PCN Social Prescribing Link Worker

NHS; London; On-site; GBP 30,000 - 36,000; Full time

Job summary

An exciting opportunity has arisen for a Social Prescribing Link Worker to join Camden Health Evolution's multidisciplinary team. This role involves supporting patients' social and emotional needs through community-based services, enhancing their overall health and wellbeing. The ideal candidate will manage referrals and coordinate care to address various social determinants of health, demonstrating strong communication and interpersonal skills.

Qualifications

• Experience supporting individuals one-to-one or with families (paid or voluntary).
• Understanding of the wider determinants of health.
• Experience working with individuals with complex social needs or mental health challenges.

Responsibilities

• Manage referrals from GP practices and provide tailored social prescribing.
• Build trusting relationships with patients and coordinate care.
• Collaborate with VCSE organisations to strengthen community support.

Skills

Communication

Empathy

Interpersonal skills

Motivational coaching

Data analysis

Education

NVQ Level 3 or equivalent qualifications

Training in motivational coaching

Job description

An exciting opportunity has arisen within Camden Health Evolution (CHE) GP Federation for a Social Prescribing Link Worker to join our Central Camden Primary Care Network (PCN) multidisciplinary team.

The successful candidate will support patients by addressing non-medical needs and connecting them to relevant community-based services and groups, providing personalised practical, social, and emotional support.

Main duties of the job

Social prescribing empowers individuals to take control oftheir health and wellbeing by connecting them with link workers who focus onwhat matters most to each individual. Link workers adopt a holistic approachand support individuals to access a wide range of community-based activities,groups, and services that meet their practical, social, and emotional needs.

As a key member of our PCNs multidisciplinary team, theSocial Prescribing Link Worker helps strengthen personal and communityresilience while addressing health inequalities. By tackling wider determinantsof health such as debt, housing, unemployment, isolation, and inactivity, thepost-holder will support patients with long-term conditions, mental wellbeingneeds, and complex social issues to improve their overall wellbeing.

The role involves managing a caseload of patients referredby member GP practices and the PCN Anticipatory Care Team, providing tailoredsupport to help them access appropriate services and achieve their goals. Italso involves collaborating with local partners and Voluntary, Community and Social Enterprise (VCSE) organisations tostrengthen community networks, identify gaps in provision, and support the development ofnew initiatives.

**We regret that this position does not provide visasponsorship. We are unable to consider applicants requiring sponsorship**

About us

Camden Health Evolution Ltd (CHE) is a GP Federation thatsupports Central Camden Primary Care Network (PCN).The PCN consists of 8member practices, serving a registered population of approximately 85,000patients.

All practices within the PCN are members of the CHE GPFederation, sharing its vision, mission, values, and key priorities. The PCN ishighly innovative, delivering services with the support of CHE, aimed atimproving the quality of care and outcomes for patients.

• Vision: Transforming clinical care for healthier lives
• Mission: High quality, population based care through collaboration
• Values: Openness, leadership, innovation

Key priorities:

• Supportingmore sustainable primary care
• More carelocally for patients
• Moreintegrated primary and community care
• Influencingimprovements in health outcomes

Job responsibilities

The following are the core responsibilities of the Social Prescribing 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.

• Manage referrals from member GP practices and the PCN Anticipatory Care Team, applying tailored social prescribing approaches that reflect each patients needs and priorities.
• Proactively identify and work with patients, including those who are frail, elderly, or living with long-term conditions, to coordinate care and navigate support across health and social care services.
• Provide personalised support to patients, families, and carers to promote independence, improve quality of life, and support better health outcomes.
• Build trusting, empathetic relationships by focusing on what matters most to each patient, using a holistic, strengths-based approach that considers the wider determinants of health.
• Co-produce personalised support plans with patients, linking them to appropriate community groups, activities, and services to ensure timely access to the right support.
• Help patients address challenges such as debt, poor housing, unemployment, loneliness, and caring responsibilities that affect their health and wellbeing.
• Collaborate closely with GP practices and the wider PCN multidisciplinary team to ensure patients receive timely, coordinated support to manage their health and access relevant services.
• Facilitate access to community, statutory, and voluntary sector services, promoting care that reflects each patients preferences and supports their overall wellbeing.
• Support and strengthen local VCSE organisations to ensure they can safely and effectively receive social prescribing referrals.
• Educate clinical and non-clinical colleagues within the PCN on the local community support offer, advising on when and how patients can access it, and champion the value of non-medical interventions.
• Promote social prescribing across the PCN and with external agencies, highlighting its role in improving health outcomes, reducing inequalities, easing pressure on healthcare services, and supporting self-management.
• Act as a trusted source of guidance on wellbeing and preventative health, raising awareness of local resources and empowering individuals to take greater control of their health.
• Engage confidently and sensitively with individuals from diverse backgrounds, adapting approaches to reflect varied cultural, social, and environmental contexts.
• Maintain accurate, timely records and produce high-quality documentation in line with organisational and information governance standards.

KEY TASKS

Referrals

• Screen and accept or reject social prescribingreferrals from PCN member practices in collaboration with the GP supervisor.
• Promote social prescribing as an approach acrossthe PCN by attending relevant MDT meetings to build relationships and raiseawareness.
• Proactively encourage equitable participation insocial prescribing across the PCN, ensuring accessibility for diverse andunderserved communities.
• Meet patients, families, and carers on aone-to-one basis, make home visits, and meet with community organisations whereappropriate.
• Use appropriate judgement to ascertain thenumber and length of sessions required, responding to the needs of theindividual and their circumstances.
• Give patients time to tell their stories andfocus on the question, "What matters to me?".
• Build trust and respect with patients, providingnon-judgemental and non-discriminatory support, taking a strengths-basedapproach that focuses on a patients assets.
• Work with patients, families, and carers andconsider how they can all be supported through social prescribing.
• Help patients identify the wider issues thatimpact their health and wellbeing, such as debt, poor housing, unemployment,loneliness and caring responsibilities.
• Co-produce simple, personalised support plansbased on patients priorities, interests, values, and cultural or religiousneeds.
• Clearly explain and provide information on theservices, groups, and activities the patient is being connected to.
• Provide information on self-care approaches toimprove health and wellbeing.
• Physically accompany patients to groups orservices where appropriate, ensuring they feel comfortable, valued, andrespected.
• Offer follow-up support to encourage ongoingengagement and ensure satisfaction.
• Help patients maintain or regain independencethrough skills training, adaptations, enablement approaches, and simplesafeguards.
• Where patients may be eligible for a personalhealth budget, help them to explore this option as a way of providing funded,personalised support to be independent, including helping them to gain skillsfor meaningful employment, where appropriate.
• Provide support in the patients preferredlanguage, either directly if fluent or through professional translationservices such as Language Line or other approved interpreters.
• Seek advice and support from the GP supervisorand/or designated individuals to discuss safeguarding concerns and followsafeguarding policies around reporting and/or escalating concerns.
• Seek advice and support from the GP supervisorand/or designated individuals to discuss concerns outside the scope of practice.
• Make appropriate onward referrals where needed.

Supporting the community offer

• Develop strong, supportive relationships withlocal VCSE organisations, community groups, and services to understand theirofferings and facilitate timely, appropriate, and well-supported referrals.
• Create strong links with local agencies toutilise existing networks and build on existing provision.
• Collaborate with local partners to ensureaccessibility and sustainability of community groups.
• Work with commissioners and local partners toidentify and share information on unmet diverse needs within the community andgaps in service provision.
• Support the development of community groups thatpromote diversity and inclusion.
• Encourage patients to volunteer or start theirown groups after engaging with community support.
• Support existing local volunteering schemes tostrengthen community resilience and explore potential to develop a team ofvolunteers to provide buddying support, peer support or to start newcommunity-based groups or activities.

Data capture and feedback

• Support referral agencies to provide appropriateinformation about the patient they are referring, including demographic dataand data on wider determinants, for example, caring status.
• Provide appropriate and timely feedback toreferral agencies about the patients they referred.
• Work sensitively with patients, their familiesand carers to capture key information to measure the impact of socialprescribing on their health and wellbeing, using validated tools determinedlocally such as the ONS4 wellbeing scale or MYCAW to assess needs and measureoutcomes.
• Encourage patients, families, and carers toprovide feedback on their experience, for example, through patient satisfactionsurveys, and to share their stories about the impact of social prescribing ontheir lives.
• Ensure that social prescribing referral SNOMEDcodes are recorded appropriately into clinical systems (as outlined in theNetwork Contract DES).
• Adhere to organisational policies around dataprotection legislation and data sharing agreements, ensuring patients giveappropriate consent.
• Collaborate as part of the MDT to gatherfeedback, drive continuous service improvement, and contribute to serviceplanning.
• Assess patient and staff feedback to evaluatethe quality of service and the impact of social prescribing.
• Undertake continual personal and professionaldevelopment in line with the Social Prescribing Workforce Development FrameworkCompetency Framework.
• Participate in regular supervision.
• Take an active role in reflecting, reviewing,and developing professional knowledge, skills and behaviours.
• Attend appropriate mandatory training beforeworking with patients and be aware of own competence, maintaining boundariesaround scope of practice and referring onwards for patients whose needs falloutside of these boundaries.
• Adhere to organisational policies andprocedures, including confidentiality, safeguarding, lone working, informationgovernance, equality, diversity and inclusion training, and health and safety.

Person Specification

Experience

• Experience supporting individuals one-to-one and/or working with families and carers (paid or voluntary)
• Experience of working in community development, adult health and social care, learning support, or public health (paid or voluntary)
• Experience of working in a person-centred, empowering role (e.g. support work, advocacy, care coordination)
• Experience of partnership working and building relationships across organisations
• Experience supporting individuals with complex social needs, long-term conditions, or mental health challenges
• Previous experience working as a PCN-based Social Prescribing Link Worker
• Experience of data collection and outcome measurement tools
• Experience of using EMIS Web, Docman, Accurx

Knowledge

• Understanding of the wider determinants of health (social, economic and environmental) and their effect on individuals, families, carers, and communities
• Knowledge of, and ability to work to, policies and procedures
• Knowledge of the personalised care approach
• Local knowledge of VCSE organisations and services
• Understanding of community development approaches
• Able to support patients in a way that builds trust and motivates them to reach their goals
• Polite, punctual, and cooperative
• Culturally sensitive and respectful of diverse backgrounds and lifestyles
• Compassionate in interactions with patients, carers, and colleagues
• Values aligned with person- and family-centred care
• Professional, tactful, and effective communicator
• Commitment to tackling health inequalities and engaging with underserved communities
• Demonstrates personal resilience and adaptability

Qualifications

• NVQ Level 3, Advanced Level, or equivalent qualifications, or working towards
• Demonstrable commitment to ongoing professional and personal development
• PCI Social Prescribing Learning for Link Workers
• Training in motivational coaching and interviewing, or equivalent experience

Skills / Abilities

• Excellent communication, interpersonal and influencing skills
• Ability to actively listen and provide empathetic, person-centred, non-judgemental support
• Ability to manage sensitive and confidential information appropriately
• High attention to detail and ability to produce high-quality documentation
• Effective time management with the ability to prioritise and manage multiple tasks
• Ability to work independently and use initiative
• Ability to maintain effective working relationships and promote collaborative practice with colleagues
• Commitment to collaborative working with all local agencies, including VCSE organisations, and community groups
• Awareness of when and how to refer individuals to other professionals or agencies when needs exceed the roles scope
• Motivational coaching and interview skills
• Ability to define, collect, analyse, and interpret data
• Understanding of NHS Long Term Plan and priorities relevant to primary care
• Awareness of current issues facing primary care

Other Requirements

• Meets Disclosure and Barring Service (DBS) reference standards
• Ability to work and travel flexibly, including to visit patients in their own homes and support individuals to attend activities as appropriate
• Attendance at annual updates and mandatory training as required
• Ability to speak an additional language/s relevant to the local population (e.g. Bengali)

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.

£30,000 to £36,000 a yearDepending on Experience