PCN Care Co-ordinator

Job description

Job responsibilities

The role exists to support the delivery of the high quality primary healthcare and the Primary Care Network agenda. We are committed to delivering the local commissioners vision of Start Well, Live Well, Age Well and you will support the delivery of a number of the Primary Network key care priorities by proactively searching for patients with unmet clinical and care needs and organising their onward appointments, gathering data for clinicians and management staff, recruiting patients to our proactive care initiatives, coordinating group education sessions with our specialist clinicians, conducting patient and carers routine care reviews, supporting the organisation of the COVID vaccination service and much more.

The role supports a variety of services such as mental health, social prescribing, pharmacy, physiotherapy, occupational therapy, vaccination, care homes and enhanced access services.

The successful candidate will have excellent interpersonal and communication skills, be organised, proactive, patient and empathetic.

At Ascent PCN we offer a friendly, supportive working environment and demonstrate a commitment to providing professional development and supervision for all staff, together with a competitive salary package and company pension.

There is also the opportunity for local links to be established with other PCNs to support professional supervision and enable the sharing of innovation and best practice through peer support.

Duties:

The duties of this post are a guide to the range of responsibilities that may be required. These may change from time to time to meet the needs of the service and/or the development needs of the post holder.

As a Care Coordinator, you will:

Proactively identify and support individuals, including the frail, elderly, and those with long-term conditions.

Provide co-ordination and appointment navigation for people and their carers across health and care services, working closely with social prescribing link workers, other primary care professionals and health and social care colleagues; helping to ensure patients receive a joined-up service and the most appropriate support.

Collaborate with clinical and non-clinical teams to ensure people receive the support they need in a timely manner, using IT search and report systems.

Empower patients to manage their conditions and access necessary services, enhancing their quality of life.

Work alongside PCN and practice clinical staff for a comprehensive approach to personalised care.

Work alongside the Occupational Therapist on the PCN Frailty project, coordinating recruitment and distribution and collection of surveys and actioning responses.

Engage with diverse populations from various cultural and social backgrounds.

Be highly motivated, forward-thinking, an excellent communicator with strong interpersonal skills. You need to be organised, patient, empathetic and able to reprioritise tasks at short notice.

Be experienced in health, social care, or support roles involving direct contact with people, families, or carers.

Use SystmOne with confidence to run searches and keep care records up-to-date by identifying and updating missing or out-of-date information about the individuals circumstances.

Use IT database systems to identify patients with unmet care needs.

Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care.

Work collaboratively with GPs and other primary care professionals within the PCN to proactively manage an ever-changing caseload, which may include patients with long-term health conditions and those requiring medication and disease monitoring e.g search and recall patients for blood tests and reviews.

Work with the Network Practices to help co-ordinate the roll out of the winter Covid Vaccination programme

Support the coordination and delivery of multidisciplinary team education groups (e.g nutrition groups, mental health groups) and attend team meetings with the PCN

Support the PCN in developing communication channels between GPs, people and their families and carers and other agencies

Identify unpaid carers and help them access services to support them

Identify those requiring additional support for health-seeking behaviours and assist them in identifying appropriate interventions.

Conduct follow-ups on communications from outpatient in-patient hospital services.

Maintain records of referrals and interventions to enable monitoring and evaluation of the service.

Contribute to risk and impact assessments, audits, monitoring and evaluations of the service.

Person Specification

Skills

Essential

• Confident and empathetic communicator
• Excellent organisational skills
• Attention to detail and accuracy

Desirable

• Developing and using searches within SystmOne clinical system.
• Proficient in the use of Microsoft Office products
• Ability to self-direct tasks, use own initiative, to meet an overall goal

Qualifications

Essential

• Qualified from appropriate training course as set out by the Personalised Care Institute for Care Co-ordinators
• or
• NVQ Level 3 in Adult Care
• or
• NVQ Level 3 in Business Administration

Desirable

• Additional Qualification in health or social care allied profession
• Long term conditions and welfare rights basic training

Experience

Essential

• Working in health, social care and other support roles in direct contact with people, families or carers (in a paid or voluntary capacity).
• Experience of data collection and using tools to measure the impact of services
• Experience of working within multi-professional team environments
• Experience or training in personalised care and support planning.

Desirable

• Working with elderly or vulnerable people
• Experience of healthcare and complying with best practice and relevant legislation
• Supporting people, their families and carers in a related role
• Minimum of 1 year experience of working with healthcare professionals and/or previous experience in the NHS or social care or relevant field

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Employer details

Employer name

Asplands Medical Centre

Address

Asplands Close

Woburn Sands

Milton Keynes

MK17 8QP

Employer's website

https://www.asplandsmedicalcentre.co.uk (Opens in a new tab)