PCN Healthy Ageing Co-ordinator

Wolverhampton Total Health Limited

Information:

This job is now closed

Job summary

Wolverhampton Total Health Limited is a company which was established to employ some shared staff who work across Wolverhampton Total Health Primary Care Network (PCN). We comprise 6 GP practices working together in Wolverhampton with the aim of improving health outcomes of our registered patients.

We currently have one Healthy Ageing co-ordinator working across the PCN and we are looking for an additional post holder to join the team.

This is a developmental role. The post holder will be supported and trained to become responsible for Healthy Ageing checks within the PCN.

The role is to play a pivotal role, in managing the coordination of Healthy Ageing checks, and the delivery of appropriate interventions across a range of agencies/ partners including care plans.

Main duties of the job

This is a developmental role. The post holder will be supported and trained to become responsible for Healthy Ageing checks within the PCN, and assisting qualified nursing and medical staff in carrying out assigned tasks, involving direct nursing care in support of and supervised by a Registered Nurse/ medical staff.

The post holder will at all times demonstrate and behave in a manner in accordance with the hosting Practices Policies and protocols.

The role is to lead on, and play a pivotal role, in managing the coordination of Healthy Ageing checks, and the delivery of appropriate interventions across a range of agencies/ partners including care plans. The post holder will be the main point of contact for professionals, patients and carers/ families if they need support/ information/ guidance/ education

The post holder will ensure relevant accurate data is recorded and maintained within the designated systems, and will support and help implement continuous quality improvement activities across the primary care network (PCN).

About us

Wolverhampton Total Health Limited is the management support company for Wolverhampton Total Health Primary Care Network.

Wolverhampton Total Health Primary Care Network (PCN) is a collaboration between 6 GP practices in Wolverhampton with a shared population of over 66,000 patients. We have a shared ambition to innovate general practice and build a sustainable model for general practice for the future. We were an early implementer of the primary care home model and have a mature relationship and proven track record of effectively working together.

We have an increasing multi-disciplinary team who work together to drive improvement in health outcomes of our patient population. The post holder will play an integral role within the PCN.

Date posted

18 April 2024

Pay scheme

Agenda for change

Band

Band 3

Salary

£22,816 to £24,336 a year pay award pending

Contract

Permanent

Working pattern

Part-time, Flexible working

Reference number

A4925-24-0002

Job locations

Head Office: Newbridge Surgery

255 Tettenhall Road

Wolverhampton

West Midlands

WV6 0DE


Job description

Job responsibilities

1.Main Responsibilities

1.Support the identification of patients who are indicated to be living with Mild/ Moderate/Severe frailty utilising a recommended toolkit (i.e eFI. Or through RWT Care of the Elderly team)

2.Undertake a Healthy Ageing check using an agreed assessment tool, such as Edmonton to determine the level of frailty the patient could be living with which will inform an appropriate intervention

3.Completing any necessary paperwork and referrals within associated Practices within the PCN

4.Collaborative working between multi-agencies across the City including (but not limited to) RWT Care of the Elderly Team, Community Nursing, Social Care, Social Prescribers, Primary Care MDT Coordinators, and other community/ voluntary sector services.

5.Undertake BP monitoring

6.Undertake Urinalysis

7.Proactively case manage patients who are aged 65 and living with mild/ moderate/severe frailty, and could be socially isolated, adopting a holistic approach to review health, social and physical aspects of current daily activities, for example nutrition, hydrations, eye and oral health, physical activities.

8.To identify carers and offer appropriate support, signposting to Carers Support for assessment, voluntary services such as Age UK, handyman services, housing assistance, lunch/ social/ physical activity groups.

9.Provide lifestyle advice to patients making any necessary referrals within associated Practices within the PCN

10.Proactively identify patients who are at risk of a fall/ fear of falling, and refer to the community falls prevention team for primary prevention assessment and intervention

11.Undertake weight monitoring at appropriate intervals

12.Ensure specimens are labelled and bagged ready for collection with the necessary paperwork completed

13.Restocking/maintenance of equipment used

14.Restocking of clinical areas and consulting rooms

This list is not exhaustive and the post holder may be asked to undertake other relevant tasks within their scope of practice. Before performing these tasks, appropriate, relevant training must be received and documented in the training pack.

2.Professional /Clinical

1.Maintain high standard of personal contact and communication with patients, particularly during treatments

2.Undertake basic observations and collecting specimens as required.

3.To avoid any behaviour which discriminates against your fellow employees, or potential employees on the grounds of their sex, sexual orientation, marital status, race, religion, creed, colour, nationality, ethnic origin or disability

4.To safeguard at all times confidentiality of information relating to patients and staff in adherence with National and local Data protection and Information governance.

5.To behave in a manner that ensures the security of the Practice

6.To adhere to all relevant Practice Policies and Procedures

This list is not exhaustive.

3.Administrative/Managerial

1.Participate in the administrative and professional responsibilities of the practice team and on behalf of the PCN

2.Ensure accurate and legible notes of all consultations and treatments are recorded in the patient notes (electronic and patient held)

3.Ensure the clinical computer system is kept up to date with accurate details recorded

4.Ensure accurate completion of all necessary documentation associated with patient health care and registration with the practice

5.Attend and participate in practice meetings as required

6.Assist in formulation of practice philosophy, strategy and policy

7.Restocking and maintenance of clinical areas and consulting rooms

8.To assist in seasonal and special projects as requested e.g. flu campaign

9.Ordering and display of Health Promotion materials

This list is not exhaustive.

4.Frailty Competency Framework Tier 1 & 2

The local service specification is strongly aligned to the core capabilities as outlined within the Frailty Core Capabilities (2018) framework. The framework comprises of a number of capabilities grouped into 4 domains. The framework describes underlying principles, knowledge and skills that may be relevant to an individual role.

The focus of this local service will be aligned to Tier 1 & 2 of the competency framework:

Tier 1 Those that require general awareness of frailty

Tier 2 Health and social care staff and others who regularly work with people living with frailty but who seek support from others for complex management

Tier 3 Health, social care and other professionals with a high degree of autonomy, able to provide care in complex situations and who may also lead services for people living with frailty.

The post holder will participate in any education and training provided which is aligned with the core capabilities as outlined within the framework 1 & 2.

5. Miscellaneous

1.Establish strong working relationships with GPs and practice teams

2.Demonstrate a flexible attitude and be prepared to carry out other duties as may be reasonably required from time to time within the general character of the post or the level of responsibility of the role, ensuring that work is delivered in a timely and effective manner;

3.Identify opportunities and gaps in the service - and review risks and issues that could impact on service delivery - and provide feedback to continually improve the service and contribute to business planning;

4.Contribute to the development of policies and plans relating to equality, diversity and health inequalities;

5.Work in accordance with the practices and PCNs policies and procedures;

6.Contribute to the wider aims and objectives of the PCN to improve and support primary care.

Job description

Job responsibilities

1.Main Responsibilities

1.Support the identification of patients who are indicated to be living with Mild/ Moderate/Severe frailty utilising a recommended toolkit (i.e eFI. Or through RWT Care of the Elderly team)

2.Undertake a Healthy Ageing check using an agreed assessment tool, such as Edmonton to determine the level of frailty the patient could be living with which will inform an appropriate intervention

3.Completing any necessary paperwork and referrals within associated Practices within the PCN

4.Collaborative working between multi-agencies across the City including (but not limited to) RWT Care of the Elderly Team, Community Nursing, Social Care, Social Prescribers, Primary Care MDT Coordinators, and other community/ voluntary sector services.

5.Undertake BP monitoring

6.Undertake Urinalysis

7.Proactively case manage patients who are aged 65 and living with mild/ moderate/severe frailty, and could be socially isolated, adopting a holistic approach to review health, social and physical aspects of current daily activities, for example nutrition, hydrations, eye and oral health, physical activities.

8.To identify carers and offer appropriate support, signposting to Carers Support for assessment, voluntary services such as Age UK, handyman services, housing assistance, lunch/ social/ physical activity groups.

9.Provide lifestyle advice to patients making any necessary referrals within associated Practices within the PCN

10.Proactively identify patients who are at risk of a fall/ fear of falling, and refer to the community falls prevention team for primary prevention assessment and intervention

11.Undertake weight monitoring at appropriate intervals

12.Ensure specimens are labelled and bagged ready for collection with the necessary paperwork completed

13.Restocking/maintenance of equipment used

14.Restocking of clinical areas and consulting rooms

This list is not exhaustive and the post holder may be asked to undertake other relevant tasks within their scope of practice. Before performing these tasks, appropriate, relevant training must be received and documented in the training pack.

2.Professional /Clinical

1.Maintain high standard of personal contact and communication with patients, particularly during treatments

2.Undertake basic observations and collecting specimens as required.

3.To avoid any behaviour which discriminates against your fellow employees, or potential employees on the grounds of their sex, sexual orientation, marital status, race, religion, creed, colour, nationality, ethnic origin or disability

4.To safeguard at all times confidentiality of information relating to patients and staff in adherence with National and local Data protection and Information governance.

5.To behave in a manner that ensures the security of the Practice

6.To adhere to all relevant Practice Policies and Procedures

This list is not exhaustive.

3.Administrative/Managerial

1.Participate in the administrative and professional responsibilities of the practice team and on behalf of the PCN

2.Ensure accurate and legible notes of all consultations and treatments are recorded in the patient notes (electronic and patient held)

3.Ensure the clinical computer system is kept up to date with accurate details recorded

4.Ensure accurate completion of all necessary documentation associated with patient health care and registration with the practice

5.Attend and participate in practice meetings as required

6.Assist in formulation of practice philosophy, strategy and policy

7.Restocking and maintenance of clinical areas and consulting rooms

8.To assist in seasonal and special projects as requested e.g. flu campaign

9.Ordering and display of Health Promotion materials

This list is not exhaustive.

4.Frailty Competency Framework Tier 1 & 2

The local service specification is strongly aligned to the core capabilities as outlined within the Frailty Core Capabilities (2018) framework. The framework comprises of a number of capabilities grouped into 4 domains. The framework describes underlying principles, knowledge and skills that may be relevant to an individual role.

The focus of this local service will be aligned to Tier 1 & 2 of the competency framework:

Tier 1 Those that require general awareness of frailty

Tier 2 Health and social care staff and others who regularly work with people living with frailty but who seek support from others for complex management

Tier 3 Health, social care and other professionals with a high degree of autonomy, able to provide care in complex situations and who may also lead services for people living with frailty.

The post holder will participate in any education and training provided which is aligned with the core capabilities as outlined within the framework 1 & 2.

5. Miscellaneous

1.Establish strong working relationships with GPs and practice teams

2.Demonstrate a flexible attitude and be prepared to carry out other duties as may be reasonably required from time to time within the general character of the post or the level of responsibility of the role, ensuring that work is delivered in a timely and effective manner;

3.Identify opportunities and gaps in the service - and review risks and issues that could impact on service delivery - and provide feedback to continually improve the service and contribute to business planning;

4.Contribute to the development of policies and plans relating to equality, diversity and health inequalities;

5.Work in accordance with the practices and PCNs policies and procedures;

6.Contribute to the wider aims and objectives of the PCN to improve and support primary care.

Person Specification

Qualifications

Essential

  • NVQ Level 3 in Health and Social care or Level 3 diploma in a health related topic, or equivalent;
  • Essential induction training and experience care certificate or equivalent

Desirable

  • GCSEs Grade A-C in Maths and English or key skills level 2 in Maths and English (to be evidenced by a test if relevant qualifications not available);
  • Evidence of recent work-based learning or self-directed learning;
  • Completion of a Healthcare Assistant development programme

Knowledge and Skills

Essential

  • Ability to work effectively as a team player under appropriate supervision, and as part of a multi-disciplinary team;
  • Insight into how to evaluate own strengths and development needs, seeking advice where appropriate;
  • Knowledge of when to seek advice and refer to a registered care professional;
  • Understanding of the importance of the promotion of health and well-being (Making Every Contact Count);
  • Ability to work on own initiative;
  • Evidence of time management skills and ability to prioritise;
  • Basic IT skills;
  • Ability to communicate with members of the public and health and care providers ;
  • The promotion of equality of opportunity and good working relationships, courteous, respectful and helpful at all times;
  • Ability to deal with non-routine and unpredictable nature of the workload and individual patient contact;

Desirable

  • Understanding of basic physiology, e.g. normal vital signs, fluid balance, nutritional requirements etc.;
  • Understanding of the scope of the role of the Health Care Assistant in context of the team and the organisation, and how the role may contribute to service development;
  • Ability to move between sites working across health and social care as required by the needs of the development programme;
Person Specification

Qualifications

Essential

  • NVQ Level 3 in Health and Social care or Level 3 diploma in a health related topic, or equivalent;
  • Essential induction training and experience care certificate or equivalent

Desirable

  • GCSEs Grade A-C in Maths and English or key skills level 2 in Maths and English (to be evidenced by a test if relevant qualifications not available);
  • Evidence of recent work-based learning or self-directed learning;
  • Completion of a Healthcare Assistant development programme

Knowledge and Skills

Essential

  • Ability to work effectively as a team player under appropriate supervision, and as part of a multi-disciplinary team;
  • Insight into how to evaluate own strengths and development needs, seeking advice where appropriate;
  • Knowledge of when to seek advice and refer to a registered care professional;
  • Understanding of the importance of the promotion of health and well-being (Making Every Contact Count);
  • Ability to work on own initiative;
  • Evidence of time management skills and ability to prioritise;
  • Basic IT skills;
  • Ability to communicate with members of the public and health and care providers ;
  • The promotion of equality of opportunity and good working relationships, courteous, respectful and helpful at all times;
  • Ability to deal with non-routine and unpredictable nature of the workload and individual patient contact;

Desirable

  • Understanding of basic physiology, e.g. normal vital signs, fluid balance, nutritional requirements etc.;
  • Understanding of the scope of the role of the Health Care Assistant in context of the team and the organisation, and how the role may contribute to service development;
  • Ability to move between sites working across health and social care as required by the needs of the development programme;

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

Wolverhampton Total Health Limited

Address

Head Office: Newbridge Surgery

255 Tettenhall Road

Wolverhampton

West Midlands

WV6 0DE


Employer's website

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

Employer details

Employer name

Wolverhampton Total Health Limited

Address

Head Office: Newbridge Surgery

255 Tettenhall Road

Wolverhampton

West Midlands

WV6 0DE


Employer's website

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

For questions about the job, contact:

PCN HR Manager

Jackie Smith

jackie.smith21@nhs.net

Date posted

18 April 2024

Pay scheme

Agenda for change

Band

Band 3

Salary

£22,816 to £24,336 a year pay award pending

Contract

Permanent

Working pattern

Part-time, Flexible working

Reference number

A4925-24-0002

Job locations

Head Office: Newbridge Surgery

255 Tettenhall Road

Wolverhampton

West Midlands

WV6 0DE


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