Care Co-Ordinator

Job description

Job responsibilities

Job Title:Frailty Care Coordinator

Location:The Abingdon Surgery

Reports to:Dr Lynette Saunders, GP Partner, The Abingdon Surgery; Abingdon Central PCN Clinical Director

Job Summary:The Frailty Care Coordinator is a new role to the practice and will play a pivotal role in supporting the management and coordination of care for patients identified as living with frailty. The role involves working closely with the multidisciplinary team to ensure personalised care plans are developed and implemented, enhancing the quality of care and improving patient outcomes.

Key Responsibilities:

1. Patient Identification and Engagement:
• Utilise population health intelligence where available and tools such as the electronic frailty index to identify patients living with frailty.
• Engage with patients and their families to understand their needs and preferences.
2. Care Coordination:
• Develop and maintain personalised care and support plans in collaboration with patients, carers, and healthcare professionals.
• Coordinate and facilitate multidisciplinary team (MDT) meetings to discuss and review patient care plans.
3. Communication and Liaison:
• Act as a point of contact for patients, families, and healthcare professionals regarding frailty care.
• Liaise with social prescribing link workers, healthcare professionals, and other relevant services to ensure comprehensive care.
4. Monitoring and Evaluation:
• Monitor patient progress and update care plans as necessary.
• Collect and report data on frailty management outcomes to support continuous improvement.
5. Education and Support:
• Provide information and support to patients and carers to help them manage their health and wellbeing.
• Raise awareness within the practice of frailty management and the role of the care coordinator.
6. Safeguarding and Risk Management:
• Ensure safeguarding processes are followed for vulnerable individuals.
• Identify and manage risks associated with frailty care.

Qualifications and Experience:

• Relevant healthcare qualification or experience in a similar role.
• Experience working within a multidisciplinary team in a healthcare setting.
• Knowledge of frailty management and care coordination.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.

Desirable:

• Experience in primary care or community health settings.
• Familiarity with NHS systems and processes.

Person Specification

Qualifications

Desirable

• Qualifications and Experience:
• Relevant healthcare qualification or experience in a similar role.
• Experience working within a multidisciplinary team in a healthcare setting.
• Knowledge of frailty management and care coordination.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Desirable:
• Experience in primary care or community health settings.
• Familiarity with NHS systems and processes.

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

The Abingdon Surgery

Address

65 Stert Street

Abingdon

Oxfordshire

OX14 3LB

Employer's website

https://www.abingdonsurgery.com/ (Opens in a new tab)