Integrated Neighbourhood Team (INT) Caseworker


Company:	NHS Jobs
Salary:	£30,000 to £34,000 a year
Hours:	Full-time
Location:	London, SE14 6LD
Job type:	Contract
Posting date:	6 Oct 2026
Closing date:	20 Oct 2026

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Summary

Duties & Responsibilities Population Health and Caseload Management Analyse and assess population health data to identify high-priority patients or cohorts for INT intervention using e.g. EMIS Web, Microsoft Excel, AccuRx, Ardens manager and other systems as needed. Manage and maintain the INT caseload, ensuring efficient prioritisation and monitoring of patient progress. Collaborate with multidisciplinary teams (MDTs) to coordinate and manage patient support plans. Holistic Patient Assessments Conduct holistic face to face assessments with patients to understand their health, social care, and personal support needs. Conducting blood pressure, weight, height and pulse check Conducting blood tests if needed training can be provided Work with patients to set SMART achievable goals and identify solutions that promote independence and well-being. Use an evidence-based approach to recognise patient priorities and encourage self-management wherever possible. Facilitate group consultations for long term conditions including Type 2 Diabetes, Atrial Fibrillation, Chronic Kidney Disease and Hypertension. Provide follow up holistic assessments prior to patient discharge from the INT service Service Linkage and Signposting Provide effective signposting for low-intervention patients to one-off or community-based support services. Act as a coordinator between various services, including primary care, secondary care, social care, mental health, and voluntary sector organisations. Ensure patients are connected with the most appropriate support resources to address their individual needs. Integrated Working and Coordination Participate in INT and MDT meetings to represent patient needs and advocate for their voice in care planning. Actively support care coordination by liaising with GPs, hospital teams, social care, and community organisations. Maintain accurate and up-to-date records of interventions, referrals, and progress in patient care plans. IT and Communication Utilise digital tools and IT systems to streamline communication and record patient data accurately. Use Microsoft excel efficiently in maintaining a patient caseload Manage INT PCN email inbox using Microsoft Outlook Address interface challenges between IT systems to ensure seamless information sharing across teams and organisations. Promote digital inclusion by supporting patients in accessing online services and tools where applicable. Community Engagement and Partnership Build strong relationships with local voluntary and community organisations to enhance the range of support available to patients. Work with partnership organisations to refine and improve pathways, ensuring effective collaboration. Gather feedback from patients and partners to continuously improve service delivery and address local needs. Working Relationships and Contacts Lifestyle Medicine Community of Practice Lead INT Clinical Lead Pharmacists Integrated Neighbourhood Core Team General Practitioners (GPs) Social Prescribing Link Workers Care Coordinators Community Link Workers Other health professionals within the PCN Network Contract Directed Enhanced Service (DES) The post holder is expected to work core hours but should also be flexible around service needs, which may include some evenings and weekends.

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