Purpose of the role Social Prescribing empowers people to take control of their health & wellbeing through referral to non-clinical Social Prescribing link workers, allowing them time to focus on what matters to me, taking a holistic approach to an individuals health and wellbeing needs in a supportive manner, to increase confidence to live a more independent life within their local community. Support people by connecting them to non-medical, community-based activities, groups and services that meet their practical, social and emotional needs, including specialist advice services, arts and culture, physical activity, and nature- and green-based activities. Supporting the development of accessible and sustainable community offers by working in partnership with Voluntary Care Service Enterprise organisations, VCSE, local authorities and others to identify gaps in provision, and take a community development approach to enabling growth in community activities and groups. Using coaching and motivational interviewing techniques to support people. Social Prescribing link workers: Take a whole population approach, working with a range of people who may benefit from social prescribing, including lonely people, who have complex social needs, low-level mental health needs, long-term conditions, as well as working with priority populations identified by the Primary Care Network, PCN as outlined in the Network Contract DES Help people to identify issues that affect their health & wellbeing and co-produce a simple personalised care and support plan using the Social Prescribing template. Together, the patient and Social Prescriber will set small, achievable goals, focusing on what is important to the person. Goals will be supportive and reviewed regularly with the person. Empower people to take control of their own health and wellbeing.
Key Responsibilities
- Take referrals from the PCNs Core Network Practices and from a wide range of agencies, including pharmacies, health and care multi-disciplinary teams MDTs, and welfare advice services, VCSE organisations, and through self-referrals list is not exhaustive.
- Promote social prescribing as an approach across the PCN and wider agencies, including its role in supported self-management, in addressing health inequalities and the wider determinants of health, reducing pressure on statutory services, improving access to healthcare and improving health outcomes, and in taking a holistic approach to care.
- .Proactively encouraging equitable participation in social prescribing through taking self-referrals and connecting with diverse local communities through a range of methods, particularly communities that statutory agencies may find hard to reach and where health inequalities are most prevalent, ensuring that those people self-referring have equal opportunities
- Provide information and guidance on what the person can do for themselves to improve their health and wellbeing
- Provide follow-up support to the person to ensure they are happy, able to engage, feel included and that they are receiving good support.
- Seek regular feedback via surveys, feedback forms, about the quality of service and the impact of social prescribing on referral agencies
- Help people maintain or regain independence through living skills, enablement approaches and simple safeguards
- Helping people to gain skills for meaningful employment, where appropriate.
- Seek advice and support from the General Practitioner GP, supervisor and/or identified individuals to discuss safeguarding concerns and follow PCN safeguarding policies around reporting and/or escalating concerns. Make appropriate onward referrals.
- Empower people where possible to reach out to their GP practice, care provider, ensuring they have relevant contact information to hand at all times.
- Develop supportive relationships with local Voluntary Care Sector Enterprise, VCSE organisations, community groups and statutory services, to understand their offer and make timely, appropriate and supported referrals
- Promote diversity and inclusion when developing or supporting new community groups.
- Encourage people who have been connected to community support through social prescribing to volunteer or to start their own activities and groups
- Support existing local volunteering schemes to strengthen community resilience and explore potential to develop a team of volunteers to provide buddying support, peer support or to start new community-based groups or activities.
- Data capture Support referral agencies to provide appropriate information about the person they are referring, including demographic data and data on wider determinants, for example, caring status, any safeguarding concerns.
- Provide appropriate and timely feedback to referral agencies about the people they referred.
- Work sensitively with people, their families and carers to capture key information to measure impact of social prescribing on their health and wellbeing, using validated tools determined locally such as the ONS4 wellbeing scale to assess need and measure outcomes.
- Encourage people, their families and carers to provide feedback on their experience, for example, through patient satisfaction surveys, and to share their stories about the impact of social prescribing on their lives.
- Ensure that social prescribing referral SNOMED codes are coded appropriately into clinical systems as outlined in the Network Contract DES using the Social Prescribing template aligns to Personalised care and Support Plan
- Adhere to PCN policies around data protection legislation and data sharing agreements, ensuring people give appropriate consent. at the start of the episode of care with the Person/ Patient.
- Provide monthly data feedback as required by the PCN.
- Using current and any future data collection systems in a timely manner.
Continuing professional development
- Work with a supervisor and/or line manager to undertake continual personal and professional development in line with the social prescribing Workforce Development Framework Competency Framework
- Work with your supervising GP and/or line manager to access regular clinical/non-managerial supervision
- Take an active role in reflecting, reviewing and developing professional knowledge, skills and behaviours
- Attend appropriate mandatory training before working with people and be aware of own competence, maintaining boundaries, both personal & around scope of practice and referring onwards for people whose needs fall outside of these boundaries
- Adhere to organisational policies and procedures, including confidentiality, safeguarding, lone working, information governance, equality, diversity and inclusion training and health and safety.
- https://www.england.nhs.uk/publication/workforce-development-framework-social-prescribing-link-workers/
Miscellaneous
- Establish strong working relationships with GPs, practice teams and relevant multidisciplinary teams and work collaboratively with other health Social Prescribers, Health and Wellbeing coaches, Mental Health and Wellbeing coaches, care co-ordinators, supporting each other, respecting each others views and meeting regularly as a team.
- Act as a champion for Social Prescribing, as a part of the PCNs personalised care offer for patients and organisations
- Demonstrate a flexible attitude and be prepared to carry out other duties as may be reasonably required from time to time within the general character of the post or the level of responsibility of the role, ensuring that work is delivered in a timely and effective manner.
- Identify opportunities and gaps in the service - and review risks and issues that could impact on service delivery - and provide feedback to continually improve the service and contribute to business planning.
- Work in accordance with the practices and PCNs policies and procedures.
- Contribute to the wider aims and objectives of the PCN to improve and support primary care, working to the PCNs priorities in accordance with the DES.
- Work as part of the MDT, to seek feedback, promote the benefits of Social Prescribing value to patients, carers and the system.
- Continually work and engage to improve the service
- 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.
- Duties may vary from time to time, without changing the general character of the post or the level of responsibility.
East of England Community Health & Care NHS Trust
Cambridgeshire and Peterborough NHS Foundation Trust