Job responsibilities
1x PCN Care Coordinators wanted at North Lambeth Primary Care Network
Role Title
PCN
Care Coordinator
Grade/Salary
upto £28K
Hours
37.5
hours per week.
Duration
Permanent
Reporting to
PCN Network Manager
Location
North
Lambeth member practices for the Primary Care Network
Key responsibilities
1.
Undertake
work in line with PCN directed priorities.
2.
Proactively identify and work with a cohort of people to support
their personalised care requirements, using the available decision support aids
3.
Ensure
regular and consistent communication with the referrer regarding patient
progress and any complications or guidance
4.
Raise awareness of health promotion and NHS health checks in
practices
5.
Work with Member Practices to facilitate the .
6.
Evaluate treatment programmes that promote health and
well-being
7.
Co-ordinate clinics, liaising with the schedulers and
contacting the identified patients with appointments.
8.
Manage patient initiated calls for help/signposting etc,
booking into named GP urgent care slots/tel slots if necessary.
9.
Document and monitor aspects of patient co-ordination and
service delivery, supporting data collection and audit using the patient
administration system
10.
Demonstrate the ability to recognise and respond
appropriately when faced with a sudden deterioration or emergency situation,
alerting the team or enabling a rapid response.
11.
Dependant on work plans, there may be a requirement to work
across different tumour groups and teams.
12.
Organise and prioritise own workload the postholder should
be comfortable working independently and as a committed member of the
multi-disciplinary team.
13.
Support national screening programmes
14.
Support immunization programmes
15.
Monitor referrals
to ensure tasks are completed and care delivered by keeping in regular
telephone contact
16.
Direct liaison
with multi agencies to coordinate care for patients
17.
Refer to PCN
social prescribing link workers were a patient is identified as potentially
benefitting from this service
18.
To support
patient/carer contact roles, and collate patient and carer feedback on their
experiences
19.
Support Quality
and Outcome Frameworks and other DES/LES specifications
20.
Maintain and
develop engagement with all practice staff and encourage best practice
21.
Act as the first port of call for patients, in their caseload
in relation to their care.
22.
Bring together all of a persons identified care
and support needs, and explore their options to meet these into a single
personalised care and support plan (PCSP), in line with PCSP best practice
23.
Help people to manage their needs, answering
their queries and supporting them to make appointments
24.
Support people to take up training, employment
and access appropriate benefits where eligible
25.
Raise awareness of shared decision-making and decision
support tools, and assist people to be more prepared to have a shared
decision-making conversation
26.
Ensure that people have good quality information
to help them make choices about their care
27.
Support people to understand their level of knowledge,
skills and confidence their Activation level when engaging with their
health and wellbeing, including using the Patient Activation Measure
28.
Assist people to access self-management education
courses, peer support or interventions that support them in their health and
wellbeing
29.
Explore and assist people to access personal
health budgets where appropriate
30.
Provide coordination and navigation for people and
their carers across health and care services, alongside working closely with
social prescribing link workers and other primary care roles
31.
Support the coordination and delivery of MDTs
within PCNs. - Manage
MDT meetings for this patients and identifying issues to be addressed, liaising
with other agencies if necessary as well as GPs, Pharmacists and Nursing team.
32.
Liaise directly with
Care Homes and other key providers, to identify patients for discussion at MDT,
and compile and circulate relevant information to attendees
33.
Other duties as
defined by the PCN as necessary
Confidentiality
In the course of seeking treatment,
patients entrust us with, or allow us to gather, sensitive information in
relation to their health and other matters. They do so in confidence and have
the right to expect that staff will respect their privacy and act
appropriately.
In the performance of the duties
outlined in this job description, the post-holder may have access to
confidential information relating to patients, their carers, practice or staff
information. All such information from any source is to be regarded as strictly
confidential.
Information relating to patients,
carers, colleagues, or the members practices may only be divulged to authorised
persons in accordance with PGPA policies and procedures relating to
confidentiality and the protection of personal and sensitive data, or under the
guidance of your manager.
This role profile is not exhaustive, and you may be directed to
complete other tasks according to the skills and requirements for individual
roles. These duties will always be reasonable and deemed within the
expectations of your position.
