Location: Exeter and Tiverton (Mostly Home-based with travel)
Fixed Term Contract 18-months
Reporting to: Flow Projects Manager
Employer: Encompass Southwest in partnership with Royal Devon University Healthcare Foundation Trust.
Are you passionate about supporting people to live well in their communities? Do you thrive on building connections and making a difference? Join us as a Community Flow Key Worker and be part of an innovative project that will transform care in Exeter and Tiverton.
About the Role
As a Community Flow Key Worker, you will be at the heart of a new initiative that connects hospital and community health and social care team patients to voluntary, community and other services and resources. You’ll work directly with patients across East Devon, ensuring they receive the support they need both to leave hospital safely and avoid unnecessary readmissions, also to support patients already at home. This person-centred role focuses on ‘What Matters to Me’ conversations understanding people’s needs, strengths and goals to help them live well at home and in their communities.
You’ll work mainly from home, building strong local networks, managing a referral caseload, conducting 'What Matters to Me' conversations, and co-creating support plans based on each person’s individual’s goals, strengths, and needs. From one-to-one support to team meetings, you’ll champion an approach where support flows around the person.
Most of your work will be by phone, with home or office visits when needed. There may be a requirement to work from RDUH offices when required.
Key Responsibilities
1. Manage a caseload of patients referred by RDUH and community teams across Exeter and Tiverton.
2. Conduct ‘What Matters to Me’ conversations to build person-centred support plans.
3. Connect people to relevant statutory, VCSE and community resources.
4. Use EPIC and Advice Pro to document patient contact and case management.
5. Work collaboratively with NHS colleagues, attend meetings, and build strong professional relationships.
6. Monitor a small patient budget to support timely and relevant interventions.
7. Chair and facilitate virtual 'Team Around the Person' meetings where appropriate.
8. Gather feedback, write case studies, identify gaps in local provision, and contribute to reporting and continuous improvement.
Who We're Looking For
9. Experience working with people with complex or multiple needs.
10. Knowledge of VCSE, statutory, and public services in East Devon.
11. Strong communication and relationship-building skills.
12. Proactive, self-motivated, and able to work independently managing a caseload and think creatively to solve problems.
13. Excellent written and verbal communication skills.
14. Proficiency in MS Office and case management systems.
15. A full driving licence and access to a vehicle. Initial induction and training will be at our Barnstaple office and ongoing occasional meetings will be at this location.
Why Community Flow?
People who need support most are often the least likely to receive it. Many feel bounced around services and unseen. Community Flow is about changing that by creating a system where people only have to tell their story once and get the right support around them. You’ll be part of a new programme to create joined-up, compassionate support in East Devon.
We are committed to equality, diversity, and inclusion, and we welcome applications from individuals of all backgrounds. This role is subject to an enhanced DBS check.
How to Apply
To apply download an application form from our website or email
Application deadline: 13th August 2025, please note if we receive a high number of applications we may close this sooner.