Job Purpose
Social prescribing empowers people to take control of their health and wellbeing through referral to a link worker who gives time, focuses on what matters to the patient, and takes a holistic approach to an individual's health and wellbeing, connecting people to community groups and statutory services for practical and emotional support. The Social Prescribing Link Worker will be embedded within CHAW Primary Care Network multi-disciplinary teams to provide personalised support to individuals, their families, and carers to take control of their wellbeing, live independently, and improve their health outcomes.
The Social Prescribing Link Worker will:
1. Develop trusting relationships by giving people time and focusing on what matters to them.
2. Take a holistic approach, based on the person's priorities and the wider determinants of health.
3. Co-produce a personalised care and support plan to improve health and wellbeing.
4. Introduce or reconnect people to community groups and services, both over the phone and in person.
5. Evaluate the individual impact of a person's wellness progress.
6. Record referrals within GP clinical systems using the national SNOMED social prescribing codes and complete case management notes on Pathways systems.
7. Support the delivery of the comprehensive model of personalised care.
8. Draw on and increase the strengths and capacities of local communities, enabling local VCSE organisations and community groups to receive social prescribing referrals.
9. Critically analyse referral trends on a regular basis, along with referrer and patient behaviours, generating development plans to guide future referral activity.
10. Engage groups and statutory agencies that are difficult to reach.
Job Description
As a care social prescriber, your key responsibilities will include, but not be limited to:
1. As a member of the Primary Care Network (PCN) team, establish referral routes and take referrals from the PCN members, expanding to take referrals from a wide range of agencies in line with PCN requirements.
2. Promote social prescribing, its role in self-management, and the wider determinants of health to members of the PCN and other agencies.
3. Build relationships with staff in GP practices within the PCN, providing information and feedback on social prescribing.
4. Be proactive in developing strong links with all local agencies in line with the social prescribing implementation plan to encourage referrals.
5. Work in partnership with all local agencies to raise awareness of social prescribing and how partnership working can reduce pressure on statutory services, improve health outcomes, and enable a holistic approach to care.
6. Ensure ongoing engagement with the PCN to ensure a minimum number of social prescribing attachments occur per year in line with PCN/contractual requirements.
7. Seek regular feedback about the quality of the service and impact of social prescribing on referral agencies.
8. Work closely with PCN and MDT to ensure that the social prescribing referral codes are inputted into clinical systems in line with PCN contract.
9. Ensure data sharing agreements are in place and adhered to.
10. Be proactive in undertaking community development to encourage self-referrals and connect with all local communities, particularly those that statutory agencies may find hard to reach.
11. Forge strong links with local VCSE organisations, community, and neighbourhood level groups.
12. Meet people on a one-to-one basis.
13. Effectively manage a caseload of clients, prioritising workload according to needs and urgency.
14. Provide 1:1 support to assess patients' current assets/needs using agreed evidence-based assessment tools.
15. Using a person-centred strengths-based approach, co-produce with the patient their personalised care and support plan.
16. Facilitate and coordinate activities to support behaviour change and maintenance.
17. Be a trusted source of information about health, wellbeing, and prevention approaches.
18. Work with the person, their families, and carers to maximise the support package.
19. Help people identify the wider issues that impact their health and wellbeing.
20. Help people maintain or regain their independence through living skills and enablement approaches.
21. Develop trusting relationships by giving people time and focusing on what matters to them.
22. Work collaboratively with local agencies/primary care to maximise health outcomes for patients.
23. Deliver interventions using a range of motivational techniques.
24. Assess, monitor, and manage risk including suicidal ideation and safeguarding issues.
25. Educate non-clinical and clinical staff within the PCN on available community services.
General Work Related Expectations
To work within CHAW's Values, Ethos, and Vision, in accordance with all Practices Policies and Procedures, identify and attend training as required, and comply with relevant legislation.
Health and Safety
All PCN staff have a duty to ensure their health and safety while at work. Safe working practices and health and safety precautions are a legal requirement.
Risk Management
All employees are required to contribute to the control of risk and alert their manager to incidents and weaknesses that may compromise service quality.
Information Security
Employees have a legal obligation to ensure that information is kept accurate, confidential, and secure.
Confidentiality
Employees may gain knowledge of confidential matters that must not be disclosed. Failure to observe confidentiality may lead to disciplinary action.
This Job Description does not provide an exhaustive list of duties and may be reviewed in conjunction with the post holder in light of service development.
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