Adult Mental Health Social Prescriber - Tunbridge Wells PCNNHS

Job summary

Social prescribing helps to strengthen personal and community resilience and reduce health inequalities by addressing the wider determinants of health. The Adult Mental Health Navigator will provide holistic support, connecting patients to local initiatives and services for practical and emotional support empowering them to take control of their own health and wellbeing, live independently, improve outcomes and maintain a healthy lifestyle. The Adult Mental Health Navigator role will work as part of the PCN Mental Health Team providing support across the whole Primary Care Network. This is a key role within the development of the PCN's Integrated Neighbourhood Team championing multi-disciplinary working.

Interviews are planned for 02 and 04 December 2026.

Main duties of the job

Provide holistic, strengths-based one-to-one and group support to individuals with mental health needs, co-producing tailored plans around 'what matters to them'. Tackle wider health determinants, such as housing, debt, unemployment, and loneliness, by linking patients to voluntary, community and social enterprise (VCSE) groups and statutory services, alongside proactive wellbeing calls.

Manage a varied caseload from referral to follow-up, tracking outcomes and collaborating with general practitioners (GPs), multi-disciplinary teams, and carers. Maintain confidential clinical records using Systematized Nomenclature of Medicine (SNOMED) codes, update service directories, and promote referral pathways. Complete mental health training and promptly escalate safeguarding or clinical risks per local protocols.

Please carefully review the attached job description and person specification for full details.

Job description

• Provide personalised one-to-one and group-based support to individuals referred for support.
• Develop trusting relationships, giving people time and focus on 'what matters to them'.
• Provide non-judgemental support and work from a strength-based approach focusing on a person's assets.
• Take a holistic approach, based on the person's priorities and the wider determinants of health that impact on their health and wellbeing, such as debt, poor housing, being unemployed, loneliness and caring responsibilities.
• Work with individuals to co-produce a personalised support plan to address their health and wellbeing needs as required and access to local resources/services. Introduce or reconnect people to community groups, voluntary, community and social enterprise organisations and statutory services, and signpost where this matters to the person.
• Conduct proactive wellbeing calls to those identified as being at additional risk of social and economic vulnerability.
• Manage and prioritise a caseload, in accordance with the needs, priorities and level of support required by individuals.
• Build relationships and work proactively with other professionals to stimulate referrals and provide timely feedback on the support provided to individuals.
• Liaise with a range of multi-disciplinary professionals who are involved in a person's care, ensuring a smooth and coordinated approach, especially where multiple agencies are involved.
• Identify when a person's needs are beyond the scope of the Adult Mental Health Navigator role and refer them to the relevant health professional and/or external service.
• Remain the point of contact throughout the individual's social prescription including follow ups to ensure outcomes are being achieved and individuals are provided with ongoing support as required.
• Capture key information from individuals through follow up calls enabling tracking of the impact of social prescribing on their health and wellbeing.
• Maintain systems to keep accurate records relating to the delivery and outcomes of the service including processing referral forms, monitoring database, and updating case notes in line with local policy.
• Maintain accurate, timely and confidential records in the GP clinical system, using relevant national SNOMED codes for referrals, activity and outcomes.
• Encourage people to provide feedback and to share their stories about the impact of social prescribing on their lives.
• Contribute to the ongoing development and maintenance of the service directory.
• Help ensure that staff across member practices understand the role of the Social Prescribing Link Worker and the referral process.

Mental Health responsibilities

• Work with specific group of patients experiencing various mental health needs.
• Promote independence, providing general support, helping with personal goals, and providing emotional support.
• Complete relevant Mental Health Training
• Maintain a high level of professional core wellbeing skills.
• Maintain effective communication when referring patients to services.
• Maintain effective clinical links with colleagues, carers and relatives of patients and develop links with community services/resources.
• To report assessment findings in the appropriate format to the people who need them.
• To recognise when mental health, safeguarding or other clinical concerns require urgent discussion or escalation to the relevant GP, safeguarding lead or emergency service in accordance with local procedures.
• To ensure confidentiality and security of patient data is always maintained in compliance with the Data Protection Act.

Please see supporting information for the full job description and person specification.

About us

West Kent Primary Care is an innovative GP Federation whose shareholders include all 50 practices in West Kent, covering nearly 500,000 patients. Within this, the practices are divided into 10 Primary Care Networks (PCN). We are made up of a core operations team, a PCN based workforce made up of clinical and non-clinical staff and a Board of Executive Directors consisting of four local GPs and twelve PCN clinical directors. The federation also offers a variety of services which complement the provisions in Primary Care. This post will work on behalf of Tunbridge Wells Primary Care Network to provide patients with access to a high-quality service in accordance with the Network Contract Directed Enhanced Service (DES).

About the PCN

Tunbridge Wells Primary Care Network (PCN) is made up of 8 member GP practices servicing over 85,000 patients. We offer PCN services ranging from First Contact Physio, Paramedics, Mental Health Practitioners and Navigators, Nurses, Care Coordinators and Clinical Pharmacy to make a range of services more accessible to our patients.

*Due to travel requirements for the role it would be beneficial for applicants to have a full driving license

Please note that we reserve the right to close this vacancy early if we receive a high volume of suitable applications. Early applications are therefore strongly encouraged.