Job summary
We are looking for a Social Prescribing Link Worker to join our team. Park and Orchard PCN in Horsham is a
new PCN with a population of 31,000 patients. We have a higher than average
population of elderly patients, many of whom live in their own homes and
require a lot of social support. There are challenges for the whole population
in terms of the cost of living, social isolation and loneliness, housing,
employment and mental health issues. We also have higher than average numbers
of young people struggling with mental health issues and we have a good working
relationship with the iRock cafe in Horsham.
During the last 5 years as part of
Horsham Central PCN we have had a strong focus on personalised care, building
our team of social prescribers, health coaches and care coordinators alongside
our mental health support workers. We led on developing our Horsham District
Befriends community service and obtained funding in order to address social
isolation after the Covid pandemic. We are also working in partnership with
Horsham Wellbeing hub and other local community organisations to offer support
to those struggling with the peri/menopause. We run a partnership Menopause
Cafe and Menopause Information Sessions. We also have a strong focus on
dementia, young peoples mental health and cost of living and are keen to
develop these further.
Our new PCN will be developing a
multidisciplinary Frailty Team which will include our social prescriber.
Main duties of the job
Social
prescribing empowers people to take control of their health and wellbeing
through referral to non-medical link
workers who
give time, focus on what
really matters to me and
take a holistic approach, connecting people to community groups and statutory
services for practical and emotional support. Link workers support existing
groups to be accessible and sustainable and work collaboratively with all local
partners.
Social
prescribing can help to strengthen community resilience and personal resilience
and reduces health inequalities by addressing the wider detriments of health,
such as debt, poor housing and physical inactivity, by increasing peoples active involvement with
their local communities. It particularly works for people with long term
conditions (including support for mental health), for people who are lonely or
isolated, or have complex social needs which affect their wellbeing.
About us
Alliance for Better
Care CIC is a GP Federation that unites 47 NHS GP practices across 12 Primary
Care Networks in Sussex and Surrey. We support our Primary Care colleagues as
well as their patients, to transform how healthcare is managed within the community.
As a membership organisation, our focus is to work in partnership with our
members and help them to improve the provision of General Practices in the
local area.
We work with and listen to our GP Practices, PCNs, Hospitals, Community
Organisations and the Third Sector. These vital partnerships ensure that,
together, we deliver a truly integrated approach that offers the support and
expertise needed to effectively serve our communities.
More about our
organisation: www.allianceforbettercare.org
Job description
Job responsibilities
Primary
duties and areas of responsibility
Work with
the GP practices within Park and Orchard PCN to provide personalised support to
individuals, their families, and carers to take control of their wellbeing,
live independently and improve their health outcomes. This will involve working
with GPs and PCN practice staff and referrals from and to a wide range of
agencies, including multi disciplinary teams, hospital discharge teams,
allied health professionals, fire service, police, job centres, social care
services, housing associations, and voluntary, community and social enterprise
(VCSE) organisations (list not exhaustive).
Develop
trusting relationships giving people time to focus on what matters to me. Take a holistic approach, based on the persons priorities and
the wider determinants of health. Co-produce a personalised support plan and
improve health and wellbeing, introducing or reconnecting people to 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 what the person
needs is beyond the scope of the link worker role, i.e. when there is a mental
health need requiring a qualified practitioner.
Draw
on and increase the strengths and capacities of local communities, enabling
local VCSE organisations and community groups to receive social prescribing
referrals. Ensure they are supported and can provide opportunities for the
person to develop friendships and a sense of belonging, and build knowledge,
skills and confidence.
Key
tasks
- Build relationships with key staff in GP practices within the
Primary Care Network (PCN), attending relevant meetings, becoming part of the
wider network team, educating, giving information and feedback on social
prescribing.
- Promoting social prescribing with patients, staff and other
agencies, its role in self-management, and the wider determinants of health.
- Be proactive in developing strong links with local agencies
to ensure PCN staff are confident in the service to make appropriate referrals.
- Work in partnership with local agencies to raise awareness of
social prescribing and how partnership working can improve health outcomes and
enable a holistic approach to care.
- Seek regular feedback about the quality of service and impact
of social prescribing on referral agencies.
- Be proactive in encouraging self-referrals and connecting
with local communities, particularly those communities that statutory agencies
may find hard to reach.
- Use the social prescribing platform to store information and
data about referrals and patient feedback for the purposes of further
developing the service.
Provide
personalised support
- Meet people on a one-to-one basis, making home visits where
appropriate. Give people time to tell their stories and focus on what matters
to me. Build trust with the person, providing non-judgemental support,
respecting diversity, and lifestyle choices. Work from a strength-based
approached focusing on a persons assets.
- Be a friendly source of information about well-being and
prevention approaches.
- Help people identify the wider issues that impact on their
health and well-being, such as debt, poor housing, being unemployed, loneliness
and caring responsibilities.
- Work with the person, their families and carers and consider
how they can all be supported through social prescribing.
- Help people maintain or regain independence through living
skills, adaptations, enablement approaches and simple safeguards.
- Work with individuals to co-produce a simple personalised
support plan based on the persons priorities, interests, values and
motivations including what they can expect from the groups, activities and
services they are being connected to and what the person can do for themselves
to improve their health and wellbeing.
- Where appropriate, physically introduce people to community
groups, activities, and statutory services, ensuring they are comfortable.
Follow up to ensure they are happy, able to engage, included and receiving good
support.
- Where people may be eligible for a personal health budget,
help them to explore this option as a way of providing funded, personalised
support to be independent, including helping people to gain skills for
meaningful employment, where appropriate.
Support
community groups and VCSE organisations to receive referrals
- Forge strong links with local VCSE organisations, community
and neighbourhood level groups, utilising their networks and building on whats
already available to create a map or menu of community groups and assets for
the PCN.
- Develop supportive relationships with local VCSE
organisations, community groups and statutory services, to make timely,
appropriate and supported referrals for the person being introduced.
- Ensure that local community groups and VCSE organisations
being referred to have basic procedures in place for ensuring that vulnerable
individuals are safe and, where there are safeguarding concerns, work with all
partners to deal appropriately with issues.
- Where policies and procedures are not in place, give help and
support to groups to work towards this standard before referrals are made to
them.
- Support local groups to act in accordance with information
governance policies and procedures, ensuring compliance with GDPR/Data
Protection.
Work
collectively with all local partners to ensure community groups are strong and
sustainable
- Work with commissioners and local partners to identify unmet
needs within the community and gaps in community provision.
- Support local partners and commissioners to develop new
groups and services where needed.
Please see full job description for further information.
Job description
Job responsibilities
Primary
duties and areas of responsibility
Work with
the GP practices within Park and Orchard PCN to provide personalised support to
individuals, their families, and carers to take control of their wellbeing,
live independently and improve their health outcomes. This will involve working
with GPs and PCN practice staff and referrals from and to a wide range of
agencies, including multi disciplinary teams, hospital discharge teams,
allied health professionals, fire service, police, job centres, social care
services, housing associations, and voluntary, community and social enterprise
(VCSE) organisations (list not exhaustive).
Develop
trusting relationships giving people time to focus on what matters to me. Take a holistic approach, based on the persons priorities and
the wider determinants of health. Co-produce a personalised support plan and
improve health and wellbeing, introducing or reconnecting people to 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 what the person
needs is beyond the scope of the link worker role, i.e. when there is a mental
health need requiring a qualified practitioner.
Draw
on and increase the strengths and capacities of local communities, enabling
local VCSE organisations and community groups to receive social prescribing
referrals. Ensure they are supported and can provide opportunities for the
person to develop friendships and a sense of belonging, and build knowledge,
skills and confidence.
Key
tasks
- Build relationships with key staff in GP practices within the
Primary Care Network (PCN), attending relevant meetings, becoming part of the
wider network team, educating, giving information and feedback on social
prescribing.
- Promoting social prescribing with patients, staff and other
agencies, its role in self-management, and the wider determinants of health.
- Be proactive in developing strong links with local agencies
to ensure PCN staff are confident in the service to make appropriate referrals.
- Work in partnership with local agencies to raise awareness of
social prescribing and how partnership working can improve health outcomes and
enable a holistic approach to care.
- Seek regular feedback about the quality of service and impact
of social prescribing on referral agencies.
- Be proactive in encouraging self-referrals and connecting
with local communities, particularly those communities that statutory agencies
may find hard to reach.
- Use the social prescribing platform to store information and
data about referrals and patient feedback for the purposes of further
developing the service.
Provide
personalised support
- Meet people on a one-to-one basis, making home visits where
appropriate. Give people time to tell their stories and focus on what matters
to me. Build trust with the person, providing non-judgemental support,
respecting diversity, and lifestyle choices. Work from a strength-based
approached focusing on a persons assets.
- Be a friendly source of information about well-being and
prevention approaches.
- Help people identify the wider issues that impact on their
health and well-being, such as debt, poor housing, being unemployed, loneliness
and caring responsibilities.
- Work with the person, their families and carers and consider
how they can all be supported through social prescribing.
- Help people maintain or regain independence through living
skills, adaptations, enablement approaches and simple safeguards.
- Work with individuals to co-produce a simple personalised
support plan based on the persons priorities, interests, values and
motivations including what they can expect from the groups, activities and
services they are being connected to and what the person can do for themselves
to improve their health and wellbeing.
- Where appropriate, physically introduce people to community
groups, activities, and statutory services, ensuring they are comfortable.
Follow up to ensure they are happy, able to engage, included and receiving good
support.
- Where people may be eligible for a personal health budget,
help them to explore this option as a way of providing funded, personalised
support to be independent, including helping people to gain skills for
meaningful employment, where appropriate.
Support
community groups and VCSE organisations to receive referrals
- Forge strong links with local VCSE organisations, community
and neighbourhood level groups, utilising their networks and building on whats
already available to create a map or menu of community groups and assets for
the PCN.
- Develop supportive relationships with local VCSE
organisations, community groups and statutory services, to make timely,
appropriate and supported referrals for the person being introduced.
- Ensure that local community groups and VCSE organisations
being referred to have basic procedures in place for ensuring that vulnerable
individuals are safe and, where there are safeguarding concerns, work with all
partners to deal appropriately with issues.
- Where policies and procedures are not in place, give help and
support to groups to work towards this standard before referrals are made to
them.
- Support local groups to act in accordance with information
governance policies and procedures, ensuring compliance with GDPR/Data
Protection.
Work
collectively with all local partners to ensure community groups are strong and
sustainable
- Work with commissioners and local partners to identify unmet
needs within the community and gaps in community provision.
- Support local partners and commissioners to develop new
groups and services where needed.
Please see full job description for further information.
Person Specification
Skills & Knowledge
Essential
- Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities
- Knowledge of community development approaches
- Knowledge of IT systems, including ability to use word processing skills, emails and the internet to create simple plans and reports
- Knowledge of motivational coaching and interview skills
Desirable
- Knowledge of the personalised care approach
- Knowledge of VCSE and community services in the locality
Other requirements
Essential
- Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
- Willingness to work flexible hours when required to meet work demands
- Access to own transport and ability to travel across the locality on a regular basis, including to visit people in their own homes
Personal Qualities & Attributes
Essential
- Ability to listen, empathise with people and provide person-centred support in a non-judgemental way
- Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
- Commitment to reducing health inequalities and proactively working to reach people from all communities
- Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
- Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders
- Ability to identify risk and assess/manage risk when working with individuals
- Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the link worker role e.g. when there is a mental health need requiring a qualified practitioner
- Able to work from an asset-based approach, building on existing community and personal assets
- Able to provide leadership and to finish work tasks
- Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
- Commitment to collaborative working with all local agencies (including VCSE organisations and community groups). Able to work with others to reduce hierarchies and find creative solutions to community issues
- Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
- High level of written and oral communication skills
- Ability to work flexibly and enthusiastically within a team or on own initiative
- Understanding of the needs of small volunteer-led community groups and ability to support their development
- Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
Experience
Essential
- Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
- Experience of supporting people, their families and carers in a related role (including unpaid work)
- Experience of working with the VCSE sector (in a paid or unpaid capacity), including with volunteers and small community groups
- Experience of partnership/collaborative working and of building relationships across a variety of organisations
Desirable
- Experience of supporting people with their mental health, either in a paid, unpaid or informal capacity
- Experience of data collection and providing monitoring information to assess the impact of services
Qualifications
Essential
- NVQ Level 3 Health and Social Care, or equivalent qualifications or working towards
- Demonstrable commitment to professional and personal development
Desirable
- Training in motivational coaching and interviewing or equivalent experience
Person Specification
Skills & Knowledge
Essential
- Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities
- Knowledge of community development approaches
- Knowledge of IT systems, including ability to use word processing skills, emails and the internet to create simple plans and reports
- Knowledge of motivational coaching and interview skills
Desirable
- Knowledge of the personalised care approach
- Knowledge of VCSE and community services in the locality
Other requirements
Essential
- Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
- Willingness to work flexible hours when required to meet work demands
- Access to own transport and ability to travel across the locality on a regular basis, including to visit people in their own homes
Personal Qualities & Attributes
Essential
- Ability to listen, empathise with people and provide person-centred support in a non-judgemental way
- Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
- Commitment to reducing health inequalities and proactively working to reach people from all communities
- Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
- Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders
- Ability to identify risk and assess/manage risk when working with individuals
- Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the link worker role e.g. when there is a mental health need requiring a qualified practitioner
- Able to work from an asset-based approach, building on existing community and personal assets
- Able to provide leadership and to finish work tasks
- Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
- Commitment to collaborative working with all local agencies (including VCSE organisations and community groups). Able to work with others to reduce hierarchies and find creative solutions to community issues
- Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
- High level of written and oral communication skills
- Ability to work flexibly and enthusiastically within a team or on own initiative
- Understanding of the needs of small volunteer-led community groups and ability to support their development
- Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
Experience
Essential
- Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
- Experience of supporting people, their families and carers in a related role (including unpaid work)
- Experience of working with the VCSE sector (in a paid or unpaid capacity), including with volunteers and small community groups
- Experience of partnership/collaborative working and of building relationships across a variety of organisations
Desirable
- Experience of supporting people with their mental health, either in a paid, unpaid or informal capacity
- Experience of data collection and providing monitoring information to assess the impact of services
Qualifications
Essential
- NVQ Level 3 Health and Social Care, or equivalent qualifications or working towards
- Demonstrable commitment to professional and personal development
Desirable
- 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.
