PCN Social Prescriber​/Care Coordinator

Braintree Primary Care Network Ltd is seeking a motivated and enthusiastic Social Prescriber/Care Coordinator to join our multidisciplinary team. The successful candidate will play a key role providing support across our three member practices and two hosted practices, serving a combined population of approximately 58,000 patients.

Working closely with GPs, nurses, and the wider primary care team, you will help deliver high-quality, patient-centered care to housebound and vulnerable individuals,supporting continuity of care and proactive management of long-term conditions.

You will be accountable to Braintree PCN Ltd and will collaborate across practices to ensure service flexibility, resilience, and effective cross-cover.

This role playsa vital part in supporting our GP practices by enhancing patient outcomes through the delivery of timely and effective healthcare in the home setting.

Take referrals from the PCNs Core Network Practices and from a wide range of agencies, including pharmacies, health andcare multi-disciplinary teams, MDTs, the emergency services, legal and welfare advice services, VCSE organisations, and through self-referrals.

Provide personalised support to individuals,their families and carers to access community-based activities and support thatcan help them to take control of their health and wellbeing throughco-producing a simple personalised care and support plan and introducing peopleto appropriate activities, groups and services as described above.

Promote social prescribing as an approach acrossthe 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.

Braintree PCN Ltd is a network comprising 3 member practices and hosts patients registered at a further two practices, covering a list size of approximately 58,000 patients.

It is a pro-active and forward thinking organisation, working with external stakeholder bodies to provide enhanced healthcare to our patients.

Purpose ofthe role

Social prescribing empowers people to take control of their healthand wellbeing through referral to non-clinical social prescribing link workers.

They give people time to focus on what matters to me and take aholistic approach to an individuals health and wellbeing.

Take a whole population approach, working with a range of people who may benefit from social prescribing, including people who are lonely, have complex social needs, lowlevel mental health needs and long-term conditions

Help peopleto identify issues that affect their health & wellbeing, and co-produce asimple personalised care and support plan

Support people by connecting them to non-medical, community-based activities, groupsand services that meet their practical, social and emotional needs, including specialist advice services and arts and culture, physical activity, and natureand green based activities

Use coaching and motivational interviewing techniques to support people to take control oftheir own health and wellbeing

Support development of accessible and sustainable community offers by working in partnership with VCSE organisations, local authorities and others to identify gaps in provision, and take a community development approach to enabling growthin community activities and groups.

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, the emergency services, legal and welfare advice services, VCSEorganisations, and through self-referrals.

Provide personalised support to individuals, their families and carers to access community-based activities and support that can help them to take control oftheir health and wellbeing through co-producing a simple personalised care and support plan and introducing people to appropriate activities, groups and services as described above

Work with appropriate supervision as part of the PCN to manage and prioritise your own caseload, in accordance with needs, priorities and support required by individuals. Refer people back to other health professionals/agencies, as appropriate or necessary.

Build ongoing relationships with local infrastructure organisations, community activities and support services to increase knowledge of the community support offer, and work collaboratively to develop effective partnership working tosupport the community offer to be sustainable, identifying gaps in provision,nurturing community assets and sharing intelligence on gaps or problems with commissioners and local authorities

Increase the strength and capacity of the community, enabling local VCSE organisations and community groups to both receive social prescribing referrals and to make referrals to social prescribing link workers.

Educate non-clinical and clinical staff…