Social prescribing empowers people to take control of their health & wellbeing through referral to link workers who give time, focus on what matters to me & take a holistic approach to an individuals health & wellbeing, connecting people to diverse community groups & statutory services for practical & emotional support. Link workers support existing groups to be accessible, sustainable & help people to start new community groups, working collaboratively with all local diverse partners.
Social prescribing link workers will work as a key part of the primary care network (PCN) multi-disciplinary team. Social prescribing can help PCNs to strengthen community & personal resilience, reduce health inequalities (in relation to timely access and outcomes) & wellbeing inequalities by addressing wider determinants of health, such as debt, poor housing & physical inactivity, by increasing peoples active involvement with their local diverse communities. In particularly for people with long term conditions (including support for mental health), people who are lonely/isolated, or have complex social needs which affect their wellbeing.
The successful candidate will manage a caseload of clients through assessment to onward-referral, working with clients in the practice that have been referred by the GP. Providing ongoing support over an allocated timeframe.
Main duties of the job
Working with direct supervision by a GP, take referrals from the PCNs Core Network Practices and from a wide range of agencies, including pharmacies, wider multi-disciplinary teams, hospital discharge teams, allied health professionals (list not exhaustive).
Provide personalised support to individuals, their families and carers to take control of their health and wellbeing, live independently and improve their health access and outcomes, as a key member of the PCN multi-disciplinary team. Develop trusting relationships by giving people time and focus on what matters to me. Take a holistic approach, based on the persons priorities and the wider determinants of health. Co-produce a simple personalised care and support plan to improve health and wellbeing, introducing or reconnecting people to appropriate community groups and statutory services. The role will require managing and prioritising your own caseload, in accordance with the needs, priorities and any urgent support required by individuals on the caseload. It is vital that you have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when the persons needs are beyond the scope of the link worker role e.g. when there is a mental health needs require a qualified practitioner.
About us
The Confederation, HillingdonCIC works with General Practice and other healthcare providers to deliver itsvision for Hillingdon to deliver the best primary care outcomes for patientsin the whole of London. We are a not for profit community interestcompany. The Confederation works to develop and support individual GPpractices, PCNs and Neighbourhoods and their changing needs. We deliverexcellent clinical services ourselves both at scale and complementary to GeneralPractice. We are the provider representative voice for local GeneralPractice into the wider NHS and other Partners. We are of the NHS butindependent, innovative and transformational.
The Confederation determinesto develop as an attractive place to work, providing rewarding roles andopportunities to grow in order to attract and retain great staff that in turndelivers our vision.
Our Values:
* We work together to make a difference for patients
* We care enough to go the extra mile
* We support, trust, and empower
* We sincerely value each other
* We support Primary Care to own its destiny
Job responsibilities
Key Tasks:
Referrals:
• Promote social prescribing, its role in self-management, addressinghealth inequalities and the wider determinants of health.
• As part of the PCN multi-disciplinary team, build relationships withstaff in GP practices within the local PCN, attending relevant MDT meetings,giving information and feedback on social prescribing.
• Be proactive indeveloping strong links with all local agencies to encourage referrals,recognising what they need to be confident in the service to make appropriatereferrals.
• To workinclusively with the Primary Care Networks member practices, The Confederation,H4All and other members of the multi-disciplinary team.
• Work inpartnership with all local agencies to raise awareness of social prescribingand how partnership working can reduce pressure on statutory services, improvehealth access and outcomes and enable a holistic approach to care.
• Provide referralagencies with regular updates about social prescribing, including training fortheir staff and how to access information to encourage appropriate referrals.
• Seek regularfeedback about the quality of service and impact of social prescribing onreferral agencies.
• Be proactive inencouraging equality and inclusion, through self-referrals and connecting withall diverse local communities, particularly those communities that statutoryagencies may find hard to reach.Providepersonalised support
• Meet people on aone-to-one basis, making home visits where appropriate within organisations’policies and procedures. Give people time to tell their stories and focus on‘what matters to me’. Build trust and respect with the person, providingnon-judgemental and non-discriminatory support, respecting diversity andlifestyle choices. Work from a strength-based approach focusing on a person’sassets.
• To undertakeholistic client needs assessments in the surgery, using the Patient ActivationMeasure (PAM) assessment and the ONS4 Wellbeing questionnaire full training ontheir use will be provided.
• Be a friendly andengaging source of information about health, wellbeing and preventionapproaches.
• Help peopleidentify the wider issues that impact on their health and wellbeing, such asdebt, poor housing, being unemployed, loneliness and caring responsibilities.
• Work with theperson, their families and carers and consider how they can all be supportedthrough social prescribing.
• Help peoplemaintain or regain independence through living skills, adaptations, enablement approachesand simple safeguards.
• Work withindividuals to co-produce a simple personalised support plan to address theperson’s health and wellbeing needs – based on the person’s priorities,interests, values, cultural and religious/faith needs and motivations –including what they can expect from the groups, activities and services theyare being connected to and what the person can do for themselves to improvetheir health and wellbeing.
• Act as the bridgebetween health and care workers and local communities in order to make more effectiveuse of social capital. Where appropriate, physically introduce people toculturally appropriate community groups, activities and statutory services,ensuring they are comfortable, feel valued and respected. Follow up to ensurethey are happy, able to engage, included and receiving good support.
• Where people maybe eligible for a personal health budget, help them to explore this option as away of providing funded, personalised support to be independent, includinghelping people to gain skills for meaningful employment, where appropriate.
• Seek advice andsupport from the GP supervisor and/or identified individual(s) to discusspatient-related concerns (e.g. abuse, domestic violence and support with mentalhealth), referring the patient back to the GP or other suitable healthprofessional if required. Support community groups and VCSE organisations toreceive referrals
Community Development:
• Forge stronglinks with a wide range of local VCSE organisations, community andneighbourhood level groups, utilising their networks and building on what’salready available to create a menu of diverse community groups and assets, whopromote diversity and inclusion.
• Developsupportive relationships with local diverse VCSE organisations, culturallyappropriate community groups and statutory services, to make timely,appropriate and supported referrals for the person being introduced. Workcollectively with all local partners to ensure community groups are strong andsustainable
• Work withcommissioners and local partners to identify unmet diverse needs within thecommunity and gaps in community provision. Map community resources and buildand build community capacity to meet identified gaps in provision.
• Encourage peoplewho have been connected to community support through social prescribing tovolunteer and give their time freely to others, building their skills andconfidence and strengthening community resilience.
• Encourage people,their families and carers to provide peer support and to do things together,such as setting up new community groups or volunteering.
• To ensure that the LinkWorker programme is integrated into Hillingdon’s well-established socialprescribing programme, delivered by H4All.
MeasuringEffectiveness:
• Work sensitivelywith people, their families and carers to capture key information, enablingtracking of the impact of social prescribing on their health and wellbeing.
• Encourage people,their families and carers to provide feedback and to share their stories aboutthe impact of social prescribing on their lives.
• Support referralagencies to provide appropriate information about the person they arereferring. Provide appropriate feedback to referral agencies about the peoplethey referred.
• Work closelywithin the MDT and with GP practices within the PCN to ensure that the socialprescribing referral codes are inputted into clinical systems (as outlined inthe Network Contract DES), adhering to data protection legislation and datasharing agreements.
• Work with yoursupervising GP and/or line manager (if different) to undertake continualpersonal and professional development, taking an active part in reviewing anddeveloping the roles and responsibilities.
• Adhere toorganisational policies and procedures, including confidentiality, safeguarding,lone working, information governance, equality, diversity and inclusiontraining and health and safety.
• Work with yoursupervising GP to access regular ‘clinical supervision’, to enable you to dealeffectively with the difficult issues that people present.
•Involved in one to one meetings with linemanager monthly to discuss targets and outcomes achieved.
•Review yearly progress and develop clear plansto achieve results within priorities set by others.
• Work as part ofthe healthcare team to seek feedback, continually improve the service andcontribute to business planning.
• Contribute to thedevelopment of policies and plans relating to equality, diversity and healthinequalities.
• Undertake anytasks consistent with the level of the post and the scope of the role, ensuringthat work is delivered in a timely and effective manner.
• Duties may vary from time to time, withoutchanging the general character of the post or the level of responsibility.
Person Specification
Experience
* As per government guidlines it is now mandatory that all staff have been fully vaccinated and can evidence this therefore if you are unable to provide us with evidence of your Covid-19 immunisation record we will be unable to recruit & Its a legal requirement that all new employees have their ID documents physically verified by one of the HR Team therefore any new starters will be expected to attend the office.
Knowledge and Skills
* Educated to NVQ Level 3, Advanced level or equivalent qualifications or equivalent work experience
* Specialist knowledge acquired through postgraduate diploma level or equivalent training/experience in qualifications such as Social Care, Psychology, Sociology, Health Management etc. & Training in motivational coaching and interviewing or equivalent experience.
Disclosure and Barring Service Check
This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.
£30,000 to £38,000 a yearDependent on Experience
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