Coaching and motivating patients through multiple sessions to identify their needs, set goals, and supporting patients to achieve their personalised health and care plan objectives. Providing interventions such as self-management education and peer support. Supporting patients to establish and attain goals that are important to the patient. Supporting personal choice and positive risk taking while ensuring that patients understand the accountability of their own actions and decisions, thus encouraging the proactive prevention of further illnesses.
Working in partnership with the social prescribing service to connect patients to community-based activities which support them to take increased control of their health and wellbeing. Increasing patient motivation to self-manage and adopt healthy behaviours. Develop collaborative relationships and work in partnership with health, social care, and community and voluntary sector providers and multi disciplinary teams to holistically support patients wider health and well being, public health, and contributing to the reduction of health inequalities. Provide education and specialist expertise to PCN staff, supporting them to improve their skills and understanding of personalised care, behavioural approaches and ensuring consistency in the follow up of peoples goals with MDT input.
Raise awareness within the PCN of shared decision-making and decision support tools.