Digital Health Coach

**JOB TITLE**:Digital Health Coach

**LINE MANAGER**:Digital Change Manager

**HOURS**: 37.5 hours per week, fixed term contract

**LOCATION**:Moorside/Marvels Lane

**Context**

One Health Lewisham is a GP Federation established in 2016 that has grown out of four neighbourhood GP federations in the North, Centre, Southeast and Southwest of the South London Borough of Lewisham. OHL works to develop pan Lewisham ways of working, reduce variation, improve quality and support GP Practices. One Health Lewisham is a federation 35 GP practices, stretching from Blackheath to Bellingham, serving a population of more than 300,000 people.

**Vision and values**

Representing 35 General Practices across the borough, One Health Lewisham plays a key role within Lewisham’s local health and care system. As the local GP federation, One Health Lewisham is a trusted partner who promotes and delivers innovative services and new approaches to improve the lives and health of our patients whilst also increasing the effectiveness and efficiency of healthcare provision.

We expect all our staff to share the values that are important to the company:

- Equity of quality and equity of access across the whole spectrum of Lewisham residents
- Protecting and sustaining general practice whilst also supporting transformation
- Being an organisation that is sustainable, self-sufficient, imaginative, innovative, courageous, entrepreneurial and unafraid to say “no”.

**Service Area**

One Health Lewisham (OHL) provides a digital option to long term condition (LTC) patients, so they can complete their annual review using Doctaly Assist via WhatsApp, rather than coming into the surgery for a face-to-face consultation. The service allows for patients to interact with a clinician remotely and provide the information required for their review. In Lewisham, the engagement rate for this service is 30% and the aim of this role is to increase the engagement rate by providing health coaching and to support the patient to complete their review. This project also aims to collate information to understand why patients did not engage with the Doctaly Assist service initially, and what elements of the coaching helped them to engage now.

**Job Summary**
- This role involves working closely with the OHL clinical team to increase patient engagement with digital tools and digitised pathways increasing digital inclusion. This includes current services as well as potential future services.
- To assist patients to engage with the remote monitoring service to complete their LTC review for COPD, Asthma, Diabetes and/or Hypertension. The role is pivotal in ensuring all patients receive the best possible care and service.
- The role also involves working closely with the practices and the multidisciplinary team (MDT) within the PCN/practices/GP Federation.
- To assist in the development and implementation of change to improve digital service provision in Lewisham and to increase the patient engagement rate for the service.

**Responsibilities**:

- To coach, motivate and support patients to complete their LTC review using the digital services.
- To provide personalised support to individuals, their families, and carers to ensure that they are active participants in their own healthcare and to empower them to take more control in managing their own health and well-being, to live independently and to improve their LTC health outcomes.
- To refer patients who require further intervention of other healthcare professionals.
- To provide support to local community groups and work with other health, social care and voluntary sector providers to support patients’ health and well-being holistically by increasing the uptake of our digital services.
- To identify risk factors and categorise patients into appropriate risk banding.
- To liaise with the practices and, where practicable, to standardise processes across Lewisham which assist with the engagement rate for our digital services.
- To maintain accurate clinical records of all patient consultations and related work.
- To promote health coaching and social prescribing amongst the PCN and networked practices and to support colleagues to improve their skills and understanding of personalised care for LTC patients.
- To support the uptake of additional digital services/digitised pathways as and when they are implemented.

**Miscellaneous**
- Assist with the gathering of statistics and information to provide a greater understanding of the cohorts of patients who did not engage with our digital services initially and also those who engaged following health coaching.
- Any other delegated duties considered appropriate to the post.

**Clinical System / Medical Records**
- Familiarity with the clinical systems - EMIS and Doctaly Assist.
- Book appointments and recalls as required, ensuring sufficient information is recorded.
- Extraction of necessary data from clinical correspondence and input into Electronic Patient Rec