Job summary
Social Prescribing empowers people to take control of their health and wellbeing through referral to Link Workers who provide the time and space to focus on non-medical needs, taking a holistic approach to explore what matters to me and connecting people to community groups and statutory services for practical and emotional support. Link Workers support existing groups to be accessible and sustainable and provide feedback to groups and strategic partners to enable development, working collaboratively with local partners. Social Prescribing can help to strengthen community resilience and personal resilience and reduces health inequalities by addressing the wider determinants of health, such as debt, poor housing, and physical inactivity. It can also increase 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 for those who have complex social needs which affect their wellbeing.
Working as part of a specialist multidisciplinary team including GPs and nurses to support those with complex needs. The Link Workers will focus on providing support for patients non-medical needs. These needs are often complex, and many patients referred to the service are frequent visitors to primary care, in particular their GP. The service is for adults over the age of 18 whose needs meet the referral criteria.
Main duties of the job
Referrals
Providing personalised support
Building relationship in the community
Personal and professional development
Communications
About us
Our Sutton PCNs are forward-looking, friendly and focused on providing a wide range of excellent healthcare services to patients in Sutton and the surrounding area. Our PCNs between them are led 9 PCN Clinical Directors. The PCNs work together as they see the benefits of working together in a larger GP partnership and are delighted to be realising some of those benefits now. Because of our scale, not only are we more resilient and efficient but we are able to invest in continuous quality improvement, enhanced care, new services and training and developing our workforce. We value the diversity of our colleagues and actively champion an inclusive culture and are committed to helping our colleagues achieve a work/life balance.
The Sutton PCNs are looking to employ Social Prescribers Linked Worker to support the Sutton Primary Care Network team in the delivery of patient services, working as part of the PCN multidisciplinary team, delivering care within their scope of practice to the entitled patient population. You’ll be joining a great team in a great place, where your commitment will be genuinely valued, your skills respected, and your ambition rewarded. Thank you for taking the time of submitting your application and agreeing to meet with our Health and Wellbeing Manager for the next stage of the recruitment process.
Main Responsibilities
Referrals
Act as a core member of the Social Prescribing Sutton team, attending regular meetings to intake and review patient progress, and plan integrated support.
Receive referrals from GPs. Work with wider health and social care agencies to ensure patient pathways are developed and maintained.
Advise on suitability of Social Prescribing for patients referred by the GP.
Manage and prioritise your own caseload, in accordance with the needs and priorities of the patient, and any urgent support required.
Promote Social Prescribing, its role in self-management, and the wider determinants of health.
Build relationships with key staff in the PCN (Primary Care Network) team, attend GP and PCN meetings, become part of the wider network team, and give information and feedback on social prescribing.
Seek and collate regular feedback about the quality of service and impact of social prescribing.
Keep accurate records of support provided and issues identified, reporting appropriately to partners, the wider PCN, and management.
Providing personalised support
Work with individuals to co-produce a 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.
Ensure patients understand that the role of the Link Worker is to connect them to appropriate services, managing expectations about length of involvement (Link Workers are expected to see a patient 1-6 times and focus on enabling contact with longer term support and activities).
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 the person and offering a person-centred, holistic wellbeing assessment.
Meet people on a one-to-one basis, working remotely or making home visits where appropriate.
Where appropriate refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the link worker role e.g., when there is a mental health need requiring a qualified practitioner.
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.
Help people maintain or regain independence through living skills, adaptations, enablement approaches and simple safeguards.
Where appropriate, refer people on to specialist agencies in the statutory or voluntary sector, to assist with specific needs e.g., benefits applications, advocacy needs, long term support.
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.
Building relationship in the community
Develop a knowledge base of statutory and VCSE services available in the borough (and wider communities) for all ages, and forge strong links with these organisations, community, and neighbourhood level groups, utilising their networks and building on what is already available.
Develop supportive relationships with local VCSE organisations, community groups and statutory services, to make timely, appropriate, and supported referrals for the person being introduced.
Ensure referrals and information sharing take place in accordance with information governance policies and procedures and legal frameworks.
Work with the wider Social Prescribing team to monitor and report any challenges with compliance in referral organisations.
Encourage people who have been connected to community support through social prescribing to consider volunteering, to build their skills and confidence, and strengthen community resilience.
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 have referred. Use a provided case management system to track the persons progress. Provide appropriate feedback to referral agencies about the people they referred.
Professional skills
Work with your line manager to undertake continual personal and professional development, taking an active part in reviewing and developing the roles and responsibilities.
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 external supervision, to enable you to deal effectively with the difficult issues that people present.
Work as part of the wider Social Prescribing team to seek feedback, continually improve the service.
Person Specification
Experience – Essential
Experience of working directly in a community development context, adult health and social care, public health, or health improvement; Experience of working in an individual support role, or experience that lends itself to this role;
Experience of working in or with the voluntary and community sector, which could include working with volunteers and small community groups;
Experience of data collection and using tools to measure the impact of services.
Other – Essential
Highly competent with electronic communications and calendar management, word processing and spreadsheets;
Ability to maintain effective working relationships and to promote collaborative practice with all colleagues;
Can work well under pressure;
Ability to work flexibly and enthusiastically within a team and on your own initiative;
Ability to work effectively with other members of the team and other partners and agencies;
Commitment to on-going personal and professional development
Knowledge and Skills – Essential
An understanding of the principles of confidentiality and how these apply when handling service user information;
Knowledge of the voluntary and community sector in Sutton.
Knowledge and Skills – Desirable
Awareness of the structure and working of a GP Surgery;
Knowledge of how Social Care systems and the NHS work including primary care.
Personal Attributes – Essential
Ability to work with and support people with a wide range of health and wellbeing needs and their carers, adopting a flexible and dynamic approach to meeting their needs;
Able to build rapport with people from all backgrounds and communities, respecting lifestyles and diversity;
Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders;
Ability to identify risk and assess/manage risk when working with individuals;
Able to work from an asset-based approach, building on existing community and personal assets;
Ability to reflect upon and evaluate ways of working and to identify how services could be developed and improved.
Disclosure and Barring Service Check
This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.