How the three additional personalised care roles fit together


How the three additional personalised care roles fit together 

 

 
Social prescribing link workers 
Health and wellbeing coaches 
Care coordinators 
What do they do? 
  1. Support people to unpick complex issues affecting their wellbeing 
  2. Connect them to sources of practical and emotional support in the community 
  3. Enable them to take more control over their lives, develop skills and give time to others through community groups 

Support people to unpick complex issues affecting their wellbeing and set goals for themselves 

 

Coach and motivate people to develop the skills, knowledge and confidence to manage their own health and move towards their goals  

Support patients – often older/frail people and people with long term conditions - to understand their health conditions and navigate the system 

 

Actively case find for GP practices, e.g. people with COPD 

  

How do they do it? 

Personalised care and support planning, motivational interviewing techniques. 

Act as a bridge between primary care and the community 

Goal setting conversations 

Behaviour change techniques 

Coaching conversations  

Single point of contact for patient and teams, offering continuity, advocacy, listening ear and connection to other services 

Who do they help? 

Usually people experiencing loneliness, complex social needs, mental health needs or multiple long term conditions 

Usually people with or at risk of physical and mental health conditions, such as type 2 diabetes, COPD, insomnia. 

Usually older/frail people and people with long term conditions 


Updated: 07/03/2023