Complex Needs Worker - Cwmtawe Cluster

Tender description

The Cwmtawe Cluster Network is made up of 3 general medical practices (Cwmtawe Medical Group, Llansamlet Surgery and Strawberry Place Surgery), 8 dental practices, 10 pharmacies, 6 nursing homes, 4 opticians, 26 schools and 3 libraries. It works with partners from key local authority departments such as social services and poverty and prevention as well as the voluntary sector and wider Swansea Bay University Health Board. The Cwmtawe Cluster network aims to be a vanguard within Wales for enabling a social model of health and wellbeing, ensuring patients have the maximum possible support to access the mechanisms needed to live a healthy lifestyle. It does this by developing a hub of services for its population involving GP Practices, the community themselves and key partners; delivering this collaboratively with a social ethos, ensuring real and tangible benefits for the patients of the Cwmtawe Cluster. Appointing a Complex Needs Worker will allow unmet needs to be identified and be the central point of referrals within the Cwmtawe Cluster. The Provider will need to: Develop the Complex Needs Service across the Cwmtawe Cluster Network, identifying unmet need and be the central point of contact for referrals to the service - work with individuals from primary care settings to undertake initial assessments. Identify and co-produce meaningful interventions to address identified issues with regard to domestic abuse, mental health and/or substance misuse - work with colleagues as an advocate for patients with complex needs across the Cwmtawe Cluster area to identify and ensure all patients gave full and equitable access to help and support - using a ‘Team Around the Family’ approach, lead and broker staff in specialist roles and from partner organisations to ensure effective outcomes - to work with third sector providers and service commissioners to ensure that adequate quality assurance/clinical governance/performance management systems are in place to underpin safe referral processes - to implement procedures for signposting and referral to third sector and partner organisations underpinned by sound information sharing protocols - strengthen and develop links and pathways with other services including but not exclusively private sector landlords and specialist providers to increase collaborative working - work closely with local housing teams to ensure communications are clear and people who need help are identified at the earliest opportunity - help people to maintain their independence, health and wellbeing through innovative interventions that fully recognise and incorporate each person’s strengths - to participate in multi-disciplinary team meetings and input into clinical reviews as deemed appropriate - to manage a budget which can be utilised to fund resources, community activities and therapeutic interventions as identified - to maintain accurate records and produce regular reports to ensure effective monitoring procedures - to manage a case load NB: This Tender Opportunity covers the Cwmtawe Cluster Network. Further opportunities may become available under this contract, as funding becomes available. Ultimately to cover other Cluster Networks across the Swansea Bay University Health Board footprint.