Job summary
Are you
looking for a new challenge? We are excited to recruit a full-time High Intensity User
(HIU) Lead to support the launch of our new
High Intensity Use (HIU) Service a pioneering initiative within our Primary
Care Network (PCN), made up of four GP practices working in close partnership
with neighbourhood teams.
The HIU Service supports
individuals who frequently attend A&E or use emergency services more than
expected. Many face complex challenges including poor physical or mental
health, housing instability, loneliness, or substance misuse. This service takes
a person-centred approach, building trusted relationships and offering
long-term, practical support to help people access the appropriate care and improve
their quality of life. The HIU Lead will
work directly with the HIU client group, delivering a highly personalised approach that aims to improve wellbeing
and health outcomes, whilst reducing inappropriate contacts with healthcare
services, particularly unscheduled care. The HIU Lead will be dedicated to helping and supporting the HIU client group to thrive, by fostering job opportunities, reconnecting with families, improving overall well-being.
The ideal candidate will be a highly motivated,
emotionally intelligent, compasstionate and resilient individual with strong leadership skills. A commitment to high-quality client care and a passion for innovation. We encourage thinking "out of
the box" to effectively support this vulnerable group.
Main duties of the job
This is a non-clinical role focused on listening, understanding, and empowering.
Identify
those at greatest risk of A&E attendance and non-elective admissions.
Proactively
work with a rolling cohort of HIU clients, really understanding what they need.
To
coordinate wellbeing and connect with other services, enrolling them to help to
get to the desired end.
Reducing
999 calls as a natural by-product (possibly ambulance and police).
Reducing
A&E attendances and avoidable non-elective admissions.
Drive
equality and client voice.
Forming
robust network of community health, social care, mental health and police to
manage clients, creating true integrated working.
Providing
a service driven by quality with positive human outcomes observed.
Act
as a conduit to negotiate and de-escalate issues before a crisis occurs; a
situation which has historically led to a destabilisation of their condition
and resulting in a A&E attendance / 999 calls.
Improving
communication and partnership working between those involved in client care
24/7.
Identify
patterns and causal factors which trigger relapse behaviours in order to shape
future commissioning of service and/or demand/capacity planning.
Empower
clients to self-manage to enable sustainable discharge.
About us
Meridian
Medical Primary Care Network brings together its four GP practices, (East Lindsey Medical Group, James Street Family Practice, Tasburgh Lodge and Marsh Medical Practice), who all work together to deliver the best possible care for our patients, along with health and
care partners, LCHS, patient organisations and the voluntary sector across Lincolnshire,
as well as working across borders with our neighbouring Primary Care Networks.
You will be employed by East Lindsey Medical Group and due to the geography of the PCN, business travel to undertake the role will be paid.
The role will support Meridian Medical PCN and its GP practices and neighbourhood teams and truly encompass the future of neighbourhood working.
Our Vision: Our vision is a community where everyone feels valued, has a sense of belonging and can achieve what is important to them.
Our Mission: Our mission is to join up our
practices with other health and care providers, charities and community groups,
so that everyone in our community receives the level of support they need, when
they need it, close to their home.
Job description
Job responsibilities
Key Tasks
and Responsibilities
1.To provide holistic one-to-one-person
centred support for people aged 18 and over who have high dependency on
emergency services and who are frequent visitors/ callers of A&E, the
Urgent Care Centre, and East Midlands Ambulance Service.
Carry out the
role of a facilitator, broker, sign poster, community connector, and navigator,
acting as an enabler between the voluntary and community sector, patients, GPs
,health clinicians, and social care.
Provide
support to patients, generally in their own homes, up to 3-4 months to help
direct and connect them to alternative sources of non-medical support services
and activities.
Offer a
personalised approach to sensitively uncover the real reasons for them calling
999 or presenting frequently at A&E/UCC.
During client
visits undertake an assessment to gather baseline data and to identify the
support needs and actions. Generating personalised care and support or
wellbeing plans, which may include risk management.
Ensure support
actions agreed with the patient are carried out by the service. Support areas
could include making referrals into a range of services provided by the
voluntary, statutory or private sector, help with non-means tested benefit form
filling e.g. Personal Independent Payments, Attendance Allowance, housing forms
etc, distributing food bank vouchers, identifying suitable volunteering
opportunities, connecting people into peer to peer led activities, initially
taking patients to services if their confidence is low etc.
Once support
has been provided carry out a final assessment
2.To meet and collaborate with A&E
clinical staff regularly, to discuss, identify and agree appropriate referrals
from the patient cohort list (patients presenting more than 12 times per year)
and other patients presenting less than 12 times per year at A&E.
Meet with a
range of health clinicians to discuss and agree appropriate referrals from the
patient cohort list.
Build and
maintain positive relationships with a range of health professionals.
Work closely
with health clinicians to facilitate optimal joint working on safe and
effective care for patients with complex needs.
Raise
awareness of voluntary and community sector activities and services on offer to
showcase the diverse range of services available to health and social care
practitioners.
Raise
awareness of the social prescribing service with health practitioners.
With health
professionals and a range of providers identify service needs, broker solutions
and when required enable individuals to be supported to kick start/lead on new
activities through Lincolnshire CVS.
3.To work and collaborate with the
voluntary and community sector to help identify appropriate referral
destinations and to explore opportunities to meet gaps in services and
activities.
Keep abreast
of a wide range of support services on offer in the voluntary and community
sector through undertaking research, making connections with organisations and
groups and by using a range of local online directories and Community
Connectors.
Build and
maintain positive relationships with a wide range of voluntary and community
sector providers.
When gaps in
services and activities are identified discuss and raise these with the team
and if required, liaise with voluntary organisations and Community Connector to
help identify solutions.
4.To ensure effective record keeping and
storage of patient data to demonstrate outputs and outcomes which is compliant
with GDPR.
Ensure all
patient records and actions are entered onto our record keeping systems.
Ensure GDPR
requirements are adhered to in relation to data management.
When required,
support in gathering any data required for working out cost savings to the
wider health and social care sector as a result of the service interventions.
5.To actively contribute as a member of a
well-established social prescribing and Neighbourhood team who support the most
vulnerable in society.
Actively
contribute to team meetings, away days, planning activities and reflective
practice activities.
Share
progress, learning and challenges within the existing Integrated Plus social
prescribing team.
Share ideas
about how the service could develop and evolve.
Adhere to all Meridian
Medical PCN policies and procedures e.g. lone working, patient consent,
information governance, and local governance policy and procedure etc.
Job description
Job responsibilities
Key Tasks
and Responsibilities
1.To provide holistic one-to-one-person
centred support for people aged 18 and over who have high dependency on
emergency services and who are frequent visitors/ callers of A&E, the
Urgent Care Centre, and East Midlands Ambulance Service.
Carry out the
role of a facilitator, broker, sign poster, community connector, and navigator,
acting as an enabler between the voluntary and community sector, patients, GPs
,health clinicians, and social care.
Provide
support to patients, generally in their own homes, up to 3-4 months to help
direct and connect them to alternative sources of non-medical support services
and activities.
Offer a
personalised approach to sensitively uncover the real reasons for them calling
999 or presenting frequently at A&E/UCC.
During client
visits undertake an assessment to gather baseline data and to identify the
support needs and actions. Generating personalised care and support or
wellbeing plans, which may include risk management.
Ensure support
actions agreed with the patient are carried out by the service. Support areas
could include making referrals into a range of services provided by the
voluntary, statutory or private sector, help with non-means tested benefit form
filling e.g. Personal Independent Payments, Attendance Allowance, housing forms
etc, distributing food bank vouchers, identifying suitable volunteering
opportunities, connecting people into peer to peer led activities, initially
taking patients to services if their confidence is low etc.
Once support
has been provided carry out a final assessment
2.To meet and collaborate with A&E
clinical staff regularly, to discuss, identify and agree appropriate referrals
from the patient cohort list (patients presenting more than 12 times per year)
and other patients presenting less than 12 times per year at A&E.
Meet with a
range of health clinicians to discuss and agree appropriate referrals from the
patient cohort list.
Build and
maintain positive relationships with a range of health professionals.
Work closely
with health clinicians to facilitate optimal joint working on safe and
effective care for patients with complex needs.
Raise
awareness of voluntary and community sector activities and services on offer to
showcase the diverse range of services available to health and social care
practitioners.
Raise
awareness of the social prescribing service with health practitioners.
With health
professionals and a range of providers identify service needs, broker solutions
and when required enable individuals to be supported to kick start/lead on new
activities through Lincolnshire CVS.
3.To work and collaborate with the
voluntary and community sector to help identify appropriate referral
destinations and to explore opportunities to meet gaps in services and
activities.
Keep abreast
of a wide range of support services on offer in the voluntary and community
sector through undertaking research, making connections with organisations and
groups and by using a range of local online directories and Community
Connectors.
Build and
maintain positive relationships with a wide range of voluntary and community
sector providers.
When gaps in
services and activities are identified discuss and raise these with the team
and if required, liaise with voluntary organisations and Community Connector to
help identify solutions.
4.To ensure effective record keeping and
storage of patient data to demonstrate outputs and outcomes which is compliant
with GDPR.
Ensure all
patient records and actions are entered onto our record keeping systems.
Ensure GDPR
requirements are adhered to in relation to data management.
When required,
support in gathering any data required for working out cost savings to the
wider health and social care sector as a result of the service interventions.
5.To actively contribute as a member of a
well-established social prescribing and Neighbourhood team who support the most
vulnerable in society.
Actively
contribute to team meetings, away days, planning activities and reflective
practice activities.
Share
progress, learning and challenges within the existing Integrated Plus social
prescribing team.
Share ideas
about how the service could develop and evolve.
Adhere to all Meridian
Medical PCN policies and procedures e.g. lone working, patient consent,
information governance, and local governance policy and procedure etc.
Person Specification
Experience
Essential
- Excellent communication and interpersonal skills.
- Experience of working in teams
- Experience of collaborative working
- Knowledge and understanding of equality and diversity
- Knowledge and understanding of GDPR
- You can plan, prioritise and carry out your work in a flexible way. You are accustomed to working on your own and in teams.
- You know how to use a range of software to produce written documents, spreadsheets, presentations. You can effectively manage communication by email, and you are comfortable using collaborative online tools (for example WhatsApp, Twitter, Facebook, using text editors such as Word/Pages and other message apps.
- Adaptability, flexibility and ability to cope with uncertainty and change
- Demonstrate ability to work in a busy environment; ability to deal with both urgent and important tasks and to prioritise effectively whilst also supporting others
- Excellent time keeping and prioritisation skills
Desirable
- Experience of providing social prescribing interventions
- Knowledge of health and social care
- Local knowledge of the voluntary and community sector
- Ability to use Microsoft 365
- Specific Aptitudes Awareness of equality and valuing diversity principles Understanding of Confidentiality and Data Protection Act
- Self-motivated and proactive
- Continued commitment to improve skills and ability in new areas of work
- Able to undertake the demands of the post with reasonable adjustments if required
- Ability to work from home on some occasions where tasks allow
Qualifications
Essential
- No formal qualifications required but must have high emotional intelligence and resilience, be win-win negotiators and be brave enough to change the culture around high intensity use of services. Needs to shine and connect well in interviews to demonstrate these skills.
- It would be desirable for the applicant to have experience in working in person-centred roles, social prescribing, and skills related to some of our most vulnerable groups, including housing, drug and alcohol services, and care and support coordination.
- Essential
- Experience of supporting vulnerable adults in a person-centred way.
- You have the ability to work sensitively in difficult emotional circumstances with empathy, compassion, respect and understanding.
- Knowledge of asset/strength-based recovery models and approaches.
- Experience in case load management.
- You will be able to cooperate with a range of health professionals, voluntary sector providers, and individuals to explore the various possibilities that might be available in enabling service provision to be more holistic to improve mental health and wellbeing of vulnerable people.
Desirable
- Motivational interviewing
- Coaching for Health and Wellbeing
- Personalised Care Institute e-learning modules PCSP, shared decision making or equivalent
- Experience of working in the voluntary and community sector
Person Specification
Experience
Essential
- Excellent communication and interpersonal skills.
- Experience of working in teams
- Experience of collaborative working
- Knowledge and understanding of equality and diversity
- Knowledge and understanding of GDPR
- You can plan, prioritise and carry out your work in a flexible way. You are accustomed to working on your own and in teams.
- You know how to use a range of software to produce written documents, spreadsheets, presentations. You can effectively manage communication by email, and you are comfortable using collaborative online tools (for example WhatsApp, Twitter, Facebook, using text editors such as Word/Pages and other message apps.
- Adaptability, flexibility and ability to cope with uncertainty and change
- Demonstrate ability to work in a busy environment; ability to deal with both urgent and important tasks and to prioritise effectively whilst also supporting others
- Excellent time keeping and prioritisation skills
Desirable
- Experience of providing social prescribing interventions
- Knowledge of health and social care
- Local knowledge of the voluntary and community sector
- Ability to use Microsoft 365
- Specific Aptitudes Awareness of equality and valuing diversity principles Understanding of Confidentiality and Data Protection Act
- Self-motivated and proactive
- Continued commitment to improve skills and ability in new areas of work
- Able to undertake the demands of the post with reasonable adjustments if required
- Ability to work from home on some occasions where tasks allow
Qualifications
Essential
- No formal qualifications required but must have high emotional intelligence and resilience, be win-win negotiators and be brave enough to change the culture around high intensity use of services. Needs to shine and connect well in interviews to demonstrate these skills.
- It would be desirable for the applicant to have experience in working in person-centred roles, social prescribing, and skills related to some of our most vulnerable groups, including housing, drug and alcohol services, and care and support coordination.
- Essential
- Experience of supporting vulnerable adults in a person-centred way.
- You have the ability to work sensitively in difficult emotional circumstances with empathy, compassion, respect and understanding.
- Knowledge of asset/strength-based recovery models and approaches.
- Experience in case load management.
- You will be able to cooperate with a range of health professionals, voluntary sector providers, and individuals to explore the various possibilities that might be available in enabling service provision to be more holistic to improve mental health and wellbeing of vulnerable people.
Desirable
- Motivational interviewing
- Coaching for Health and Wellbeing
- Personalised Care Institute e-learning modules PCSP, shared decision making or equivalent
- Experience of working in the voluntary and community sector
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
Additional information
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
Employer details
Employer name
Lincolnshire And District Medical Services (LADMS)
Address
Meridian Medical PCN - Office 10
Fairfield Enterprise Centre
Fairfield Industrial Estate
Louth, Lincolnshire
LN11 0LS
Employer's website
http://www.ladms.co.uk/ (Opens in a new tab)
