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Social Prescribing Link Worker Vulnerable and Home bound Patients
3 months ago
Job summary
An exciting opportunity for a forward thinking motivated Social Prescribing Link Worker to join the team working within the St Pauls Primary Care Network in the heart of Cheltenham, Gloucestershire.
The successful candidate will work across the four practices and community hubs developing this exciting role closely supported by our team. As a progressive PCN, the role will suit a forward-thinking, innovative and enthusiastic candidate who is able to work collaboratively across the team and keen to deliver the ethos of the network.
Main duties of the job
To support patients in setting, meeting and achieving goals through agreed care plans ensuring they appropriately involve the patients, family and carers which will ensure the needs of the patients are met.
To collate, record and signpost appropriate referrals to approved agencies on behalf of the Network using agreed read codes and Arden, monitoring activity timelines and ensuring correct coding and information is recorded in patients records.
To actively signpost patients to local services to enable them to improve their physical and emotional well-being, This will include, but is not limited to benefits, housing, social isolation, loneliness, respite and local clubs for patients and family.
Identify local groups able to support the interests of patients who feel isolated engage in accordance with their ability and interests.
About us
The Network comprises four practices (Weston House Practice, St Catherines Surgery, St Georges Surgery, Royal Well surgery). The PCN benefits from operating at a single site, St Pauls Medical Centre with a branch surgery in Hatherley.
Job description
Job responsibilities
Takereferrals from health care professionals and staff within the Primary CareNetwork (PCN)
Take alead role in the development of carefor frail, elderly and home bound patients, with the aim of providing proactivecare and follow up of home bound patients across St Pauls PCN practices.
Work withother health and care providers to share information, jointly plan care andprovide a streamlined, integrated service.
Meetwith patients either face to face or conduct appointments/consultations overthe phone to help patients.
oassesswhat matters to them and what support, information, or advice they may need.
Toco-produce where necessary a personalised care and support plan with patientsto help improve their health and wellbeing.
Towork with the PCN Advanced Care Practitioner to support management ofCo-morbidities by the patient having a home visit.
Whenappropriate, actively signpost patients to local services to improve theiremotional and physical wellbeing. This will include but not limited tobenefits/finances, housing, social isolation, debt, respite, bereavement, andother learning disability support.
Tosupport patients in accessing tools and implementing strategies to help managetheir own mental health.
Toassist patients to take decisions on what type of support they require thatbest meets their health and wellbeing needs. This will involve using a range ofbehavioural change techniques such as motivational interviewing; healthcoaching and strengths-based approaches to determine their skills, interests.
Inpartnership complete the most appropriate referral pathway to agencies onbehalf of patients, particularly working closely with the complex care at hometeam.
Toaccurately record contact with patients through the GP clinical system, SystmOne, as well as maintaining other computerized records within the PCN. Thiswill involve reviewing and coding frailty including moderate and Severe.
Beproactive in developing strong links with statutory and voluntary agencies aswell as local community groups.
Buildrelationships with staff within the PCN, attend multi-disciplinary teammeetings (MDTs) and help promote social prescribing to staff.
Tomonitor and manage risk, including suicide ideation and safeguarding issues inline with organisational safeguarding policy.
RepresentSt Pauls PCN on all relevant statutory and voluntary sector committees,working parties, steering groups and management committees as required by theOperational Director.
Promotegood public relations using local media, participating in relevant publicevents, and organising promotional events for the PCN through the production ofpublicity material.
Contributeto monitoring and evaluation of services, ensuring that data is captured andrecorded via appropriate methods.
ToSupport the Lead Social Prescriber in any other appropriate duty, including theteams development of our Patient Participation Groups.
There may be,on occasion, a requirement to carry out other tasks; this will depend onfactors such as workload and staffing levels.
Person Specification
Experience
Essential
Previous experience of providing structured support and advice to others
Desirable
Experience of working with others to obtain successful outcomes for vulnerable adults
Knowledge
Essential
Good understanding of social prescribing Good understanding of the wider determinants of health and how to help reduce health inequalities A proven understanding of safeguarding for vulnerable adults and ability to implement relevant policies and procedures
Desirable
Good understanding of local service provision in the statutory, voluntary and community sector Good knowledge and understanding of interventions and behavioural motivational change methods Good understanding of mental health conditions and how these can impact a persons wellbeing and the challenges this can present in accessing services.
Skills and abilities
Essential
Good verbal and written communication skills Empathic and caring; sensitive to peoples life stages, concerns and problems Good IT skills, able to use relevant Office packages (Word, Excel, Databases and Outlook for e-mail/calendar) Readiness to work cooperatively with a range of professionals, agencies, organisations, and individuals Ability to motivate Ability to adapt, cope under pressure and meet deadlines Problem solving skills Commitment to working flexibly Ability to work individually and as part of a team good use of initiative. To maintain confidentiality To act professionally at all times
Qualifications
Essential
5 GCSEs at grade 4 (c) or above including maths and English
Desirable
Health, social care or wellbeing qualification or equivalent experience