Job summary
Andover PCN are looking for an enthusiastic and highly organised person
to work collaboratively across all 5 practices within the PCN and the linked
care homes, providing coordination and administrative support to the GPs,
clinical teams and members of the PCN to support patient care
The Care Coordinator post is seen as a critical and evolving role to
support the Multi-Disciplinary Teams (MDTs) and the practices within the PCN to
deliver effective, proactive and co-ordinated
care to patients. Working closely with the PCN Manager and the PCN team they will
support the effective workload management of GPs and other clinical colleagues.
They act as a link
between the PCN, practices and wider healthcare community
and also signpost towards Social Prescribers or Health Coaches. The role
requires you to be able to work with, and understand the roles of a variety of
different people working in the practice and across the PCN including doctors,
nurses, healthcare assistants, social prescribing link workers,
physiotherapists, physician associates, paramedics, health & wellbeing
coaches, occupational therapists and pharmacy technicians.
Main duties of the job
The Care Coordinator will support
clinicians to bring together a patient identified care and support needs and
ensure all patients have a single personalised care support plan in line with
best practice, based on what matters to the person. They will ensure that
clinicians have access to the tools they need to develop a personalised care
plan. The Care Coordinator will help patients and their carers with queries to
allow them to navigate or signpost for their health needs and ensure they have
excellent good quality written or verbal information. The care coordinator will also be involved in efficient running of the PCN Vaccination centre.
.
About us
Primary Care Networks form a key building block of the NHS long-term plans. Bringing general practices together allow us to provide a wider range of services to patients, whilst also decreasing the workload on GP’s. This improves the ability of practices to recruit and retain staff, manage finances and facilities more efficiently, and to more easily integrate with the wider health and care system.
Andover Primary Care Network is a collaborative project involving the following GP Surgeries: Adelaide Medical Centre, Andover Health Centre Medical Practice, Charlton Hill Surgery, Shepherds Spring Medical Centreand St Mary’s Surgery.
As we come out of the Covid Pandemic and demand pressures on primary care continue to grow, the time for reorganisation of the NHS and a political appetite for transformation of services is increasing. Primary Care in Andover suffers these pressures on top of longer standing issues of socio-economic deprivation and the resulting health problems, which have been exacerbated by the pandemic.
The PCN offers additional roles working across practices, providing alternatives for patients to seeing a GP. Using pharmacists and care-coordinators to proactively manage our elderly and complex patients. We expect the PCN to continue to develop and improve patient care in Andover, and to create opportunities for innovative ways of promoting wellbeing.
Job description
Job responsibilities
Main Responsibilities
- Be responsible for arranging, attending and minuting care home Multidisciplinary Team Meetings. Proactively prepare any actions prior to the MDT ensuring all relevant clinicians are present
- Be responsible for running searches and daily updating of patients on electronic workflow management systems to identify care residents to support the PCN team with identifying community pathways that might prevent hospital admission and for identifying potential gaps in care
- To record patient interventions on relevant electronic database systems (e.g. EMIS) and contribute to report generation, analysis and production
- Follow up on patients and all forward actions resulting from MDT discussions.
- To support clinicians and colleagues in the logging and making referrals
- To ensure regular and consistent communication with the referrer regarding patient progress and any complications or guidance.
- To co-ordinate health hub clinics, liaising with the schedulers and contacting the identified patients with appointments.
- To work at the vaccination centre to organise vaccination clinics, invite patients and manage vaccine stocks
- To work in the Health Hub to organise and conduct health checks, learning difficulties checks, assist on chronic illness management and care.
- May be given a caseload of identified patients and be required to ensure that their changing needs are addressed by considering local priorities, health inequalities and/or population health management risk stratification
- To manage patient initiated calls for support/signposting, booking into named GP urgent care slots/telephone slots where necessary.
- To use population health data to proactively identify and work with a cohort of people to support their personalised care requirements, using the available decision support aids.
- To offer appropriate support and guidance to patients and their families/carers
- To document and monitor aspects of patient co-ordination and service delivery, supporting data collection and audit using the patient administration system
- To contribute to the integration of health and social care by maintaining up to date recording systems for all agencies within the PCN Team and providing information to any member of the PCN Team in order to ease processes and communication in agreement with data protection protocol
- To support the population health project with liaising with identified cohorts of patients and other agencies
- To be responsible for recording, reporting and producing evaluation reports which will include evaluation detailing effectiveness outcomes of new roles.
- To work effectively as part of a team to provide cover for Care Coordination Teams when required and to be flexible regarding working hours to meet the needs of the service
- To ensure all electronic records are updated and complete within the agreed time-scales
- To monitoring the social prescribing and PCN enquiries task inbox
- Work with the PCN Manager to develop & support collective general practice projects including areas of federated working
- Provide coordination of and participate in relevant internal and external working groups and provide project advice, expertise and support when requested
- Work closely and in partnership with the other Care Coordinators, Social Prescribing Link Workers and Health coaches(s)
- To be customer (patient, carer, GP) focused when representing the service
- Dependant on work plans, there may be a requirement to work across different groups and teams
- To use a range of verbal and non-verbal communication tools to communicate effectively with patients, carers and families and colleagues
- To research appropriate websites, downloading and circulating documents as requested to support patient care
- Maintaining communication channels about the PCN including the PCN website and newsletters.
- To work collaboratively with other teams and services to maintain an effective and efficient service
- To support the induction and integration of new staff.
- To plan / organise work using own initiative, whilst being able to work as a valuable member of a team
- To work with other team members to cover leave and sickness as required.
- To support the PCN manager and Clinical Directors in diary management, arranging meetings, taking minutes as needed and circulating papers.
- To have excellent IT skills, to include Microsoft Office, Outlook and Excel
- To undertake general office duties to support the role
- To carry out any other reasonable duties as requested by a manager to ensure quality of service
Education and Training
- To work towards completing the appropriate training to deliver and support the Comprehensive Model for Personalised Care
- To participate in any relevant training/courses/conferences
- To complete mandatory training
- To maintain your own continuing professional development, keeping up to date with developments
Information management
- To maintain appropriate confidentiality of information relating to the organisation and its staff and maintain compliance with the Data Protection Act.
- To be responsible for maintaining the confidentiality of all patient and staff records
- Support good integrated governance and information governance practice within the practice
- Report any concerns or incidents as per policy
Job description
Job responsibilities
Main Responsibilities
- Be responsible for arranging, attending and minuting care home Multidisciplinary Team Meetings. Proactively prepare any actions prior to the MDT ensuring all relevant clinicians are present
- Be responsible for running searches and daily updating of patients on electronic workflow management systems to identify care residents to support the PCN team with identifying community pathways that might prevent hospital admission and for identifying potential gaps in care
- To record patient interventions on relevant electronic database systems (e.g. EMIS) and contribute to report generation, analysis and production
- Follow up on patients and all forward actions resulting from MDT discussions.
- To support clinicians and colleagues in the logging and making referrals
- To ensure regular and consistent communication with the referrer regarding patient progress and any complications or guidance.
- To co-ordinate health hub clinics, liaising with the schedulers and contacting the identified patients with appointments.
- To work at the vaccination centre to organise vaccination clinics, invite patients and manage vaccine stocks
- To work in the Health Hub to organise and conduct health checks, learning difficulties checks, assist on chronic illness management and care.
- May be given a caseload of identified patients and be required to ensure that their changing needs are addressed by considering local priorities, health inequalities and/or population health management risk stratification
- To manage patient initiated calls for support/signposting, booking into named GP urgent care slots/telephone slots where necessary.
- To use population health data to proactively identify and work with a cohort of people to support their personalised care requirements, using the available decision support aids.
- To offer appropriate support and guidance to patients and their families/carers
- To document and monitor aspects of patient co-ordination and service delivery, supporting data collection and audit using the patient administration system
- To contribute to the integration of health and social care by maintaining up to date recording systems for all agencies within the PCN Team and providing information to any member of the PCN Team in order to ease processes and communication in agreement with data protection protocol
- To support the population health project with liaising with identified cohorts of patients and other agencies
- To be responsible for recording, reporting and producing evaluation reports which will include evaluation detailing effectiveness outcomes of new roles.
- To work effectively as part of a team to provide cover for Care Coordination Teams when required and to be flexible regarding working hours to meet the needs of the service
- To ensure all electronic records are updated and complete within the agreed time-scales
- To monitoring the social prescribing and PCN enquiries task inbox
- Work with the PCN Manager to develop & support collective general practice projects including areas of federated working
- Provide coordination of and participate in relevant internal and external working groups and provide project advice, expertise and support when requested
- Work closely and in partnership with the other Care Coordinators, Social Prescribing Link Workers and Health coaches(s)
- To be customer (patient, carer, GP) focused when representing the service
- Dependant on work plans, there may be a requirement to work across different groups and teams
- To use a range of verbal and non-verbal communication tools to communicate effectively with patients, carers and families and colleagues
- To research appropriate websites, downloading and circulating documents as requested to support patient care
- Maintaining communication channels about the PCN including the PCN website and newsletters.
- To work collaboratively with other teams and services to maintain an effective and efficient service
- To support the induction and integration of new staff.
- To plan / organise work using own initiative, whilst being able to work as a valuable member of a team
- To work with other team members to cover leave and sickness as required.
- To support the PCN manager and Clinical Directors in diary management, arranging meetings, taking minutes as needed and circulating papers.
- To have excellent IT skills, to include Microsoft Office, Outlook and Excel
- To undertake general office duties to support the role
- To carry out any other reasonable duties as requested by a manager to ensure quality of service
Education and Training
- To work towards completing the appropriate training to deliver and support the Comprehensive Model for Personalised Care
- To participate in any relevant training/courses/conferences
- To complete mandatory training
- To maintain your own continuing professional development, keeping up to date with developments
Information management
- To maintain appropriate confidentiality of information relating to the organisation and its staff and maintain compliance with the Data Protection Act.
- To be responsible for maintaining the confidentiality of all patient and staff records
- Support good integrated governance and information governance practice within the practice
- Report any concerns or incidents as per policy
Person Specification
Other requirements
Essential
- Disclosure Barring Service (DBS) check
- Evidence of continuing professional development
Desirable
- Access to own transport and ability to travel across the locality on a regular basis
- Flexibility to work outside of core office hours
Qualifications
Essential
- A-level / NVQ level 3 or equivalent experience in admin / business / marketing / customer service environment
Desirable
- Degree level education or equivalent
- Healthcare qualification (level 3 or 4) or working towards gaining equivalent level
Experience
Essential
- Experience of office procedures working at a high level as a part of an administration team / within an administration role
- Broad knowledge of general practice and experience with healthcare setting
- Experience of dealing with sensitive / confidential information
Desirable
- An appreciation of the new NHS landscape including the relationships between individual practices, PCNs and the commissioners
- Experience of working with a multi-disciplinary team
- Experience of working in a primary care environment
- Experience of delivering patient care services and working with health hubs
Knowledge and skills
Essential
- Understanding and able to deal with confidential and sensitive issues when liaising with patients /other professional team members
- Ability to communicate complex and sensitive information effectively with people at all levels by telephone, email and face to face
- Knowledge of IT systems, including the ability to learn new ones to meet continuously evolving needs of the PCN
- Ability to prioritise and organise workload to meet deadlines while multi-tasking and maintaining accuracy at all times
- Effective time management (Planning & Organising)
- Demonstrate personal accountability, emotional resilience and work well under pressure
Desirable
- Good clinical system IT knowledge of EMIS or equivalent
Personal attributes & qualities
Essential
- Ability to follow legal, ethical, professional and organisational policies/procedures and codes of conduct
- Ability to use own initiative, discretion and sensitivity
- Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
- Flexible and cooperative
- Ability to adapt with new working processes to meet the changing needs of the service.
- Ability to identify risk and assess/manage risk when working with individuals
- Sensitive and empathetic in distressing situations
- Able to provide leadership and to finish workflow tasks
- Ability to solve problems and support others in resolving problems utilising analytical skills
- Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
Person Specification
Other requirements
Essential
- Disclosure Barring Service (DBS) check
- Evidence of continuing professional development
Desirable
- Access to own transport and ability to travel across the locality on a regular basis
- Flexibility to work outside of core office hours
Qualifications
Essential
- A-level / NVQ level 3 or equivalent experience in admin / business / marketing / customer service environment
Desirable
- Degree level education or equivalent
- Healthcare qualification (level 3 or 4) or working towards gaining equivalent level
Experience
Essential
- Experience of office procedures working at a high level as a part of an administration team / within an administration role
- Broad knowledge of general practice and experience with healthcare setting
- Experience of dealing with sensitive / confidential information
Desirable
- An appreciation of the new NHS landscape including the relationships between individual practices, PCNs and the commissioners
- Experience of working with a multi-disciplinary team
- Experience of working in a primary care environment
- Experience of delivering patient care services and working with health hubs
Knowledge and skills
Essential
- Understanding and able to deal with confidential and sensitive issues when liaising with patients /other professional team members
- Ability to communicate complex and sensitive information effectively with people at all levels by telephone, email and face to face
- Knowledge of IT systems, including the ability to learn new ones to meet continuously evolving needs of the PCN
- Ability to prioritise and organise workload to meet deadlines while multi-tasking and maintaining accuracy at all times
- Effective time management (Planning & Organising)
- Demonstrate personal accountability, emotional resilience and work well under pressure
Desirable
- Good clinical system IT knowledge of EMIS or equivalent
Personal attributes & qualities
Essential
- Ability to follow legal, ethical, professional and organisational policies/procedures and codes of conduct
- Ability to use own initiative, discretion and sensitivity
- Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
- Flexible and cooperative
- Ability to adapt with new working processes to meet the changing needs of the service.
- Ability to identify risk and assess/manage risk when working with individuals
- Sensitive and empathetic in distressing situations
- Able to provide leadership and to finish workflow tasks
- Ability to solve problems and support others in resolving problems utilising analytical skills
- Knowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
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.