Job Description

Pioneers Integrated Partnership PCN JOB DESCRIPTION JOB TITLE:

Temporary Social Prescriber Link Worker GROUP: Primary Care Network GRADE: Local Pay Negotiable dep on experience RESPONSIBLE TO: PCN Clinical Director/PCN &Practice Manager ACCOUNTABLE TO: PCN Clinical Director/PCN &Practice Manager JOB SUMMARY: Social prescribing empowers people to take control of their health and wellbeing through referral to link workers who give time, focus on what matters to me and take a holistic approach to an individuals health and wellbeing, connecting people to community groups and statutory services for practical and emotional support. Link workers also support existing groups to be accessible and sustainable and help people to start new community groups, working collaboratively with all local partners. Social prescribing link workers will work as a key part of the primary care network (PCN) multidisciplinary team. Social prescribing can help PCNs to strengthen community and personal resilience and reduces health and wellbeing inequalities by addressing the wider determinants 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 Key Relationships (not exhaustive): Patients, carers and relatives Partnership Social Prescribing Leads and ICS Leads Partnership GPs,Nurses and the wider practice staff Other members of the wider Primary Care multi-disciplinary Team (including Commissioners) Other relevant organisations bodies from time to time as required Main duties and responsibilities: Working with direct supervision by a GP, take referrals from a wide range of agencies, including PCNs GP practices and multi-disciplinary team in pharmacies, wider 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. Provide personalised support to individuals, their families and carers to take control of their health and wellbeing, live independently and improve their health outcomes, as a key member of the PCN multi-disciplinary team. Develop trusting relationships by giving people time and focus on what matters to me. Take a holistic approach, based on the persons priorities and the wider determinants of health.



Co-produce a simple personalised care and support plan to 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 persons needs are beyond the scope of the link worker role e.g. 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. Alongside other members of the PCN multi-disciplinary team, work collaboratively with all local partners to contribute towards supporting the local VCSE organisations and community groups to become sustainable and that community assets are nurtured, through sharing intelligence regarding any gaps or problems identified in local provision with commissioners and local authorities. Social prescribing link workers will have a role in educating non-clinical and clinical staff within their PCN multi-disciplinary teams on what other services are available within the community and how and when patients can access them. This may include verbal or written advice and guidance.



They will also create a full directory of services available within our local communities Key Tasks Referrals Promote social prescribing, its role in self-management, and the wider determinants of health. As part of the PCN multi-disciplinary team, build relationships with staff in GP practices within the local PCN, attending relevant MDT meetings, 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. 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 those communities that statutory agencies may find hard to reach. Provide personalised support Meet people on a one-to-one basis, making home visits where appropriate within organisations policies and procedures.



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 approach focusing on a persons assets. Be a friendly source of information about health, 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 living skills, adaptations, enablement approaches and simple safeguards. 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 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. Seek advice and support from the GP supervisor and/or identified individuals to discuss patient-related concerns e.g.



abuse, domestic violence and support with mental health, referring the patient back to the GP or other suitable health professional if required. 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 menu of community groups and assets. Develop supportive relationships with local VCSE organisations, community groups and statutory services, to make timely, appropriate and supported referrals for the person being introduced. 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.



Encourage people who have been connected to community support through social prescribing to volunteer and give their time freely to others, building their skills and confidence and strengthening community resilience. Develop a team of volunteers within your service to provide buddying support for people, starting new groups and finding creative community solutions to local issues. Encourage people, their families and carers to provide peer support and to do things together, such as setting up new community groups or volunteering. Provide a regular confidence survey to community groups receiving referrals, to ensure that they are strong, sustained and have the support they need to be part of social prescribing.