Care Coordinator

Job summary

The Care Coordinator role is an important and evolving job within the SAPA5 Primary Care Network (PCN). It involves working closely with doctors and other healthcare professionals to manage a group of patients, ensuring they and their carers receive the right care and support as their needs change. Care Coordinators focus on providing personalised care based on local needs and health priorities and support patients and carers to navigate the health and social care systems.

Main duties of the job

Facilitate and ensure the effective delivery of patient-centred, personalised health and social care plans for patients, monitoring progress and reporting outcomes, contributing to patient reviews and care planning within appropriate time frames and clinical skills

Explain the management of a patients pathway to clinical staff, liaising between services and service users, contacting services using the appropriate procedures/referral mechanisms.

Work closely with all relevant care agencies (health, community services, social services, ambulance service, voluntary sector, and other relevant service providers) to ensure a coordinated patient care plan, without requiring a further referral from the GP.

• To provide advice, guidance and practical support to individuals and their families/carers to ensure they are accessing the right care, at the right time, both clinically and socially.

Ensure a proper handover of care between different settings has taken place, including mutual transfer of all organisations communications and patient notes, and ensuring care packages are set up.

Collect data on patients/carers for recognised outcome measures and document for service interpretation. Ensure all patient notes are updated to reflect any changes, including details on plans.

About us

The SAPA5 Primary Care Network (PCN) consists of six General Practitioner (GP) practices that collaborate closely in the northern region of Sheffield. The PCN serves a population of 38,000 patients, many of whom face significant medical and social complexities. The PCN is dedicated to making a substantial impact on reducing health inequalities and supporting the population in leading healthier and more fulfilling lives.

The SAPA5 personalised care team has received both regional and national recognition for its innovative approaches to healthcare and its success in enhancing the lives of patients.