Social Prescribing Referral Management Act as the central point for the referral within the Primary Care Network, managing the coordination and connection of people to the local community statutory and voluntary assets. Working autonomously, take referrals from a wide range of agencies, working with GP practices within primary care networks, pharmacies, 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. Triage and oversee the referral process to ensure the individual receives the most appropriate level of personalised support to meet their needs. This may be with the Social Prescribing Link Worker, or may be more suitably placed with partners e.g., Community Connectors, Health Trainers.
Establish relationships with referred people to determine personalised support to individuals, family and carers in pursuit of holistic independent control of choice and support of what matters to me. Utilising the Our Rochdale Directory of Services, together with community and voluntary service networks and build on whats already available to create a map or menu of community groups and assets. Build a robust relationship and pathways with the statutory services and community groups to ensure effective connection of individuals, family and carers. To establish links with the PCN Mental Health Multi-Disciplinary Team, attending referral review meetings as required and playing an active role in the triage of referrals and escalating patients with more complex needs to other team members.
Communication Promoting social prescribing, its role in self-management, and the wider determinants of health such as housing, finance management and employment. Build relationships with key staff in GP practices within the local Primary Care Network (PCN), attending relevant meetings, becoming part of the wider network team, giving information and feedback on social prescribing. Be proactive in developing strong links with all local agencies to encourage referrals, recognising what they need to be confident in the service to make appropriate referrals. 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.
Provide referral agencies with regular updates about social prescribing, including training for their staff and how to access information to encourage appropriate referrals. Service Quality 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 all local communities particularly the hard-to-reach groups. Meet people on a one-to-one basis, making home visits where appropriate within organisations policies and procedures.
Build trust with the person, providing non-judgemental support, respecting diversity and lifestyle choices. Work from a strength-based approach focusing on a persons assets. Be a friendly source of information about wellbeing and prevention approaches. 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 the person, their families, and carers, and consider how they can all be supported through social prescribing. Help people maintain or regain independence through connecting to resources that support 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. Conduct reviews of the plan at set intervals to determine the impact of social prescribing.
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. Ensure that local community groups and voluntary organisations, the individual is 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. Support local groups to act in accordance with information governance policies and procedures, ensuring compliance with the Data Protection Act.
Service Impact Work with the network lead, employer, and local partners to identify unmet needs within the community and gaps in community provision. Work sensitively with people, their families, and carers to capture key information, enabling tracking of the impact of social prescribing on their health and wellbeing. Encourage people, their families, and carers to provide feedback and to share their stories about the impact of social prescribing on their lives. Support referral agencies to provide appropriate information about the person they are referring.
Use the case management system to track the persons progress. Provide appropriate feedback to referral agencies about the people they referred. Work closely with GP practices within the PCN to ensure that social prescribing referral codes are inputted to EMIS, and that the persons use of the NHS can be tracked, adhering to data protection legislation and data sharing agreements between GP Practices. Professional Development Work with your line manager to undertake mandatory training and continual personal and professional development, taking an active part in reviewing and developing the roles and responsibilities.
Participate in role development programmes delivered and coordinated by the Primary Care Academy Adhere to organisational policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety. Work with your line manager to access regular clinical supervision, to enable you to deal effectively with the difficult issues that people present.
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