Personalised Care Roles

According to NHS England ‘Personalised Care will benefit up to 2.5 million people by 2024, giving them the same choice and control over their mental and physical health that they have come to expect in every other aspect of their life. A one-size-fits-all health and care system simply cannot meet the increasing complexity of people’s needs and expectations. Personalised care is based on ‘what matters’ to people and their individual strengths and needs. The NHS Long Term Plan says personalised care will become business as usual across the health and care system and Universal Personalised Care confirms how we will do it’

See this video for more details and you can sign up to the NHSE bulletin to stay informed about recent personalised care news.

There are three personalised care roles

Care Co-ordinators
Social Prescribing Link Workers (SPLW)
Health & Wellbeing Coaches

Further information

NHS England » Personalised care

Personalised Care Roles (hee.nhs.uk)

Care co-ordinators

Care co-ordinators help to co-ordinate and navigate care across the health and care system, helping people make the right connections, with the right teams at the right time. They can support people to become more active in their own health and care and are skilled in assessing people’s changing needs. Care co-ordinators are effective in bringing together multidisciplinary teams to support people’s complex health and care needs (NHS England )

Care Coordinators play an important role within a PCN to proactively identify and work with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services.

Care Coordinators could potentially provide extra time, capacity, and expertise to support patients in preparing for or in following-up clinical conversations they have with primary care professionals. They will work closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that their changing needs are addressed. This is achieved by bringing together all the information about a person’s identified care and support needs and exploring options to meet these within a single personalised care and support plan, based on what matters to the person (HEE)

For a full overview of the role, including funding, training & development, skills, and competencies, please click here

The new NHS England » Workforce development framework: social prescribing link workers released January 2023-

The purpose of the social prescribing link worker (SPLW) workforce development framework is to:

Provide clear and consistent standards for SPLW practice, including their knowledge, skills and behaviours
Provide guidance on the support, supervision, and learning and development offer required from employers to support SPLWs
Promote the development of a strong and capable workforce of SPLWs and their future development
Support improved quality and consistency of social prescribing and reduced variation in outcome and access standards.
Demonstrate the benefits of SPLWs working as part of a multidisciplinary team.

Further information

NHS England » Care co-ordinators

Care Coordinator – bswtraininghub.nhs.uk

Care Co-ordinators - Dorset Primary Care Training Hub (primarycaredorset.co.uk)

You searched for care coordinators – Frimley Training Hub

Social Prescriber Link Worker (SPLW)

Social prescribing enables all primary care staff and local agencies to refer people to a link worker

Social prescribing link workers play a key role in delivering social prescribing by giving people time, developing trusting relationships and providing personalised support, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing in order to connect them to appropriate community groups and services.

They work within multi-disciplinary teams and collaborate with local partners to support community groups to be accessible and sustainable and help people to start new groups. Social prescribing complements other approaches such as ‘active signposting’. Link workers typically support people on average over 6-12 contacts (including phone calls, meetings and home visits) with a typical caseload of 200-250 people per year, depending on the complexity of people’s needs and the maturity of the social prescribing scheme (HEE)

They are also uniquely placed to tackle growing health and wellbeing challenges, such as our ageing population, people living with complex, long-term conditions, and increasing pressure on the health and care system resulting from COVID-19 and waiting list times.

A standard model of social prescribing has been developed in partnership with stakeholders, which shows the key elements that need to be in place for effective social prescribing:

The new NHS England » Workforce development framework: social prescribing link workers, released January 2023-

The purpose of the social prescribing link worker (SPLW) workforce development framework is to:

Provide clear and consistent standards for SPLW practice, including their knowledge, skills and behaviours
Provide guidance on the support, supervision, and learning and development offer required from employers to support SPLWs
Promote the development of a strong and capable workforce of SPLWs and their future development
Support improved quality and consistency of social prescribing and reduced variation in outcome and access standards.
Demonstrate the benefits of SPLWs working as part of a multidisciplinary team.

For a full overview of the role, including funding, training & development, skills and competencies, please click here

Further information

Social prescribing link worker | Health Careers

NHS England » Social prescribing: Reference guide and technical annex for primary care networks

NHS England » Social prescribing – frequently asked questions

NHS England » Social prescribing link workers

Social prescribing: applying All Our Health - GOV.UK (www.gov.uk)

bma-social-prescribing-guidance-2019.pdf

Social prescribing in action | Public Health | Royal College of Nursing (rcn.org.uk)

Home - Social Prescribing Network

The National Academy for Social Prescribing | NASP (socialprescribingacademy.org.uk)

Health & Wellbeing Coach (HWBCs)

Health and wellbeing coaches support people to increase their ability to self-manage, motivation levels and commitment to change their lifestyle. They are experts in behaviour change and focus on improving health related outcomes by working with people to set personalised goals and change their behaviours. They work with people with physical and/or mental health conditions and those at risk of developing them.

HWBCs can be an effective intervention for people experiencing a range of long-term conditions, including respiratory, cardiovascular (including type 2 diabetes and hypertension), and stress/low mood. They can also support people with weight management, diet and increasing activity levels.

HWBCS will use a non-judgemental approach that supports the person to self-identify existing issues and encourages proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills, supports personal choice and positive risk taking, addresses potential consequences, and ensures people understand the accountability of their own decisions based on what matters to the person. They will work alongside people to coach and motivate them through multiple sessions, supporting them to self- identify their needs, set goals, and help them to implement their personalised health and care plan. (HEE)

The new NHS England » Workforce development framework for health and wellbeing coaches released February 2023

This Workforce development framework for health and wellbeing coaches:

sets clear and consistent standards for health and wellbeing coaches
demonstrates the benefits of health and wellbeing coaches working in the NHS
provides information about the training, support, supervision, and continuous professional development needed to enable health and wellbeing coaches to succeed
supports the development of a strong and capable workforce of health and wellbeing coaches
supports improved quality and consistency of health coaching and reduces variation in outcomes and access standards.