality issues.
- Awareness of legislation relating to Equal Opportunities and KCC and NHS equality and diversity policies, procedures and legislation.
- Knowledge of assessment processes or willingness to undertake
- Effective communicator at all levels
Desirable
- Knowledge of QOF and Enhanced Services
Experience
Essential
- Experience of supporting people, their families and carers in a related role (including unpaid work)
- Experience of partnership/collaborative working and of building relationships across a variety of organisations.
- Experience of data collection and providing monitoring information to assess the impact of services
- Full driving license and access to a car. Ability to travel across the locality on a regular basis, including to visit people in their own homes
Qualifications
Essential
- GCSE grade A* to C (9-4) in English and Maths or equivalent
- Demonstrable commitment to professional and personal development
- Willingness to work towards further educational qualifications required for the role
Desirable
- NVQ Level 3, Advanced level or equivalent qualifications
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.