PCN Care Coordinator (Medicines Optimisation)

Job description

Job responsibilities

Job Summary

A care coordinator is required to deal with patients and, if appropriate, their carer, before or after the patients consultation with a clinician or other healthcare professional.

Working closely with the patient and their clinician and/or other healthcare professionals, the care coordinator co-ordinates patients healthcare and supports them to access the appropriate service to ensure that they get the most suitable care from whatever health or social care provider is appropriate.

The care coordinators role requires them to be able to work with, and understand the roles of, a variety of different people working in a practice and across the PCN including doctors, nurses, healthcare assistants, social prescribing link workers, physiotherapists, pharmacists, health and wellbeing coaches and pharmacy technicians.

They will be given a caseload of identified patients and be required to ensure that their changing needs are addressed by taking into account local priorities, health inequalities and/or population health management risk stratification. This role will specifically work within the GP Clinical Pharmacist (GPCP) Team and with patients on significant or complex medication regimes on behalf of all 7 member practices but may shift on to other projects as services develop.

Key Responsibilities

Work closely with practice and PCN healthcare roles, the care coordinator is to work within the GPCP Team acting as first point of contact

Collate all of a patients identified care and support needs and review the options to meet these needs and bring them into a single personalised care and support plan (PCSP) in line with best practice

Support people to manage their needs by answering their queries and supporting them in making appointments or accessing appropriate services

Support the clinical team to engage with wider health professionals to coordinate care

Managing referrals and ensuring the patient understands and inputs into the care plan

Assist patients to be better prepared to have conversations on shared decision making and to improve awareness of shared decision making and related support tools

Provide patients with high quality, easy to understand information to assist them in making choices about their care

Liaise with other care coordinators in other practices within the PCN and share best practice

Provide coordination and navigation of patients, and where appropriate their carers, across health and social care services

Support in the delivery of enhanced services and other service requirements on behalf of the PCN

Lead in the management of patient complaints and participate in the identification of any necessary learning brought about through clinical incidents and near-miss events

Organise, attend and participate in the delivery of multi-disciplinary teams (MDT) within PCNs.

Undertake all mandatory training and induction programmes

Contribute to and embrace the spectrum of clinical governance

Develop yourself and the role through participation in training and service redesign activities

Attend a formal appraisal with their manager at least every 12 months. Once a performance/training objective has been set, progress will be reviewed on a regular basis so that new objectives can be agreed.

Contribute to public health campaigns (e.g. flu clinics) through advice or direct care

Maintain a clean, tidy, effective working area at all times

Coordinate care and support for patients on significant or complex medications

Act as first point of contact for queries as they come, looking out for trends across the practices

Manage the team rota to ensuring each practice gets its fair share of allocated time

Measure outcomes and monitor reports

Manage timely comms between the GPCP team and the 7 PCN Practices

Develop patient communications

Keep abreast of what is going on locally/nationally (i.e. PQRS, DES & QOF)

Working with the practices to understand the individual need

Facilitate a Brighter Birkenhead network for medicines admin colleagues, developing learning opportunities and sharing best practice

Communicate with local pharmacies.

Work with the GPCP to create processes and procedures that streamline patient pathways

Work with the GPCP and other services to create links and pathways for example wellbeing practitioners, health coaches

To support patient education around medicine compliance

Person Specification

Experience

Essential

• N/A

Desirable

• Experience of working in primary care

Qualifications

Essential

• N/A

Desirable

• N/A

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

St Catherine’s Surgery

Address

St Catherine’s Health Centre

Church Road

Birkenhead

Wirral

CH42 0LQ

Employer's website

https://www.stcatherinessurgery-wirral.nhs.uk/ (Opens in a new tab)