Job description

Job responsibilities

Primary duties and areas of responsibility

Work with the GP practices within Park and Orchard PCN to provide personalised support to individuals, their families, and carers to take control of their wellbeing, live independently and improve their health outcomes. This will involve working with GPs and PCN practice staff and referrals from and to a wide range of agencies, including 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).

Develop trusting relationships giving people time to focus on what matters to me. Take a holistic approach, based on the persons priorities and the wider determinants of health. Co-produce a personalised support plan and 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 person needs is beyond the scope of the link worker role, i.e. 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. Ensure they are supported and can provide opportunities for the person to develop friendships and a sense of belonging, and build knowledge, skills and confidence.

Key tasks

• Build relationships with key staff in GP practices within the Primary Care Network (PCN), attending relevant meetings, becoming part of the wider network team, educating, giving information and feedback on social prescribing.
• Promoting social prescribing with patients, staff and other agencies, its role in self-management, and the wider determinants of health.
• Be proactive in developing strong links with local agencies to ensure PCN staff are confident in the service to make appropriate referrals.
• Work in partnership with local agencies to raise awareness of social prescribing and how partnership working can improve health outcomes and enable a holistic approach to care.
• 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 local communities, particularly those communities that statutory agencies may find hard to reach.
• Use the social prescribing platform to store information and data about referrals and patient feedback for the purposes of further developing the service.

Provide personalised support

• Meet people on a one-to-one basis, making home visits where appropriate. 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 approached focusing on a persons assets.
• Be a friendly source of information about well-being and prevention approaches.
• Help people identify the wider issues that impact on their health and well-being, 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 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.

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 map or menu of community groups and assets for the PCN.
• 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 that local community groups and VCSE organisations being 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.
• Where policies and procedures are not in place, give help and support to groups to work towards this standard before referrals are made to them.
• Support local groups to act in accordance with information governance policies and procedures, ensuring compliance with GDPR/Data Protection.

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.
• Support local partners and commissioners to develop new groups and services where needed.

Please see full job description for further information.

Job responsibilities

Primary duties and areas of responsibility

Work with the GP practices within Park and Orchard PCN to provide personalised support to individuals, their families, and carers to take control of their wellbeing, live independently and improve their health outcomes. This will involve working with GPs and PCN practice staff and referrals from and to a wide range of agencies, including 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).

Develop trusting relationships giving people time to focus on what matters to me. Take a holistic approach, based on the persons priorities and the wider determinants of health. Co-produce a personalised support plan and 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 person needs is beyond the scope of the link worker role, i.e. 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. Ensure they are supported and can provide opportunities for the person to develop friendships and a sense of belonging, and build knowledge, skills and confidence.

Key tasks

• Build relationships with key staff in GP practices within the Primary Care Network (PCN), attending relevant meetings, becoming part of the wider network team, educating, giving information and feedback on social prescribing.
• Promoting social prescribing with patients, staff and other agencies, its role in self-management, and the wider determinants of health.
• Be proactive in developing strong links with local agencies to ensure PCN staff are confident in the service to make appropriate referrals.
• Work in partnership with local agencies to raise awareness of social prescribing and how partnership working can improve health outcomes and enable a holistic approach to care.
• 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 local communities, particularly those communities that statutory agencies may find hard to reach.
• Use the social prescribing platform to store information and data about referrals and patient feedback for the purposes of further developing the service.

Provide personalised support

• Meet people on a one-to-one basis, making home visits where appropriate. 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 approached focusing on a persons assets.
• Be a friendly source of information about well-being and prevention approaches.
• Help people identify the wider issues that impact on their health and well-being, 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 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.

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 map or menu of community groups and assets for the PCN.
• 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 that local community groups and VCSE organisations being 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.
• Where policies and procedures are not in place, give help and support to groups to work towards this standard before referrals are made to them.
• Support local groups to act in accordance with information governance policies and procedures, ensuring compliance with GDPR/Data Protection.

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.
• Support local partners and commissioners to develop new groups and services where needed.

Please see full job description for further information.

Person Specification

Skills & Knowledge

Essential

• Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities
• Knowledge of community development approaches
• Knowledge of IT systems, including ability to use word processing skills, emails and the internet to create simple plans and reports
• Knowledge of motivational coaching and interview skills

Desirable

• Knowledge of the personalised care approach
• Knowledge of VCSE and community services in the locality

Other requirements

Essential

• Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
• Willingness to work flexible hours when required to meet work demands
• Access to own transport and ability to travel across the locality on a regular basis, including to visit people in their own homes

Personal Qualities & Attributes

Essential

• Ability to listen, empathise with people and provide person-centred support in a non-judgemental way
• Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
• Commitment to reducing health inequalities and proactively working to reach people from all communities
• Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
• 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
• 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 person needs is beyond the scope of the link worker role e.g. when there is a mental health need requiring a qualified practitioner
• Able to work from an asset-based approach, building on existing community and personal assets
• Able to provide leadership and to finish work tasks
• Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
• Commitment to collaborative working with all local agencies (including VCSE organisations and community groups). Able to work with others to reduce hierarchies and find creative solutions to community issues
• Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
• High level of written and oral communication skills
• Ability to work flexibly and enthusiastically within a team or on own initiative
• Understanding of the needs of small volunteer-led community groups and ability to support their development
• Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety

Experience

Essential

• Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
• Experience of supporting people, their families and carers in a related role (including unpaid work)
• Experience of working with the VCSE sector (in a paid or unpaid capacity), including with volunteers and small community groups
• Experience of partnership/collaborative working and of building relationships across a variety of organisations

Desirable

• Experience of supporting people with their mental health, either in a paid, unpaid or informal capacity
• Experience of data collection and providing monitoring information to assess the impact of services

Qualifications

Essential

• NVQ Level 3 Health and Social Care, or equivalent qualifications or working towards
• Demonstrable commitment to professional and personal development

Desirable

• Training in motivational coaching and interviewing or equivalent experience

Skills & Knowledge

Essential

• Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities
• Knowledge of community development approaches
• Knowledge of IT systems, including ability to use word processing skills, emails and the internet to create simple plans and reports
• Knowledge of motivational coaching and interview skills

Desirable

• Knowledge of the personalised care approach
• Knowledge of VCSE and community services in the locality

Other requirements

Essential

• Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
• Willingness to work flexible hours when required to meet work demands
• Access to own transport and ability to travel across the locality on a regular basis, including to visit people in their own homes

Personal Qualities & Attributes

Essential

• Ability to listen, empathise with people and provide person-centred support in a non-judgemental way
• Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
• Commitment to reducing health inequalities and proactively working to reach people from all communities
• Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
• 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
• 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 person needs is beyond the scope of the link worker role e.g. when there is a mental health need requiring a qualified practitioner
• Able to work from an asset-based approach, building on existing community and personal assets
• Able to provide leadership and to finish work tasks
• Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
• Commitment to collaborative working with all local agencies (including VCSE organisations and community groups). Able to work with others to reduce hierarchies and find creative solutions to community issues
• Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
• High level of written and oral communication skills
• Ability to work flexibly and enthusiastically within a team or on own initiative
• Understanding of the needs of small volunteer-led community groups and ability to support their development
• Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety

Experience

Essential

• Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
• Experience of supporting people, their families and carers in a related role (including unpaid work)
• Experience of working with the VCSE sector (in a paid or unpaid capacity), including with volunteers and small community groups
• Experience of partnership/collaborative working and of building relationships across a variety of organisations

Desirable

• Experience of supporting people with their mental health, either in a paid, unpaid or informal capacity
• Experience of data collection and providing monitoring information to assess the impact of services

Qualifications

Essential

• NVQ Level 3 Health and Social Care, or equivalent qualifications or working towards
• Demonstrable commitment to professional and personal development

Desirable

• Training in motivational coaching and interviewing or equivalent experience

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.

Employer details

Employer name

Alliance for Better Care CIC

Address

The Park Surgery

Albion Way

Horsham

West Sussex

RH12 1BG

Employer's website

https://allianceforbettercare.org/ (Opens in a new tab)