Social Prescribing Link Worker - Age Well Team

South Hambleton and Ryedale Primary Care Network; Easingwold; Hybrid; GBP 25,000 - 30,000; Full time

Job summary

A community healthcare provider in Easingwold is seeking a Social Prescribing Link Worker for the Age Well Team. The role focuses on providing holistic support to older adults, helping them live independently by connecting them with local resources and services. Ideal candidates will have a commitment to professional development, experience in community work, and strong interpersonal skills. This position offers flexibility and a chance to innovate in elderly care.

Benefits

Excellent professional development opportunities

Flexible working arrangements

Qualifications

• Demonstrable commitment to professional and personal development.
• Training in motivational coaching and interviewing or equivalent experience.
• Experience of working directly in community development or health and social care.

Responsibilities

• Conduct holistic assessments with older people in their homes.
• Develop personalized care support plans addressing health and social needs.
• Build partnerships with local community organizations.
• Support older people to access appropriate services.
• Travel flexibly across SHaR PCN practices.

Skills

Empathy

Communication

Problem-solving

Teamwork

Education

NVQ Level 3 or equivalent

Job description

Go back South Hambleton and Ryedale Primary Care Network

Social Prescribing Link Worker - Age Well Team

The closing date is 05 October 2025

Join SHaR PCN's innovative Age Well team as a Social Prescribing Link Worker and make a genuine difference to older people's lives across Ryedale and South Hambleton. This exciting role combines compassionate, person-centred care with community development, supporting over-65s to live independently and thrive in their communities.

You'll work within our award-winning Primary Care Network, connecting older adults with local resources, developing personalised care plans, and addressing the wider determinants of health such as socioeconomic status, housing issues, and social isolation. Working closely with GPs, occupational therapists, and community partners, you'll be at the heart of our preventative approach to healthcare.

This is more than a job - it's an opportunity to pioneer a new model of care, build meaningful relationships, and help create sustainable community solutions. If you're passionate about empowering older people and want to work flexibly within a supportive, collaborative team, we'd love to hear from you.

Main duties of the job

• Conduct holistic assessments with older people in their homes and community settings, focusing on "what matters to me"
• Develop and coordinate personalised care and support plans addressing health, social, and practical needs
• Build strong partnerships with local VCSE organisations, community groups, and statutory services
• Support older people to access appropriate services and maintain independence through practical solutions
• Support older people with their long-term conditions including cancer
• Work collaboratively within the multidisciplinary Age Well team, attending meetings and sharing expertise
• Maintain accurate records and provide outcome reports to clinicians and referring agencies
• Identify gaps in local services and contribute to developing new community resources
• Promote social prescribing across the PCN and with external partners
• Manage a caseload based on population health needs and individual complexity
• Travel flexibly across all seven SHaR PCN practices (Pickering, Kirkbymoorside, Helmsley, Terrington, Stillington, Tollerton, and Millfield) while based from Easingwold Health Centre. Deliver community-based support and maintain strong working relationships with practice teams across the network.

About us

SHaR PCN is an award-winning Primary Care Network serving seven GP practices across Ryedale and South Hambleton. We're proud of our well-established Personalised Care Team, which has recently expanded to include our innovative Age Well and Live Well programmes.

Our team culture is built on collaboration, innovation, and putting patients at the centre of everything we do. You'll join passionate professionals including occupational therapists, health and wellbeing coaches, care coordinators, and fellow social prescribing link workers who support each other and share a commitment to reducing health inequalities.

We offer excellent professional development opportunities, flexible working arrangements, and the chance to shape new models of care. As part of our integrated neighbourhood teams, you'll work with diverse partners from health, social care, and the voluntary sector.

What makes us special is our focus on prevention and early intervention, our strong community connections, and our commitment to addressing the wider determinants of health. Join us in transforming healthcare for older people in our communities.

Job responsibilities

About This Exciting Opportunity

Step into a pioneering role that's reshaping healthcare for older people across Ryedale and South Hambleton. As our Social Prescribing Link Worker for the Age Well team, you'll be at the forefront of innovative, person-centred care that goes far beyond traditional medical interventions.

This isn't just about connecting people to services - you'll be empowering older adults to take control of their health and wellbeing, addressing everything from social isolation to housing concerns, and helping create vibrant, supportive communities where people can age well.

What You'll Be Doing

Building Meaningful Relationships You'll spend quality time with older people in their own homes and community settings, really listening to their stories and understanding what matters most to them. Using a strength-based approach, you'll help them identify their own assets and capabilities whilst providing non-judgemental support that respects their diversity and lifestyle choices.

Creating Personalised Solutions Working collaboratively with individuals, their families, and carers, you'll co-produce simple, personalised support plans based on their priorities, interests, and motivations. These plans will clearly outline what they can expect from services and what they can do themselves to improve their health and wellbeing.

Connecting Communities You'll forge strong links with local voluntary, community, and social enterprise organisations, building a comprehensive map of community assets and resources. This includes identifying opportunities for micro-commissioning and small grants to develop new services where gaps exist.

Collaborative Working As an integral member of our multidisciplinary team, you'll work closely with GPs, occupational therapists, nurses, social care professionals, and other PCN colleagues. You'll attend regular meetings, share insights about frailty and specialist social prescribing, and contribute to holistic care planning.

Supporting Independence Help older people maintain or regain their independence through practical solutions including living skills support, home adaptations, enablement approaches, and simple safeguarding measures. You'll follow up with people to ensure they're receiving good support and can fully engage with the services they've been connected to.

Data and Outcomes Work sensitively with people and their families to capture key information that helps track the impact of social prescribing on their health and wellbeing. You'll encourage feedback and story-sharing whilst maintaining accurate records using SystmOne and adhering to all data protection requirements.

Service Development Play an active role in developing and improving our Age Well service by providing regular feedback on the model, identifying unmet needs in the community, and supporting the development of new groups and services through partnership working.

Why This Role Matters

Social prescribing addresses the reality that health and wellbeing are influenced by much more than medical conditions. By focusing on the wider determinants of health - including social connections, housing quality, financial security, and community engagement - you'll be helping to reduce health inequalities and strengthen both community and personal resilience.

This approach is particularly effective for older people with long-term conditions, those experiencing loneliness or isolation, and individuals with complex social needs. You'll be making a real difference to people's quality of life whilst reducing pressure on traditional healthcare services.

Professional Development and Support

You'll work with a named clinical point of contact for advice and ongoing support, with excellent opportunities for continual professional development. We're committed to helping you grow in your role whilst contributing to the wider development of social prescribing practice.

The role includes comprehensive training in safeguarding, information governance, equality and diversity, and health and safety, ensuring you're fully equipped to provide safe, effective, and compassionate care.

Location & Travel Requirements

While based at Easingwold Health Centre, you'll be required to travel flexibly across all seven of our GP practices (Pickering, Kirkbymoorside, Helmsley, Terrington, Stillington, Tollerton, and Millfield) to deliver services and support patients in their local communities. This role therefore requires a current full driving licence and sole use of your own vehicle.

Person Specification

Qualifications

• Demonstrable commitment to professional and personal development
• NVQ Level 3, Advanced level or equivalent qualifications (or working towards this level)
• Training in motivational coaching and interviewing or equivalent experience

Experience

• Experience of working directly in community development, 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 (paid or unpaid), including with volunteers and small community groups
• Experience of partnership/collaborative working and building relationships across various organisations
• Experience of supporting people with their mental health (paid, unpaid, or informal capacity)
• Experience of data collection and providing monitoring information to assess service impact
• Knowledge of VCSE and community services in the locality

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 name

South Hambleton and Ryedale Primary Care Network