Care Coordinator - Mental Health and Wellbeing

Nexus Devon Primary Care Network

Information:

This job is now closed

Job summary

This is a new role working within the Nexus Primary Care Network (PCN) Mental Health and Wellbeing Team in delivering a contemporary, multi-disciplined Primary Care Wellbeing Service that aligns with and supports the CMHT and wider system. The role will have the confidence to work across Secondary, Primary and Community services.

The post holder will deliver high quality wellbeing services. The role involves managing a caseload to meet the health and wellbeing needs of the patients. The focus will be in supporting the assessment and treatment to people with mental health/wellbeing needs and their carers.

The Care Coordinator will refer people back to other health professionals within the PCN utilising existing IT and MDT channels to screen patients, with an aim of identifying those that would benefit most from the services on offer and supporting external referrals when appropriate.

Main duties of the job

  • Manage and prioritise a caseload, in partnership with the health and wellbeing coaches and social prescribers, taking an approach that is non-judgemental, based on strong communication and negotiation skills, while considering the whole person when addressing existing issues.
  • Where required and as appropriate, the Care Coordinator will refer people back to their GP or other health professionals within the PCN.
  • Utilise existing IT and MDT channels to screen patients, with an aim to identify those who would benefit most from health coaching.
  • Provide personalised support to individuals, their families, and carers to support them to be active participants in their own healthcare, empowering them to manage their own health and wellbeing and live independently.
  • Support the coaches to motivate patients through multiple sessions to identify their needs, set goals, and support patients to achieve their personalised health and care plan objectives.
  • Support patients to establish and attain goals that are important to the patient.
  • Work in partnership with the existing services to connect patients to community-based activities which support them to take increased control of their health and wellbeing.

About us

NEXUS PCN is a network of five practices, covering an urban population of approx. 42,000 patients in Exeter. We are building an extensive and experienced multidisciplinary team and encourage close working relationships with other community staff including the Urgent Community Response team and Community Nurses. We have a well-established patient participation group and close links with voluntary sector organisations in the city.

Date posted

11 October 2021

Pay scheme

Other

Salary

Depending on experience

Contract

Permanent

Working pattern

Full-time

Reference number

A2049-21-7851

Job locations

Mount Pleasant Health Centre

Mount Pleasant Road

Exeter

Devon

EX4 7BW


Job description

Job responsibilities

Job Summary

The role will contribute to the development of the PCN Mental Health and Wellbeing service will develop to:

  • Provide a support structure for patients with mild to moderate clinical needs.
  • Form alliances with Social Prescribing and Community teams.
  • Jointly Plan and Develop Multi-disciplinary team structure proposals.
  • Support the triage/assessment of Primary Care mental health/wellbeing patients as a first call.
  • Develop group work facilities where appropriate.
  • Engage in a multi-disciplinary team structure across all five practices in Nexus PCN.
  • Engage and support community services in developing services for mental health and wellbeing.
  • Advise on Primary Care development of Mental Health and Wellbeing services.

COMMUNICATION

The post-holder should recognise the importance of effective communication within the team and will strive to:

  • Communicate effectively with other team members.
  • Communicate effectively with patients and carers.
  • Recognise peoples needs for alternative methods of communication and respond accordingly.
  • Communicate information in a way that makes it relevant and understandable for service users and carers, working in line with PCN standards and operational policies.
  • Actively contribute to and develop multi-disciplinary team working processes.
  • Facilitate fair access to social care services and promote social inclusion for service users without prejudice towards ethnicity, gender, sexual orientation or disability.

ADMINISTRATION

Other duties and responsibilities to be undertaken may include any or all the items in the following list:

  • Taking messages and passing on as appropriate.
  • Computer data entry/data allocation and collation, processing and recording information in accordance with practice procedures.
  • Initiating contact with and responding to requests from patients, other team members and associated healthcare professionals and providers.
  • Helping to keep all practice areas tidy and free from obstructions and clutter.
  • Helping to maintain a positive, supportive culture across the whole of the practice team.
  • Any other duties commensurate with this position.

Duties will vary from time to time under the direction of the PCN Manager/Operations Manager dependent on current and evolving practice workload and staffing levels.

ANALYTICAL AND JUDGMENTAL SKILLS

The postholder will be expected to:

Participate in risk assessments and determine the appropriate course of action, which has taken into consideration a range of possible options. Where necessary, ensure that consultation with senior colleagues is undertaken.

Have an awareness of your own clinical competencies, knowledge base and experience, and ensure that you practice within this and seek support as required.

Be able to triage patients based on structured introductory calls and direct to the appropriate clinician or service within the PCN based on set questions.

PLANNING AND ORGANISATIONAL SKILLS

Duties of the postholder will include:

Organisation of meetings

Taking responsibility for managing own workload to ensure the needs of the individuals who use our services are met, whilst taking the wider needs of the team into consideration.

Ensuring that interventions are planned in an integrated and co-ordinated manner. This may include liaison with external agencies.

Planning and organising individuals packages of care and ensure that reviews are held within the required time frames.

Planning their own workload and supporting the workload of other members of the multi-disciplinary team to ensure that care is provided in the most effective and cost efficient manner.

Responsibility for Patient/Client Care, Treatment and Therapy

The postholder should:

Ensure that their designated caseload is well managed and that care and treatment is provided in line with practice standards.

Deliver services using a recovery and strengths approach where the needs of the individual and their carer(s) are held as central and their involvement is proactively encouraged.

Deliver care in line with evidence-based practice and employ engagement skills that are appropriate to the clinical situation presented.

Ensure that appropriate action is taken to safeguard adults and children. This will include attending safeguarding meetings and implementing relevant care plans.

Practice in a way that actively minimises dependency and promotes recovery.

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.

The post-holder may have access to confidential information relating to patients and their carer(s), practice staff and other healthcare workers in the performance of their duties outlined in this job description. They may also have access to information relating to practices within the PCN as a business organisation. All such information from any source is to be regarded as strictly confidential.

Information relating to patients, carers, colleagues, other healthcare workers or the business of practices within the PCN may only be divulged to authorised persons in accordance with PCN policies and procedures relating to confidentiality and the protection of personal and sensitive data.

HEALTH & SAFETY:

The post-holder will assist in promoting and maintaining their own and others health, safety and security as defined in Nexus PCN Health & Safety Policy, individual practice Health & Safety Manuals, and practice Control policies and published procedures. This will include:

  • Using personal security systems within the workplace according to practice guidelines.
  • Identifying the risks involved in work activities and undertaking such activities in a way that manages those risks.
  • Making effective use of training to update knowledge and skills.
  • Using appropriate infection control procedures, maintaining work areas in a tidy and safe way and free from hazards.
  • Actively reporting of health and safety hazards and infection hazards immediately when recognized.
  • Keeping own work areas and general / patient areas generally clean, assisting in the maintenance of general standards of cleanliness consistent with the scope of the job holders role.
  • Undertaking periodic infection control training (minimum annually).
  • Reporting potential risks identified.

EQUALITY AND DIVERSITY:

The post-holder will support the equality, diversity and rights of patients, carers and colleagues, to include:

  • Acting in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with PCN procedures and policies, and current legislation.
  • Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues.
  • Behaving in a manner which is welcoming to and of the individual, is non-judgmental and respects their circumstances, feelings, priorities and rights.

PERSONAL/PROFESSIONAL DEVELOPMENT:

The post-holder will participate in any training program implemented by the PCN as part of this employment, such training to include:

  • Participation in an annual individual performance review, including taking responsibility for maintaining a record of own personal and/or professional development.
  • Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work.

QUALITY:

The post-holder will strive to maintain quality within the PCN, and will:

  • Alert other team members to issues of quality and risk.
  • Assess own performance and take accountability for own actions, either directly or under supervision.
  • Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance.
  • Work effectively with individuals in other agencies to meet patients needs.
  • Effectively manage own time, workload, and resources.

Job description

Job responsibilities

Job Summary

The role will contribute to the development of the PCN Mental Health and Wellbeing service will develop to:

  • Provide a support structure for patients with mild to moderate clinical needs.
  • Form alliances with Social Prescribing and Community teams.
  • Jointly Plan and Develop Multi-disciplinary team structure proposals.
  • Support the triage/assessment of Primary Care mental health/wellbeing patients as a first call.
  • Develop group work facilities where appropriate.
  • Engage in a multi-disciplinary team structure across all five practices in Nexus PCN.
  • Engage and support community services in developing services for mental health and wellbeing.
  • Advise on Primary Care development of Mental Health and Wellbeing services.

COMMUNICATION

The post-holder should recognise the importance of effective communication within the team and will strive to:

  • Communicate effectively with other team members.
  • Communicate effectively with patients and carers.
  • Recognise peoples needs for alternative methods of communication and respond accordingly.
  • Communicate information in a way that makes it relevant and understandable for service users and carers, working in line with PCN standards and operational policies.
  • Actively contribute to and develop multi-disciplinary team working processes.
  • Facilitate fair access to social care services and promote social inclusion for service users without prejudice towards ethnicity, gender, sexual orientation or disability.

ADMINISTRATION

Other duties and responsibilities to be undertaken may include any or all the items in the following list:

  • Taking messages and passing on as appropriate.
  • Computer data entry/data allocation and collation, processing and recording information in accordance with practice procedures.
  • Initiating contact with and responding to requests from patients, other team members and associated healthcare professionals and providers.
  • Helping to keep all practice areas tidy and free from obstructions and clutter.
  • Helping to maintain a positive, supportive culture across the whole of the practice team.
  • Any other duties commensurate with this position.

Duties will vary from time to time under the direction of the PCN Manager/Operations Manager dependent on current and evolving practice workload and staffing levels.

ANALYTICAL AND JUDGMENTAL SKILLS

The postholder will be expected to:

Participate in risk assessments and determine the appropriate course of action, which has taken into consideration a range of possible options. Where necessary, ensure that consultation with senior colleagues is undertaken.

Have an awareness of your own clinical competencies, knowledge base and experience, and ensure that you practice within this and seek support as required.

Be able to triage patients based on structured introductory calls and direct to the appropriate clinician or service within the PCN based on set questions.

PLANNING AND ORGANISATIONAL SKILLS

Duties of the postholder will include:

Organisation of meetings

Taking responsibility for managing own workload to ensure the needs of the individuals who use our services are met, whilst taking the wider needs of the team into consideration.

Ensuring that interventions are planned in an integrated and co-ordinated manner. This may include liaison with external agencies.

Planning and organising individuals packages of care and ensure that reviews are held within the required time frames.

Planning their own workload and supporting the workload of other members of the multi-disciplinary team to ensure that care is provided in the most effective and cost efficient manner.

Responsibility for Patient/Client Care, Treatment and Therapy

The postholder should:

Ensure that their designated caseload is well managed and that care and treatment is provided in line with practice standards.

Deliver services using a recovery and strengths approach where the needs of the individual and their carer(s) are held as central and their involvement is proactively encouraged.

Deliver care in line with evidence-based practice and employ engagement skills that are appropriate to the clinical situation presented.

Ensure that appropriate action is taken to safeguard adults and children. This will include attending safeguarding meetings and implementing relevant care plans.

Practice in a way that actively minimises dependency and promotes recovery.

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.

The post-holder may have access to confidential information relating to patients and their carer(s), practice staff and other healthcare workers in the performance of their duties outlined in this job description. They may also have access to information relating to practices within the PCN as a business organisation. All such information from any source is to be regarded as strictly confidential.

Information relating to patients, carers, colleagues, other healthcare workers or the business of practices within the PCN may only be divulged to authorised persons in accordance with PCN policies and procedures relating to confidentiality and the protection of personal and sensitive data.

HEALTH & SAFETY:

The post-holder will assist in promoting and maintaining their own and others health, safety and security as defined in Nexus PCN Health & Safety Policy, individual practice Health & Safety Manuals, and practice Control policies and published procedures. This will include:

  • Using personal security systems within the workplace according to practice guidelines.
  • Identifying the risks involved in work activities and undertaking such activities in a way that manages those risks.
  • Making effective use of training to update knowledge and skills.
  • Using appropriate infection control procedures, maintaining work areas in a tidy and safe way and free from hazards.
  • Actively reporting of health and safety hazards and infection hazards immediately when recognized.
  • Keeping own work areas and general / patient areas generally clean, assisting in the maintenance of general standards of cleanliness consistent with the scope of the job holders role.
  • Undertaking periodic infection control training (minimum annually).
  • Reporting potential risks identified.

EQUALITY AND DIVERSITY:

The post-holder will support the equality, diversity and rights of patients, carers and colleagues, to include:

  • Acting in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with PCN procedures and policies, and current legislation.
  • Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues.
  • Behaving in a manner which is welcoming to and of the individual, is non-judgmental and respects their circumstances, feelings, priorities and rights.

PERSONAL/PROFESSIONAL DEVELOPMENT:

The post-holder will participate in any training program implemented by the PCN as part of this employment, such training to include:

  • Participation in an annual individual performance review, including taking responsibility for maintaining a record of own personal and/or professional development.
  • Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work.

QUALITY:

The post-holder will strive to maintain quality within the PCN, and will:

  • Alert other team members to issues of quality and risk.
  • Assess own performance and take accountability for own actions, either directly or under supervision.
  • Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance.
  • Work effectively with individuals in other agencies to meet patients needs.
  • Effectively manage own time, workload, and resources.

Person Specification

Qualifications

Essential

  • Educated to GCSE or equivalent
  • Demonstrable commitment to professional and personal development

Desirable

  • Training in motivational coaching / counselling or equivalent experience

Experience

Essential

  • Experience of working as part of a team
  • Experience of working with vulnerable adults (including unpaid work)
  • Experience of supporting people, their families, and carers in a related role (including unpaid work)
  • Experience of supporting people with their mental health, either in a paid, unpaid, or informal capacity

Desirable

  • Experience of working within a primary care setting
  • Experience of working with the VCSE sector (in a paid or unpaid capacity), including with volunteers and small community groups
  • Experience of data collection and providing monitoring information to assess the impact of services
  • Experience of working in a multi-disciplinary setting

Personal characteristics

Essential

  • Ability to listen, empathise with people and provide person-centred support to vulnerable adults
  • Ability to engage with clients experiencing a wide range of mental health and wellbeing problems
  • Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
  • Commitment to reducing health inequalities and proactively working to reach people from all communities
  • Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
  • Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders
  • Ability to identify risk and assess/manage risk when working with vulnerable adults
  • Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role e.g., when there is a mental health need requiring a qualified practitioner
  • Ability to communicate with a wide range of professionals from various settings
  • Able to recognise problems and get involved in working through solutions
  • Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
  • Ability to work independently and as part of a team

Desirable

  • Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
  • High level of written and oral communication skills
  • Ability to work flexibly and enthusiastically within a team or on own initiative
  • Ability to manage change in a positive manner
  • Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
  • Maintain a positive approach, good sense of humour, high energy levels along with being confident and resilient
Person Specification

Qualifications

Essential

  • Educated to GCSE or equivalent
  • Demonstrable commitment to professional and personal development

Desirable

  • Training in motivational coaching / counselling or equivalent experience

Experience

Essential

  • Experience of working as part of a team
  • Experience of working with vulnerable adults (including unpaid work)
  • Experience of supporting people, their families, and carers in a related role (including unpaid work)
  • Experience of supporting people with their mental health, either in a paid, unpaid, or informal capacity

Desirable

  • Experience of working within a primary care setting
  • Experience of working with the VCSE sector (in a paid or unpaid capacity), including with volunteers and small community groups
  • Experience of data collection and providing monitoring information to assess the impact of services
  • Experience of working in a multi-disciplinary setting

Personal characteristics

Essential

  • Ability to listen, empathise with people and provide person-centred support to vulnerable adults
  • Ability to engage with clients experiencing a wide range of mental health and wellbeing problems
  • Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
  • Commitment to reducing health inequalities and proactively working to reach people from all communities
  • Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
  • Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders
  • Ability to identify risk and assess/manage risk when working with vulnerable adults
  • Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role e.g., when there is a mental health need requiring a qualified practitioner
  • Ability to communicate with a wide range of professionals from various settings
  • Able to recognise problems and get involved in working through solutions
  • Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
  • Ability to work independently and as part of a team

Desirable

  • Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
  • High level of written and oral communication skills
  • Ability to work flexibly and enthusiastically within a team or on own initiative
  • Ability to manage change in a positive manner
  • Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
  • Maintain a positive approach, good sense of humour, high energy levels along with being confident and resilient

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

Nexus Devon Primary Care Network

Address

Mount Pleasant Health Centre

Mount Pleasant Road

Exeter

Devon

EX4 7BW


Employer's website

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

Employer details

Employer name

Nexus Devon Primary Care Network

Address

Mount Pleasant Health Centre

Mount Pleasant Road

Exeter

Devon

EX4 7BW


Employer's website

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

For questions about the job, contact:

Andy Stapley

andy.stapley@nhs.net

Date posted

11 October 2021

Pay scheme

Other

Salary

Depending on experience

Contract

Permanent

Working pattern

Full-time

Reference number

A2049-21-7851

Job locations

Mount Pleasant Health Centre

Mount Pleasant Road

Exeter

Devon

EX4 7BW


Supporting documents

Privacy notice

Nexus Devon Primary Care Network's privacy notice (opens in a new tab)