Job description
Patient Support
Receive referrals from GPs, nurses, allied health professionals, care coordinators, and other members of the multidisciplinary team.
Undertake person-centred assessments to identify social, emotional, practical, and wellbeing needs.
Develop personalised care and support plans based on each patient's goals and priorities.
Empower patients to improve their confidence, resilience, independence, and self-management.
Frailty and Housebound Focus
Provide dedicated support for patients living with frailty and those who are housebound.
Undertake home visits when clinically appropriate to assess wellbeing, social circumstances, environmental factors, and support needs.
Identify risks relating to isolation, nutrition, mobility, falls, safeguarding, loneliness, and carer strain.
Support patients to access services that help maintain independence and prevent avoidable hospital admissions.
Work alongside community nursing, therapy teams, adult social care, and voluntary organisations to coordinate holistic support.
Social Prescribing
Connect patients with community groups, voluntary organisations, statutory services, and local resources.
Support referrals to services including:
o Befriending services
o Falls prevention programmes
o Welfare benefits and financial advice
o Housing support
o Carers' organisations
o Dementia support
o Mental health and wellbeing services, PCN Mental Health team
o Exercise and rehabilitation programmes
o Community transport
o Food support services
Home Visiting
Complete home visits independently where appropriate.
Carry out holistic assessments in patients' homes.
Identify environmental concerns affecting health and wellbeing.
Liaise with family members and unpaid carers where appropriate.
Document assessments accurately and escalate concerns promptly.
Care Coordination
Work collaboratively within the multidisciplinary team.
Attend MDT meetings, frailty meetings, and care planning discussions.
Support continuity of care through effective communication with partner organisations.
Ensure timely follow-up and review of patients receiving social prescribing support.
Safeguarding
Recognise safeguarding concerns relating to adults at risk.
Follow local safeguarding policies and procedures.
Escalate concerns appropriately and participate in safeguarding meetings where required.
Record Keeping
Maintain accurate clinical records using the practice clinical system.
Record interventions, outcomes, and follow-up activity.
Health Promotion
Promote healthy ageing, independence, and self-care.
Encourage patients to engage in preventative health initiatives where appropriate.
Support patients to access vaccinations, health checks, and community wellbeing activities.
Equality & Diversity
Demonstrates knowledge and understanding of equality of opportunity and diversity, taking into account and being aware of how individual actions contribute to and make a difference to the equality agenda.
The PCN is a friendly, flexible, forward thinking and supportive Network.
What can we offer you in return?
Our PCN reflects the NHS values of working together for our patients and the communities we serve; we will support you with a robust induction programme to help you achieve your full potential and highlight areas of training to ensure good progression.
We highly value a teamworking ethos and strongly promote a culture of support and development for our staff.
All our mandatory learning opportunities are free to all employees, and many can be used towards revalidation for those with a professional qualification.
Equal opportunity
Bournemouth East Collaborative PCN is committed to creating a diverse and inclusive environment and is proud to be an equal opportunity employer. All applicants meeting the minimum criteria for the role will receive consideration for employment without regard to age, marriage or civil partnership status, gender, gender expression or gender identity, disability, race or ethnicity, religion or belief, sexual orientation or veteran status.
Immigration Act 2016
All applicants will be asked to provide the required documented evidence of eligibility to live and work in the UK, prior to the interview. In completing this application, you are giving Bournemouth East Collaborative PCN permission to contact the Home Office/UKBA to establish your immigration status and eligibility to work at Bournemouth East Collaborative PCN.
Bournemouth East Collaborative PCN is not a Licence Sponsor and can only consider applicants who have the right to live and work in the UK.
Bournemouth East Collaborative PCN reserves the right to close this vacancy early should we receive sufficient applications
Benefits
• Company events
• Company pension
• Employee discount via Blue light Discount
• Free flu jabs
• Free parking
• Health & wellbeing programme
• On-site parking
Job description
Job responsibilities
Patient Support
Receive referrals from GPs, nurses, allied health professionals, care coordinators, and other members of the multidisciplinary team.
Undertake person-centred assessments to identify social, emotional, practical, and wellbeing needs.
Develop personalised care and support plans based on each patient's goals and priorities.
Empower patients to improve their confidence, resilience, independence, and self-management.
Frailty and Housebound Focus
Provide dedicated support for patients living with frailty and those who are housebound.
Undertake home visits when clinically appropriate to assess wellbeing, social circumstances, environmental factors, and support needs.
Identify risks relating to isolation, nutrition, mobility, falls, safeguarding, loneliness, and carer strain.
Support patients to access services that help maintain independence and prevent avoidable hospital admissions.
Work alongside community nursing, therapy teams, adult social care, and voluntary organisations to coordinate holistic support.
Social Prescribing
Connect patients with community groups, voluntary organisations, statutory services, and local resources.
Support referrals to services including:
o Befriending services
o Falls prevention programmes
o Welfare benefits and financial advice
o Housing support
o Carers' organisations
o Dementia support
o Mental health and wellbeing services, PCN Mental Health team
o Exercise and rehabilitation programmes
o Community transport
o Food support services
Home Visiting
Complete home visits independently where appropriate.
Carry out holistic assessments in patients' homes.
Identify environmental concerns affecting health and wellbeing.
Liaise with family members and unpaid carers where appropriate.
Document assessments accurately and escalate concerns promptly.
Care Coordination
Work collaboratively within the multidisciplinary team.
Attend MDT meetings, frailty meetings, and care planning discussions.
Support continuity of care through effective communication with partner organisations.
Ensure timely follow-up and review of patients receiving social prescribing support.
Safeguarding
Recognise safeguarding concerns relating to adults at risk.
Follow local safeguarding policies and procedures.
Escalate concerns appropriately and participate in safeguarding meetings where required.
Record Keeping
Maintain accurate clinical records using the practice clinical system.
Record interventions, outcomes, and follow-up activity.
Health Promotion
Promote healthy ageing, independence, and self-care.
Encourage patients to engage in preventative health initiatives where appropriate.
Support patients to access vaccinations, health checks, and community wellbeing activities.
Equality & Diversity
Demonstrates knowledge and understanding of equality of opportunity and diversity, taking into account and being aware of how individual actions contribute to and make a difference to the equality agenda.
The PCN is a friendly, flexible, forward thinking and supportive Network.
What can we offer you in return?
Our PCN reflects the NHS values of working together for our patients and the communities we serve; we will support you with a robust induction programme to help you achieve your full potential and highlight areas of training to ensure good progression.
We highly value a teamworking ethos and strongly promote a culture of support and development for our staff.
All our mandatory learning opportunities are free to all employees, and many can be used towards revalidation for those with a professional qualification.
Equal opportunity
Bournemouth East Collaborative PCN is committed to creating a diverse and inclusive environment and is proud to be an equal opportunity employer. All applicants meeting the minimum criteria for the role will receive consideration for employment without regard to age, marriage or civil partnership status, gender, gender expression or gender identity, disability, race or ethnicity, religion or belief, sexual orientation or veteran status.
Immigration Act 2016
All applicants will be asked to provide the required documented evidence of eligibility to live and work in the UK, prior to the interview. In completing this application, you are giving Bournemouth East Collaborative PCN permission to contact the Home Office/UKBA to establish your immigration status and eligibility to work at Bournemouth East Collaborative PCN.
Bournemouth East Collaborative PCN is not a Licence Sponsor and can only consider applicants who have the right to live and work in the UK.
Bournemouth East Collaborative PCN reserves the right to close this vacancy early should we receive sufficient applications
Benefits
• Company events
• Company pension
• Employee discount via Blue light Discount
• Free flu jabs
• Free parking
• Health & wellbeing programme
• On-site parking