Job responsibilities
About the Role
This Health & Wellbeing Coach position represents an exciting opportunity to join South Hambleton and Ryedale Primary Care Network's innovative Personalised Care Team. As a non-clinical role embedded within our multidisciplinary team, you'll work at the forefront of preventative healthcare and behaviour change, supporting people across our community to improve their health outcomes and quality of life.
Health and wellbeing coaches are recognised nationally as a key component of the NHS Long Term Plan's commitment to personalised care. This role focuses on improving health-related outcomes by working with people to set personalised goals based on what matters to them. You'll support individuals with physical and/or mental health conditions, those with long-term conditions such as diabetes, cardiovascular disease, respiratory conditions, and persistent pain, as well as people at risk of developing these conditions.
Your work will directly contribute to tackling health inequalities through targeted engagement with specific groups identified through population health management data, ensuring equitable access to support across our diverse communities.
What You'll Be Doing
Building Therapeutic Relationships and Providing Personalised Support
At the core of this role is the ability to build trust quickly and establish supportive, non-judgmental relationships with people from diverse backgrounds. You'll meet with individuals on a one-to-one basis and facilitate group coaching sessions, giving people time to tell their stories and focusing on 'what matters to me' rather than 'what's the matter with them.'
Through multiple coaching sessions tailored to individual needs, you'll work from a strength-based approach, helping people identify their own resources, priorities, and motivations. Your coaching conversations will be guided by evidence-based frameworks and models of behaviour change, adapting your approach based on each person's level of activation.
Health Coaching and Behaviour Change
You'll use structured coaching frameworks to guide people through a journey of self-discovery and change. This includes helping them understand their current situation, exploring what outcomes are important to them, identifying goals that align with their values, and breaking these down into achievable steps. You'll provide supportive challenge to help raise awareness of their current reality and explore any disconnections between what they say they want and what they're currently doing.
Your expertise in behaviour change will enable you to assess where people are in their readiness to change specific habits, working with models such as the transtheoretical model of change, COM-B, and patient activation approaches. You'll support people to self-reflect and understand the relationships between their emotions, feelings, and behaviours.
Caseload Management
You'll manage your own caseload of patients with varying complexity and support needs. Coaching sessions typically last 45-50 minutes, with frequency determined collaboratively between you and the individual based on their needs. You'll conduct regular reviews to assess progress towards goals and determine next steps.
A crucial aspect of caseload management is recognising when someone's needs are beyond the scope of the health and wellbeing coach role. You'll have strong awareness of when to refer people back to other health professionals or agencies, particularly when mental health needs require an appropriately qualified practitioner or when clinical assessment is required.
Care Planning and Coordination
Working collaboratively with individuals, their families, and carers, you'll develop personalised care and support plans that holistically bring together all identified needs. These living documents will reflect genuine partnership and shared decision-making, regularly reviewed and updated to reflect changing needs and progress.
You'll work closely with GPs, practice nurses, pharmacists, and other members of the primary care team to ensure care plans are communicated effectively. Your role includes maintaining accurate, appropriately coded records in patients' notes using relevant SNOMED codes, ensuring all documentation complies with information governance policies.
Multidisciplinary Team Working
As an integral member of our PCN's multidisciplinary team, you'll attend regular MDT meetings, contributing your unique perspective on behaviour change and patient activation. You'll work particularly closely with Social Prescribing Link Workers to connect people with community-based activities, and with Care Coordinators when people require coordination across multiple services.
You'll act as a champion for personalised care and health coaching approaches within the PCN, helping colleagues understand how health coaching can support their patients and when to make appropriate referrals.
Addressing Health Inequalities and Social Determinants of Health
You'll identify and address health inequalities within our patient population, working proactively to engage groups experiencing barriers to accessing services. You'll explore wider determinants of health that impact on people's wellbeing such as housing, debt, unemployment, loneliness, and caring responsibilities working collaboratively with colleagues to ensure people receive appropriate support.
Promoting Self-Management and Supporting Access to Resources
You'll actively support people to engage with self-management principles, including shared decision-making, effective use of personalised health plans, participation in self-management education and peer support, and connection to community activities through social prescribing.
You'll develop and maintain comprehensive knowledge of local health and care services, community resources, and statutory support available, enabling you to provide accurate information and signposting.
Group Work and Peer Support
You'll facilitate group-based health coaching sessions and structured self-management programmes, creating supportive environments where people can learn from each other. This includes managing group dynamics, facilitating group-based problem-solving and action planning, and supporting the development of peer support networks.
Service Development and Quality Improvement
You'll contribute to ongoing development and improvement of the Health Coaching Service within the PCN. This includes gathering feedback from people you support and referral agencies, identifying gaps in services or unmet needs, and providing insights on how to adapt service delivery.
You'll participate in relevant audits and data collection activities to track the impact of health coaching on people's health outcomes, helping demonstrate the value of health coaching and inform strategic planning.
Safeguarding and Professional Responsibilities
You'll have strong knowledge of safeguarding policies and processes, with ability to identify and manage risk when working with individuals. This includes recognising signs of abuse, domestic violence, mental health crises, and other safeguarding concerns, and knowing who to contact for immediate support.
You'll work within clearly defined organisational protocols at all times, including those related to confidentiality, information governance, lone working, equality and diversity, and health and safety. Access to clinical supervision ensures support for patient-related concerns.
Record Keeping and Information Governance
You'll maintain accurate, appropriately coded records in patients' notes, including details of coaching sessions, progress towards goals, and any referrals made. All work will be conducted in accordance with information governance policies, maintaining confidentiality whilst ensuring appropriate information sharing to support coordinated care.
Working Environment
Your base will be Easingwold Health Centre but you'll work across all seven practices within the PCN as needed. The role requires independent travel between sites, so a driving licence and access to your own transport are essential. You'll work flexibly within clear boundaries, with significant professional autonomy within appropriate governance frameworks.
Professional Development and Training
You'll complete comprehensive induction including mandatory training in safeguarding, confidentiality, information governance, and relevant IT systems. You'll also undertake a four-day Personalised Care Institute accredited health coaching training course.
We're committed to supporting your ongoing professional development through regular supervision (line management, clinical, and health coaching supervision), access to training programmes, peer learning networks, and opportunities to develop specialisms aligned with PCN priorities.
You'll develop and maintain a portfolio of evidence as part of continuous professional development, helping evidence your knowledge, skills and behaviours, support reflective practice, and demonstrate the impact of your work. As you gain experience, opportunities may arise to progress through the four tiers of health coaching practice.
Making a Real Difference
This role offers the opportunity to see transformational changes in people's lives. You'll support individuals to develop the knowledge, skills, and confidence to self-manage their conditions, make healthier lifestyle choices, and improve their health outcomes. The impact of your work extends beyond individual patients by freeing up clinical capacity and contributing to better health outcomes, you'll play a vital role in transforming how our healthcare system supports people with long-term conditions.
