PCN Health & Wellbeing Coach

Playing a health and Wellbeing Coaching role; teaching and supporting patients/carers to understand and manage their own conditions and maintain an independent lifestyle through health coaching techniques to encourage patient activation. Supporting the development of personalised patient care plans, liaising with the practice team, patient/carer and the complex care team as appropriate. Proactively supporting practice targets for number of patients who have seen a health coach. Proactively outreaching to patients on a regular and agreed basis. Playing an active role in MDT meetings if required (regular practice meetings to discuss high risk and / or complex patients) by gathering information and being prepared to update the team on patient progress towards goals etc. (as per their care plan)Coordinating patient visits to primary care amongst the primary care team, ensuring efficient and effective visits for the patient cohort. Map and connect community activities/ resources at a locality level including supporting the development of a network of community health champions. Support the delivery of community based public health initiatives such as physical activity, healthy eating and social connectedness. Build and maintain strong links with the voluntary sector, supporting the voluntary and statutory sector to network and improve partnership working. Contribute to keeping the community directory up to date for their allocated area. Support delivery of systematic self-care support plans for those with COPD, diabetes and multiple long term conditions. Managing the effective use of available resources and services in order to provide constant standards of care in terms of both quality and quantity. Adopting a multi-disciplinary and multi-agency approach to care, ensuring that all aspects of the patients needs are met. Understand when it is appropriate or necessary to refer people to other health professionals/agencies. Ensure the patient record is accurately updated and maintained. Manage waiting lists if appropriate. Understand the barriers for individuals/groups in accessing support in the community, and use this insight in developing community-based support, working as part of the wider social prescribing model. Promote the service within the Primary Care Network, both for users and clinicians, building positive working relationships. Contribute to and work with others to organise awareness raising events for services that help support people to improve their health and wellbeing. Communicate effectively with colleagues, patients and carers so that information is shared in order to meet patients needs. The post holder will have a key role in helping to raise the local populations awareness of the support, groups and opportunities available to assist them in achieving their health and wellbeing goals.