Social Prescriber Link Workers

6 months ago

StokeonTrent, United Kingdom North Staffordshire GP Federation Full time

**HIPC Primary Care Network**

Holistic Person-Centred Care Primary Care Network (PCN) consists of the 4 GP surgeries in the North area of Stoke on Trent which covers approx. 37,000 patients. Our mission is to work collaboratively to develop high quality services for our patients, so that we can improve health outcomes that enable people to live well, for longer, whilst developing resilient primary care.

The PCN already hosts a strong and supportive multi-disciplinary wellbeing team consisting of mental health practitioners, peer support workers, social prescribers, and care coordinators.

We work collaboratively with our local Federation who support core General Practice and sustaining the future for General Practice. The Federation are facilitating and supporting the recruitment of the new roles within our Primary Care Network.

**Job Overview**

Social Prescribers are a key part of our Primary Care Network multidisciplinary team. They work alongside our integrated team of Mental Health Practitioners and Care Coordinators to provide an all-encompassing approach to personalised care and promote and embed the personalised care approach across the PCN.

Social prescribing link workers work collaboratively across the health and care system, targeting populations with greatest need and risk of health inequalities. They collaborate with partners to identify gaps in provision and support community offers to be accessible and sustainable.

Social prescribers will work with patients of all-ages with a whole population approach and support people who:

- Have one or more long term conditions.
- Who need support with low level mental health issues.
- Who are lonely or isolated.
- Who have complex social needs which affect their wellbeing.

Social Prescribers manage and prioritise a caseload, according to the needs, priorities and support required by individuals in the caseload. They identify when a person’s needs are beyond the scope of the Social Prescribing role and refer them back to other health professionals or organisations.

**Person Specification**

The role will involve coproducing a "Social Prescription" with individuals referred to the service which provides the individual with positive health and wellbeing outcomes through addressing non-medical/social issues in their life, such as housing, debt or social isolation.

**Key responsibilities**:

- To undertake holistic assessments and co-design Health and Well-being Plans with individual service users, identifying support needs to ensure maximum engagement in improving their health and wellbeing.
- Develop trusting relationships by giving people time and focus on ‘what matters to them
- To provide service users with continuity and a coordinated experience of care, remaining a point of contact throughout the individual’s social prescription.
- Take a holistic approach, based on the person’s priorities, and the wider determinants of health. The role will require social prescribing link workers to manage and prioritise their own caseload, in accordance with the health and wellbeing needs of their population.
- To work in partnership with all voluntary and community organisations to build a comprehensive database of local resources to design and support the Social Prescription Menu.
- Identify and engage effectively in a non-judgemental and respectful manor with members of the community from all backgrounds, abilities and ages, listening and interpreting complex health information into understandable terms about health and health improvement.
- To train and develop GPs and primary care health teams’ knowledge on how to identify patients suitable for social prescribing service referral on a quarterly basis.
- Set up and maintain comprehensive data and evaluation systems, including individual health outcome tools.
- Support the development of a service steering group including representation from all stakeholder groups.
- Provide quarterly comprehensive outcome focused reports detailing the progress of the service.
- To recruit, train and supervise volunteers, matching them to individual service users for specific time-limited support in achieving positive engagement in activities promoting health and well-being.
- To keep records of your work and adhere to confidentiality, information sharing protocols and provide monitoring information as required.

**Dimensions**:
The role requires social prescribing link workers to manage and prioritise their own referrals in accordance with the health and wellbeing needs of their population. Where required and as appropriate, the social prescribing link workers will refer people back to other health and social care organisations within the city where appropriate.

**Structure / Reporting / Relationship**:
**Key Result Areas**:

- Improved health and quality of life
- Increased patient satisfaction
- Fewer primary care consultations
- Reductions in the number of hospital admissions, visits to Accident and Emergenc

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