High Intensity Use Lead

First Coastal PCN; Alford, Spilsby, Boston; On-site; GBP 30,000 - 40,000; Full time

Job summary

A primary care network in the United Kingdom is seeking a HIU Lead to provide holistic support for individuals reliant on emergency services. This role involves understanding patients' needs, collaborating with community services, and driving positive health outcomes. Ideal candidates will demonstrate emotional intelligence, resilience, and strong leadership abilities. The position also requires effective record-keeping and a commitment to safeguarding policies. Competitive salary and opportunities for professional development are offered.

Qualifications

• Experience of supporting vulnerable adults in a person centred way.
• Ability to work sensitively in difficult emotional circumstances.
• Strong understanding of safeguarding policy and practice.

Responsibilities

• Provide one-to-one person-centred support for individuals with high dependency on emergency services.
• Work collaboratively with the voluntary and community sector for appropriate referrals.
• Ensure effective record-keeping compliant with GDPR.

Skills

Emotional intelligence

Communication skills

Resilience

Negotiation skills

Collaboration

Job description

Are you looking for a challenging yet rewardingopportunity to make a positive impact on people lives?

Are you passionate about ensuring thatindividuals have access to the best opportunities and support to live theirbest lives?

Do you possess a strong determination, tenacity,and a collaborative, person-centred approach to improving outcomes for people?

Are you a person who is looking for autonomy andinitiative within your role?

Are you looking for a role which by workingtogether, we can make a difference in the lives of those who need it most?

First Coastal PCN has an excitingopportunity to recruit a HIU Lead tojoin the First Coastal PCN in the High Intensity Use Service. We are seeking an individual with the ability to connect with patients, whilst maintain clear boundaries in order to positively impact the behaviour and outcomes of those with the most complex medical and social needs.

Main duties of the job

In working with some of the mostdeprived communities in this area, it is crucial to understand and address thecomplex and unique needs that come with it. This role is not merely aboutfixing problems, but rather about listening and truly understanding theindividuals we aim to support. Being open-minded and non-judgemental is key inbuilding trust and rapport with those facing challenging circumstances.Patience is a virtue in this line of work, as progress may not happen asquickly as we hope. It is about embracing the individual's journey and movingat their pace, recognizing that this pace will vary for each person.

About us

First Coastal Primary Care Networkis a group of seven practices who know they have a number of people in theircommunity that need something different.For reasons we do not always understand people find themselves accessingurgent and emergency care and we need the right people with the right attitudesand skills to change this.

Job responsibilities

Job Summary

A highly motivated, emotionally intelligent, and resilientperson with leadership skills, whose drive is quality client care and whothrives off innovation. Lateral thinking, which is out of the boxis encouraged to support this vulnerable client group.

The Objectives of the Service are

Identify those at greatest risk of A&Eattendance and non-elective admissions.

Proactively work with a rolling cohort of HIUclients, really understanding what they need.

To coordinate wellbeing and connect with otherservices, enrolling them to help to get to the desired end.

Reducing 999 calls as a natural by-product(possibly ambulance and police).

Reducing A&E attendances and avoidablenon-elective admissions

Drive equality and client voice.

Forming robust network of community health,social care, mental health and police to manage clients, creating trueintegrated working.

Providing a service driven by quality withpositive human outcomes observed.

Act as a conduit to negotiate and de-escalateissues before a crisis occurs; a situation which has historically led to adestabilisation of their condition and resulting in a A&E attendance / 999calls.

Improving communication and partnership workingbetween those involved in client care 24/7.

Identify patterns and causal factors whichtrigger relapse behaviours in order to shape future commissioning of serviceand/or demand/capacity planning.

Empower clients to self-manage to enablesustainable discharge.

Expected Outcomes

The key outcomes that the proposed service willdeliver are:

Impact positively on reducing the high intensityuse of healthcare.

To support clients to flourish throughsustaining job opportunities, reconnecting with families, improving well-beingetc.

A new culture of 1:1 coaching as a medium todeliver sustainable change.

It is recognised that the latter two points of expectedoutcomes are more difficult to measure but they are essential outcomes if aculture change is to occur to lower the stigma associated with this cohort.

The post holder is responsible for creating an innovativeway of supporting the reduction in high intensity use ofA&E. They will facilitate discussions and advise colleagues asto how best practice might be adopted for future development of the service andoversee their delivery.

Lead in removing potential barriers and stigma associatedwith HIU to promote equality, diversity and safeguarding service wide.

The HIU Lead will act as an advocate for the client, guidingthem through the complex journey and multi-faceted approach to encourageappropriate use of scheduled and unscheduled care services.

A further element of the role would be coordination, sharingand learning of the work with community-based staff to promote safe practiceand sustainability.

The post is responsible for providing professional expertiseto the outcome of the business processes for the Lincolnshire IntegratedCommissioning Board, including report writing and presenting evaluationreports.

Main Purpose of Job

To provide holistic one-to-one-person centred support forpeople aged 18 and over who have high dependency on emergency services and whoare frequent visitors/callers of A&E, the Urgent Care Centre and EastMidlands Ambulance Service.

To meet and collaborate with identified MDT partners toidentify, discuss, and prioritise appropriate referrals from the patient cohortlist.

To work and collaborate with the voluntary and communitysector, including Community Connector and wider Partnerships, to help identifyappropriate referral destinations and to explore opportunities to meet gaps inservices and activities.

To ensure effective record keeping and storage of patientdata to demonstrate outputs and outcomes which is compliant with GDPR.

To actively contribute as a member of a well-establishedsocial prescribing team and Neighbourhood network team who support the mostvulnerable in society, contributing to the response to Population HealthManagement and Health Inequalities.

Key Tasks and Responsibilities

1.To provide holistic one-to-one-person centred supportfor people aged 18 and over who have high dependency on emergency services andwho are frequent visitors/ callers of A&E, the Urgent Care Centre and EastMidlands Ambulance Service.

Carry out the role of a facilitator, broker, sign poster,community connector and navigator, acting as an enabler between the voluntaryand community sector, patients, GPs and health clinicians, and social care.

Provide support to patients, generally in their own homes,up to 3-4 months to help direct and connect them to alternative sources ofnon-medical support services and activities.

Offer a personalised approach to sensitively uncover thereal reasons for them calling 999 or presenting frequently at A&E/UCC.

During client visits undertake an assessment to gatherbaseline data and to identify the support needs andactions.Generating personalised care and support or wellbeingplans, which may include risk management.

Ensure support actions agreed with the patient are carriedout by the service. Support areas could include making referrals into a rangeof services provided by the voluntary, statutory or private sector, help withnon-means tested benefit form filling e.g. Personal Independent Payments,Attendance Allowance, housing forms etc, distributing food bank vouchers,identifying suitable volunteering opportunities, connecting people into peer topeer led activities, initially taking patients to services if their confidenceis low etc.

Once support has been provided carry out a final assessment

2. To work and collaborate with the voluntary andcommunity sector to help identify appropriate referral destinations and toexplore opportunities to meet gaps in services and activities.

Keep abreast of a wide range of support services on offer inthe voluntary and community sector through undertaking research, makingconnections with organisations and groups and by using a range of local onlinedirectories and Community Connectors.

Build and maintain positive relationships with a wide rangeof voluntary and community sector providers.

When gaps is services and activities are identified discussand raise these with the team and if required liaise with voluntaryorganisations and Community Connector to help identify solutions.

3.To ensure effective record keeping and storage ofpatient data to demonstrate outputs and outcomes which is compliant with GDPR.

Ensure allpatient records and actions are entered onto our record keeping systems.

Ensure GDPRrequirements are adhered to in relation to data management.

Whenrequired, support in gathering any data required for working out cost savingsto the wider health and social care sector as a result of the serviceinterventions.

4.To activelycontribute as a member of a well-established Neighbourhood team who support themost vulnerable in society.

Actively contribute to team meetings, away days, planningactivities and reflective practice activities.

Share progress, learning and challenges within the existingIntegrated Plus social prescribing team.

Share ideas about how the service could develop and evolve.

5. Minimum Qualifications, Knowledge,Training and Experience Required for the Post

No formal qualifications required but must havehigh emotional intelligence and resilience, be win-win negotiators and bebrave enough to change the culture around high intensity use of services.Needs to shine and connect well in interviews to demonstrate these skills.

It would be desirable for applicant to have experience inworking in person centred roles, social prescribing and skills linked with someof our most vulnerable groups, housing, drug and alcohol etc or care andsupport co-ordination.

GeneralDuties

Financial and Physical Resources

Responsible for advising on the commissioning andstreamlining of services to support project delivery as well as highlightinggaps in service provision for high intensity use of health.

Interpret and produce quarterly quality and financialreports.

Provide advice and prepare strategic reports and briefingsfor directors and stakeholders.

Constantly strive for providing quality care for HIU byaddressing any underlying issues.

Constantly strive to provide value for money and greaterefficiency in the use of unscheduled care services and to contribute to howthey operate in recurrent financial balance for future years.

Human Resources

The post holder will be responsible for colleaguedevelopment and knowledge in this area of expertise.

Work to manage confidential information about anindividuals wellbeing and capability development.

Information Resources

Present complex information about the project, initiativesand service providers to a wide range of stakeholders in a formalsetting.

Highlight exceptions and risks ensuring mitigating actioncan be taken to keep the programme on track.

Draft reports summarising status on issues, client outcomes,and providing progress reports for the Clinical Commissioning Group /ICB.

Collate as required, qualitative and quantitativeinformation and lead appropriate analysis to develop robust businesscases.

Analyse, interpret and present data to highlight issues,risks and support decision making within the niche of HIU.

Person Specification

Qualifications

• Motivational interviewing
• Personalised Care Institute e-learning modules PCSP, shared decision making or equivalent

Experience

• Experience of supporting vulnerable adults in a person centred way
• Experience of working in the voluntary and community sector
• You have the ability to work sensitively in difficult emotional circumstances with empathy, compassion, respect and understanding.
• Knowledge of asset/strength-based recovery models and approaches
• Experience of case load management.
• You will be able to cooperate with a range of health professionals, voluntary sector providers and people around the range of possibilities that might be available enabling service provision to be more holistic to improve mental health and wellbeing of vulnerable people.
• You are a person who is willing to go the extra mile for a person to ensure they get the right care and support. You are passionate about making a difference to peoples lives
• You possess a strong and practical understanding of safeguarding policy and practice and are up to date with current legislation.
• Excellent communication and interpersonal skills.
• Experience of working in teams
• Experience of collaborative working
• Knowledge and understanding of equality and diversity
• Knowledge and understanding of GDPR
• You can plan, prioritise and carry out your work in a flexible way. You are accustomed to working on your own and in teams.
• You know how to use a range of software to produce written documents, spreadsheets, presentations. You can effectively manage communication by email, and you are comfortable using collaborative online tools (for example WhatsApp, Twitter, Facebook, using text editors such as Word/Pages and other message apps.
• Adaptability, flexibility and ability to cope with uncertainty and change
• Demonstrate ability to work in a busy environment; ability to deal with both urgent and important tasks and to prioritise effectively whilst also supporting others
• Excellent time keeping and prioritisation skills
• Flexibility to work outside of core office hours
• Access to own transport and ability to travel across the PCN locality on a regular basis
• Experience of providing social prescribing interventions
• Knowledge of health and social care
• Local knowledge of the voluntary and community sector
• Ability to use Microsoft 365
• Specific Aptitudes Awareness of equality and valuing diversity principles Understanding of Confidentiality and Data Protection Act
• Continued commitment to improve skills and ability in new areas of work
• Able to undertake the demands of the post with reasonable adjustments if required
• Ability to work from home on some occasions where tasks allow

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.