Job Description

Job title Social Prescriber Link Worker Line manager Partners, Practice Manager Accountable to Hours per week 30 - 37.5 hours per week Job purpose The post holder will be an integral part of the practice team. A referral to a non-medical link worker is designed to support patients in being able to take a holistic approach, connecting people to community groups and statutory services for practical and emotional support. Social prescribing can help to strengthen community resilience and personal resilience whilst reducing health inequalities by addressing the wider determinants of health such as debt, poor housing and physical inactivity by increasing peoples activeinvolvement with their local communities. This role can be particularly beneficial to patients with long-term conditions, those with mental health issues and those who are lonely or isolated or who have complex social needs which affect their wellbeing.



Primary key responsibilities The following are the core responsibilities of the Social Prescriber Link Worker. There may be, on occasion, a requirement to carry out other tasks; this will be dependent upon factors such as workload and staffing levels. a. Assess how far a patients health and well-being needs can be met by services and other opportunities available in the community b.



Co-produce a simple personalised care and support plan to address the patients health and well-being needs by introducing or reconnecting people to community groups and statutory services, including weight management support and signposting when appropriate and it matters to the person c. Evaluate how far the actions in the care and support plan are meeting the patients health and wellbeing needs d. Provide personalised support to patients, their families and carers to take control of their health and well-being, live independently, improve their health outcomes and maintain a healthy lifestyle e. Develop trusting relationships by giving people time and focus on what matters to them f.



Take a holistic approach, based on the patients priorities and the wider determinants of health, including supporting people to take up employment, training and welfare support g. Explore and support access to a personal health budget where appropriate h. Manage and prioritise their own caseload-, in accordance with the health and well-being needs of their population i. When required and as appropriate, refer patients back to other health professionals within Bretton Park Healthcare j.



Work as part of a multi-disciplinary team in a patient facing role using expert knowledge within the SPLW areas and promote social prescribing and its role in self-management k. Work together with all local partners to collectively ensure that local VCSE organisations and community groups are sustainable and that community assets are nurtured l. Build relationships with key staff, attending relevant meetings, which includes the PCN -becoming part of the wider network team, giving information and feedback on social prescribing at the monthly learning event. m.



Ensure that social prescribing referral codes are inputted into Systm1, and that the persons use of the NHS can be tracked, adhering to data protection legislation and data sharing agreements with the ICS/ICB n. 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 o. Be proactive in encouraging self-referrals and connecting with all local communities, particularly those communities that statutory agencies may find hard to reach p. Meet people on a one-to-one basis, making home visits when appropriate and inline with the practice policy and procedures giving people time to tell their stories and focus on what matters to me and building trust with the person, providing non-judgemental support, respecting diversity and lifestyle choices.



The role requires working from a strength-based approach focusing on a persons assets q. Help people to identify the wider issues that impact on their health and well-being such as debt, poor housing, being unemployed, loneliness and caring responsibilities r. Help people to maintain or regain independence through living skills, adaptations, enablement approaches and simple safeguards s. Work with individuals to co-produce a simple personalised support plan t.



When 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 when appropriate u. Forge strong links with local VCSE organisations, community and neighbourhood level groups, utilising their networks and building on what is already available v. Work with commissioners and local partners to identify unmet needs within the community and gaps in community provision w. Support local partners and commissioners to develop new groups and services where needed through small grants for community groups, micro-commissioning and development support x.



Support the delivery of enhanced services and other service requirements on behalf of the practice, including the monthly safeguarding adults submission. y. Deliver training, mentoring and guidance to other clinicians and staff on SPLW matters z. Produce SPLW newsletters or bulletins when required and feedback at the monthly practice meetings on current/ongoing issues.



aa. Support virtual and remote models of consultation and support including e-consultations, remote medication review and telehealth and telemedicine bb. Participate in the management of patient complaints when requested to do so and participate in the identification of any necessary learning brought about through incidents and near-miss events cc. Manage a caseload of potentially complex patients and provide advice for the GP management on the more complex patients dd.



Review the latest guidance ensuring the practice conforms to NICE, CQC etc. ee. Actively signpost patients to the correct healthcare professional ff. Provide targeted support and proactive reviews for vulnerable, complex patients and those at risk of admission and re-admission to secondary care gg.



Seek regular feedback about the quality of service and impact of social prescribing on referral agencies hh. Work with your line manager to undertake continual personal and professional development, taking an active part in reviewing and developing the roles and responsibilities ii. Work with your line manager to access regular clinical supervision, to enable you to deal effectively with the difficult issues that people present jj. Undertake all mandatory training and induction programmes kk.



Attend a formal appraisal with their manager at least every 12 months. Once a performance/training objective has been set, progress will be reviewed on a regular basis so that new objectives can be agreed ll. Contribute to public health campaigns (e.g., flu clinics) through advice or direct care. Secondary responsibilities The SPLW may be requested to: a.



Draw on and increase the strength and capacity of local communities, enabling local VCSE organisations and community groups to receive social prescribing referrals from the SPLW b. Work collaboratively with all local partners to contribute towards supporting the local VCSE organisations and community groups to become sustainable and ensure that community assets are nurtured through sharing intelligence regarding any gaps or problems identified in local provision with commissioners and local authorities d. Support the delivery of QOF, incentive schemes, QIPP and other quality or cost effectiveness initiatives. e.



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. f. Duties may vary from time to time without changing the general character of the post or the level of responsibility.