Social Prescribing Link Worker

6 months ago

SouthendonSea, United Kingdom Southend East Primary Care Network Full time

Purpose of Role There is wide recognition that peoples health is determined primarily by a range of social, economic and environmental factors. The NHS has published a bold new vision for Social Prescribing, a relatively new function within Primary Care that seeks to address peoples needs in a non-medicalised way, focusing on What Matters to Me to agree personalised care plans, and then support individuals to take greater control of their health, by connecting them to diverse community groups and statutory services for both practical and emotional support. An existing team of social prescribers have already been working with Primary Care to provide social prescribing. This scheme is highly valued and we are looking to expand the existing capacity and enhance the role to encompass more complex case load, and integrate with existing clinical teams to work on preventative health projects Primary Care Networks (PCNs) were established in 2019 as part of NHS Englands long term plan to enable services to work collaboratively to meet the needs of patients.

As Primary Care Networks are becoming the vehicle of change for most primary care services, the NHS recognised the need to evolve other services and integrate Primary Care Networks into a newly formed Integrated Care System. Integrated care systems are geographically based partnerships that bring together providers and commissioners of NHS services with local authorities and other local partners to plan, co-ordinate and commission health and care. Main Responsibilities. Working within practices to assess and allocate referrals from a wide range of agencies, including GP practices and multi-disciplinary teams Working with practices and patients to be a representative within the newly forming Integrated Care System.

Handle your own caseload of more complex cases Support practices undertaking and delivering elements of health and social care population health projects Supporting the service specifications detailed in the PCN DES contract. Promote the service and educate relevant parties Oversee the data, reporting and evaluation of the service to strive for continuous improvement and community development Key Tasks Assess and Allocate Referrals: The PCN Social prescriber will review all referrals and allocate appropriate referrals to: A programme of self care Hold own case load of complex cases Introduce or coordinate an appropriate group support session Make referrals directly to external providers e.g. DWP, VSC, Help Hub Manage dedicated caseload of complex cases: Develop trusting relationships, giving individuals time and focus on what matters to them. Support individuals to identify the wider issues that impact their health and Wellbeing, such as debt, poor housing, unemployment, isolation and caring responsibilities.

Co-produce a simple personalised care and support plan to improve health and wellbeing. Where appropriate introduce individuals to appropriate community groups, activities and statutory services, ensuring they feel comfortable, valued and respected. Hold 1-1 appointment with individuals at the most appropriate location to meet individual needs, making home visits where appropriate within Southend East PCN Limited policies and procedures. Work with individuals their families and carers to maintain or regain independence through living skills, adaptations, enablement and simple safeguards.

Have an awareness and understanding of when it is appropriate or necessary to refer individuals back to other health professionals/agencies, when there are additional needs such as mental health that requires a trained practitioner. Where people are eligible for a personal health budget, support them to explore this option as a way of providing funding to enhance personalised support, to be independent and gain skills for meaningful employment, where appropriate. Seek advice and support from the GP supervisor to discuss patient related concerns (e.g. abuse, domestic violence and support with mental health) referring back to the GP or other suitable health professional.

**Support population health management projects**: Work as part of the PCN project team to pilot new ways of working in response to population health data, delivering any aspect relating to social prescribing, and advising on community and voluntary sector services that should be included in the solution Support the implementation of the PCN service specifications: Work with the PCN to develop the service where individuals require social prescribing activity, or advice regarding available community and additional activity other than that already undertaken within the role. Promote the service to wider partners: Be proactive in developing strong links with the PCN practice teams to encourage referrals and raise awareness on what other services are available within the community and how patients can access them Expanding the referral criteria to include wider agencies such as; pharmacies, hospital

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