Job responsibilities
Key responsibilities
Take
referrals from the PCNs Core Network Practices and from a range of local agencies
and through self-referrals .
Provide
personalised support to individuals, their families and carers to access
community-based activities and support that can help them to take control of
their health and wellbeing through co-producing a simple personalised care and
support plan and introducing people to appropriate activities, groups and
services as described above
Work
with appropriate supervision as part of the PCN to manage and prioritise your
own caseload, in accordance with needs, priorities and support required by
individuals. Refer people back to other health professionals/agencies, as
appropriate or necessary.
Build
ongoing relationships with local infrastructure organisations, community
activities and support services to increase knowledge of the community support
offer, and work collaboratively to develop effective partnership working to
support the community offer to be sustainable, identifying gaps in provision,
nurturing community assets and sharing intelligence on gaps or problems with
commissioners and local authorities
Increase
the strength and capacity of the community, enabling local VCSE organisations
and community groups to both receive social prescribing referrals and to make
referrals to social prescribing link workers.
Educate
non-clinical and clinical staff within PCN MDTs on the community support offer,
how and when patients can access it, and the value of non-medical community-based
interventions. This may include verbal or written advice and guidance.
Promote
social prescribing as an approach across the PCN and wider agencies, including
its role in supported self-management, in addressing health inequalities and
the wider determinants of health, reducing pressure on statutory services,
improving access to healthcare and improving health outcomes, and in taking a
holistic approach to care.
Key Tasks
Referrals
Promote
social prescribing as an approach across the PCN by attending relevant MDT
meetings to build relationships and developing links with local agencies
Proactively
develop strong links with local agencies to encourage appropriate referrals
Provide
referral agencies with regular updates about social prescribing, including
training for their staff and how to access information to encourage appropriate
referrals.
Seek
regular feedback about the quality of service and impact of social prescribing
on referral agencies.
Proactively
encourage equitable participation in social prescribing through taking
self-referrals and connecting with diverse local communities through a range of
methods, particularly communities that statutory agencies may find hard to
reach and where health inequalities are most prevalent.
Provide personalised support
Meet
people on a one-to-one basis, making home visits and visits to community
organisation where appropriate and within organisations policies and
procedures.
Use
appropriate judgement to ascertain the number and length of sessions required,
responding to the needs of the individual and their circumstances, for
approximately 6-12 contacts over 3 months.
Give
people time to tell their stories and focus on the question, what matters to
me?
Build
trust and respect with the person, providing non-judgemental and
non-discriminatory support, taking a strength-based approach that focuses on a
persons assets.
Work
with the person, their families and carers and consider how they can all be
supported through social prescribing.
Help
people identify the wider issues that impact on their health and wellbeing,
such as debt, poor housing, being unemployed, loneliness and caring
responsibilities.
Work
with individuals to co-produce a simple personalised support plan to address
the persons health and wellbeing needs based on the persons priorities,
interests, values, cultural and religious/faith needs and motivations
Provide
information on what people can from the groups, activities and services they
are being connected to
Provide
information on what the person can do for themselves to improve their health
and wellbeing
Physically
introduce people to appropriate community groups and activities, peer support
groups, or statutory services, ensuring they are comfortable, feel valued and
respected.
Provide
follow up support to the person to ensure they are happy, able to engage, feel
included and that they are receiving good support.
Help
people maintain or regain independence through living skills, adaptations,
enablement approaches and simple safeguards
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.
Seek
advice and support from the GP supervisor and/or identified individual(s) to
discuss safeguarding concerns and follow PCN safeguarding policies around
reporting and/or escalating concerns
Seek
advice and support from the GP supervisor and/or identified individual(s) to
discuss concerns outside the scope of the social prescribing link workers
practice and make appropriate onward referrals
Supporting the community offer
Develop
supportive relationships with local VCSE organisations, community groups and
statutory services, to understand their offer and make timely, appropriate and
supported referrals
Create
strong links with local agencies to utilise existing networks and build on
existing provision
Work
collectively with all local partners to ensure community groups are accessible
and sustainable
Support
development of community groups and assets who promote diversity and inclusion
Encourage
people who have been connected to community support through social prescribing
to volunteer or to start their own activities and groups
Support
existing local volunteering schemes to strengthen community resilience and
explore potential to develop a team of volunteers to provide buddying support,
peer support or to start new community-based groups or activities.
Data capture
Support
referral agencies to provide appropriate information about the person they are
referring, including demographic data and data on wider determinants, for
example, caring status.
Provide
appropriate and timely feedback to referral agencies about the people they
referred.
Work
sensitively with people, their families and carers to capture key information
to measure impact of social prescribing on their health and wellbeing, using
validated tools determined locally such as the ONS4 wellbeing scale to assess
need and measure outcomes.
Encourage
people, their families and carers to provide feedback on their experience, for
example, through patient satisfaction surveys, and to share their stories about
the impact of social prescribing on their lives.
Ensure
that social prescribing referral SNOMED codes are coded appropriately into
clinical systems (as outlined in the Network Contract DES)
Adhere
to PCN policies around data protection legislation and data sharing agreements,
ensuring people give appropriate consent.
Continuing professional development
Work with a supervisor and/or line manager to undertake
continual personal and professional development in line with the social
prescribing Workforce Development Framework Competency Framework
Work
with your supervising clinician and/or line manager to access regular
clinical/non-managerial supervision
Take
an active role in reflecting, reviewing and developing professional knowledge,
skills and behaviours
Attend
appropriate mandatory training before working with people and be aware of own
competence, maintaining boundaries around scope of practice and referring
onwards for people whose needs fall outside of these boundaries
Adhere
to organisational policies and procedures, including confidentiality, safeguarding,
lone working, information governance, equality, diversity and inclusion
training and health and safety.
Miscellaneous
Work
as part of the MDT to seek feedback, continually improve the service, and
contribute to service planning.
Contribute
to the development of policies and plans relating to equality, diversity and
inclusion, accessibility, and health inequalities.
Undertake
any tasks consistent with the level of the post and the scope of the role,
ensuring that work is delivered in a timely and effective manner.
The above is a non exhaustive list of
duties and you are expected to undertake any other duties as requested by your
Manager. The Company reserves the right
to amend your job description in line with the changing demands of the business.
