Job Description
Post: Community Integrated Team (CIT) Social Prescriber
Contract Type: Permanent
Location: The City of Sunderland with an HQ at Age UK Sunderland (AUKS) Bradbury Centre, Stockton Road
Responsible to: Programmes Manager
Accountable to: AUKS
The purpose of the Community Integrated Team (CIT) Social Prescribing Service is to put older people in personal control of their health & wellbeing and provide them with integrated care and support in their local community,focusing on prevention of ill health and the promotion of wellbeing.
The service enables older people to have improved health outcomes and independence whilst reducing the burden on NHS services in Sunderland through the reduction in need for GP visits, Out of Hours Contacts, emergency admissions/readmissions etc.
Key working Relationships:
Statutory and Community based providers
Integrated Care Teams
Older people aged 65+
Carers and Carer Organisations
Other clinical and non-traditional provider groups as required
Purpose of the post:
The post provides an interface between voluntary sector provider organisations and service users, health and social care multi-disciplinary teams (MDT) and other statutory bodies. The social prescriber will support individuals to self-manage their needs. The post holder willwork in a designated Sunderland locality visiting older people in their homes as well as other community settings. Many older people will have complex health needs and the service will focus on practical support to encourage the utilisation of services within the local communities.
This may include:
Assisted signposting to services in the community that help maintain older people’s health & wellbeing such as leisure & learning, social groups etc.
One to One Support to help with issues such as arranging for support to access appointments, travel, access to community care assessments (or carers assessments), where appropriate advise on main choices regarding personal budgets and helping with domestic support etc.
Social Contact to establish support from befriending services for those in social isolation or risk of and make referrals to appropriate internal and partner services
Interim support to help support the older person whilst other support is put in place
The post holder will also identify unpaid carers and enable access to appropriate services.
Key Responsibilities
The post holder will be an excellent communicator and develop a wide knowledge of the services offered by non-traditional providers. The post holder will require strong organisation skills, must be flexible in approach, able to exercise initiative and demonstrate a consistently high standard of professionalism, being aware of the need for confidentiality and integrity.
Tasks:
Liaison with Community Integrated Locality Teams
Assessments & home visits
GP & professional liaison
Patient information gathering & analysis to provide a holistic plan of support (social, financial, health & wellbeing etc.)
In depth knowledge gathering on available services (community & statutory), multidisciplinary services etc.
Publicity & promotion of offering
Record keeping, monitoring & evaluation
Identification of step up care and safeguarding
Identification of gaps in services to inform future development
Key skills
Integrated Care Coordination
Signposting older people to the multitude of support services that are available through voluntary and statutory providers tailored to the person’s specific needs
Be the point of liaison for service users and carers principally with voluntary sector providers as well as useful commercial services, and liaising with other statutory professionals involved in patient’s care
Delivering case work to support older people to reach specific goals in accordance with KPIs
Promote the independence & empowerment of older people
Build strong relationships with partners and providers
Deal in a professional, helpful & sensitive manner with older people, staff, carers & other agencies.
Information and Data Coordination
To be proficient in using Microsoft office packages and other identified IT systems and support other team members in their use
To record relevant patient documentation on identified IT systems as required in line with GDPR requirements
Facility for learning new software packages which may be in continued development
Maintain Excel, Charity Log and other databases to input patients’ engagement
Support completion of patient referrals, record electronically and feedback to team members
Input data onto the patient information management systems to update patient details, and periodically use reports to ensure patient details are correct
Extract caseload information from the patient database as required for reporting purposes
Be responsible for updating the electronic service directory on a regular basis, sourcing referral criteria and ensuring these are accessible to all relevant parties
Patient Support
Ensure older people’s requirements are managed smoothly with no fragmentation in service delivery.
Ensure appropriate actions from Multi-Disciplinary Team (MDT)/Integrated team meetings are completed in a timely fashion.
Communicate with members of the MDT/Integrated teams as required.
Communicate effectively with older people and their families/carers, other staff both internal and external and members of the public.
General
The post holder must at all times carry out duties and responsibilities with due regard to the organisations’ equal opportunity policies and procedures.
The post holder must at all times respect patient confidentiality and, in particular, the confidentiality of electronically stored personal data in line with the requirements of GDPR/Data Protection Act.
The post holder is expected to take responsibility for self-development on a continuous basis, undertaking on-the-job training as required.
The post holder must be aware of individual responsibilities under the Health and Safety at Work Act, and identify and report as necessary any untoward accident incident or potentially hazardous environment.
The post holder will ensure they accurately represent Age UK Sunderland and ensure the values of Age UK Sunderland are upheld at all times in carrying out their work
The post holder must act as a Safeguarding alerter in line with AUKS policy
The post holder must work in general accordance with the organisation’s policies and guidelines at all times..
This job description is intended as a guide to the main responsibilities of the post and not as an exhaustive list of duties and tasks. The post holder may be required to undertake other duties appropriate to his/her grade, which are not listed above, at the direction of AUKS Chief Executive Officer. The job description may be amended from time to time after consultation with the post holder.
This post is subject to a Disclosure & Barring Service (DBS) Enhanced check.
Person Specification
Post: Community Integrated Team (CIT) Social prescriber
Location: The City of Sunderland with an HQ at Age UK Sunderland (AUKS) Bradbury Centre, Stockton Road
Responsible to: Programmes Manager
Accountable to: AUKS
Essential Criteria
NVQ Level 3 in health, social care or equivalent
At least 2 years’ experience in health/social care or information & advice or work in direct contact with people, families & carers (paid or voluntary capacity)
IT competence and experience of Microsoft packages and admin skills
Proven record of written and verbal communication skills
Able to deal sensitively with patients
Able to work as part of a team
Able to prioritise and manage own workload
Analytical skills and be able to interpret information and data and present it in a clear concise manner
Good people skills with a friendly approachable style and ability to generate trust and form positive relationships
A good listener
Flexible & responsive to changing needs of clients
Ability to communicate and extract information sensitively & tactfully
Creative approach to problem solving
Tactful and diplomatic, able to build a rapport with people from a wide range of backgrounds
Experience in use of databases
Experience of working in a voluntary, NHS or social care setting delivering services to vulnerable people
Experience of risk assessment & risk management
Knowledge of voluntary care organisations (preferably within the Sunderland area)
Understanding of patient confidentiality
Understanding of health and social care processes
Understanding of the complexity of older people’s lives & the barriers they face
Understanding of safeguarding responsibilities
Knowledge of the range of voluntary, statutory and private sector orgs/services working with older people
Understanding of welfare benefits available to older people
Knowledge of GDPR
Willingness to undergo further training or development
To abide by and implement all policies and procedures of Age UK Sunderland, including being aware of and responsible corporately and as an individual for Health and Safety policy.
Possess a full clean driving licence and have access to a car for work
Desirable
Experience in motivational interviewing
Experience of person centred planning