South Southwark Pcn Health

Interveiws will be held on 17th January 2025

The NHS Long Term Plan describes the prominent role Primary Care Networks (PCN) will play in delivering proactive, personalised and more integrated health and social care for their local populations. Our South Southwark PCN is made up of all 18 GP Practices in Camberwell, Peckham and Dulwich, approximately 154,000 patients, supported by their GP Federation, Improving Health (IHL). We are seeking a cadre of self-motivated and forward-thinking Health & Well-being coaches to work across our network providing dedicated support to our local population.

We are a large PCN with 60 staff in post to date and expanding significantly over the coming year. We are committed to supporting and developing our staff, knowing this is crucial to our success. We have robust systems in place, including clinical supervision and peer support, and will continue to build on this as we expand our PCN team.

1. Job summary

As a Health and Wellbeing Coach you will
- Support local residents in managing their health conditions (e.g. diabetes) in areas including diet, exercise, mobility, sleep hygiene, weight management as well as broader mental well-being;
- Provide one-to-one and group health coaching support for people based on what is important to them, aiming to improve their knowledge, skills, confidence in managing their condition/s
- Empower individuals to manage their own health and wellbeing, taking an approach which supports personal choice, is non-judgemental and based on strong communication and negotiation skills.
- Manage and prioritise a caseload based on the health and wellbeing needs of each individual
- Operate as part of the expanding multidisciplinary PCN/practice team to maximise support available to individuals including working with
- social prescribers to address wider social needs
- clinical colleagues to provide support as felt appropriate
- Work across a neighbourhood of approximately four to five practices, providing support to residents
- Actively promote and raise understanding of the Health & Well-being Coach role amongst PCN and general practice staff
- Work with the PCN leads to continually improve how the service supports the local population, consider opportunities for innovation and supporting delivery of PCN objectives

2. Key responsibilities

**a) Provide personalised support**
- Meet people on a one-to-one or group consultation basis, by phone, video conference, or face-to-face.
- Support local residents in managing their health conditions (e.g. diabetes) and areas may include diet, exercise, mobility, sleep hygiene, weight management as well as broader mental well-being;
- Coach individuals across a series of sessions to: identify what’s important to them; set personal goals and appropriate steps; build skills and confidence to achieve goals; and use problem-solving to work through challenges;
- Give people time to tell their stories and focus on ‘what matters to the person’;
- Build trust and respect with the person, providing non-judgemental and non-discriminatory support, respecting diversity and lifestyle choices;
- Increase patient motivation to self-manage and adopt healthy behaviours;
- Utilise appropriate coaching techniques, approaches and frameworks;
- Work with the principles of self-management to actively support shared decision making, engagement with services, connection to community resources and peer support

**b) Relationships with staff and services**
- Work closely with the social prescribing team to ensure that individuals can access support to address wider social needs that can impact on their health and wellbeing, such as such as debt, poor housing, being unemployed, loneliness and caring responsibilities.
- Promote a good understanding of health coaching, across practices, the PCN and wider system, acting as an advocate for this role and the impact it can have;
- Build strong relationships with practices and PCN staff (in particular social prescribers), working collaboratively and ensuring effective two way communication;
- Develop a good understanding and strong links with local statutory, voluntary and community organisations to better enable referred patients to access the support they need;
- Seek regular feedback about the quality of service and impact of health coaching
- Raise awareness within the PCN of shared decision making and decision support tools and supporting people in shared decision-making conversations.

**c) Information and service improvement**
- Work sensitively with people, their families and carers to gather key information;
- Work with practices to ensure effective two-way communication and sharing of appropriate information throughout the process i.e. from referral to end of support;
- Work with PCN leads to ensure activity is recorded in the appropriate way ;
- Encourage people, their families and carers to provide feedback and to share their stories about the impact of health coaching on their live