Job summary
Interviews for this role will be on Thursday 17th August 2023. Those successful at the shortlisting stage will be notified by close of play on Monday 14th August 2023.
Please note that this role is a non-clinical role.
The PCN Care
Co-ordinator plays an important role within a PCN to proactively identify and
work with people to provide coordination and navigation of care and support
across health and care services.
This role works
closely with the existing Patient Care Coordinator team and will act as a
central point of contact to ensure appropriate support is made available to patients
from the Bridgwater Bay area.
This role covers the
extended hours provision and will include working 2 evenings (currently a
Wednesday & Thursday until 8pm) or a Saturday (9-5) on a rota basis.
Main duties of the job
Key
responsibilities
Be the first point of contact to patients who are using
the Health and Wellbeing hub. This include Face to Face, telephone or email contact.
Recalling and booking patients into appropriate services
at the Health & Wellbeing Hub using appropriate clinical record systems.
Actively talk to the patients about the services
available in Bridgwater for the community
Signpost patients coming into the hub to ensure they
receive healthy living checks such as blood pressure & NHS Health Checks.
Actively promote and participate in Hub community
events including leading on the promotion of the Hub services using Social
Media platforms such as Facebook and Instagram.
Supporting the PCN management team in delivering population
health management using the PCN website and other reporting tools to reach
patients.
Support as required the daily Neighbourhood MDT to build
on collaboration with our Somerset NHS Foundation Trust partners.
About us
Bridgwater Primary Care Network
(PCN) is the largest PCN in Somerset with 9 GP practices and a diverse
population spread across town and rural locations.
As a PCN we are forward
thinking, innovate and driven to deliver the best patient care for our
population. This includes health population management, and this role ties in
with supporting that and tracking the improvements we can make to patients
lives.
We have recently started an
exciting joint venture with Somerset NHS Foundation Trust to open a Health and Wellbeing
Hub at the old Victoria Park Medical Centre. This is a flagship hub, the first
of its kind that will bring together Primary and Secondary care all under one
roof to support the Bridgwater Bay community.
The focus of the hub is
preventative care and supporting self-care management to the population.
Victoria Park is a vibrant community and
based onsite are a Community Centre with a café, a pharmacy and a nursery all
hub employees will be offered a special package with the nursery should you
register your child(ren) with them and plenty of free parking.
Job description
Job responsibilities
Coordinate and integrate care
Help patients transition seamlessly between services
and support them to navigate through the health and care system.
Refer onwards to Health visitors, mental health
workers, prevention care, voluntary sector workers and health and wellbeing
coaches where required.
Actively participate in multidisciplinary team
meetings in the PCN and individual practices as and when appropriate.
Identify when action or additional support is
needed, alerting a named clinical contact in addition to relevant
professionals, and highlighting any safety concerns.
Keep accurate and up-to-date records of contacts,
appropriately using GP and other records systems relevant to the role, adhering
to information governance and data protection legislation;
Work sensitively with patients to capture key
information, while tracking of the impact of care coordination on their health
and wellbeing;
Record and collate information according to agreed
protocols and contribute to evaluation reports required for the monitoring and
quality improvement of the service.
This role will involve working closely with our
Somerset NHS Foundation Trust partners.
Professional development
Work within a clinical team point for advice and
support.
Undertake continual personal and professional
development, taking an active part in reviewing and developing the role and
responsibilities, and provide evidence of learning activity as required;
Adhere to organisational policies and procedures,
including confidentiality, safeguarding, lone working, information governance,
equality, diversity and inclusion training and health
and safety.
Miscellaneous
Establish strong working relationships with GPs and
practice teams and hub teams and work collaboratively with other care coordinators,
social prescribing link workers and health and wellbeing coaches, supporting
each other, respecting each others views and meeting regularly as a team;
Act as a champion for personalised care and shared
decision making within the PCN;
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;
Identify opportunities and gaps in the service and
provide feedback to continually improve the service and contribute to service
planning;
Contribute to the development of policies and plans
relating to equality, diversity and reduction of health inequalities;
Work in accordance with the PCNs policies and
procedures
Duties may vary from time to time without changing
the general character of the post or the level of responsibility
Contribute to the wider aims and objectives of the
PCN to improve and support primary care.
To support in the delivery of the PCN Network DES,
enhanced services and other service requirements on behalf of the PCN
Job description
Job responsibilities
Coordinate and integrate care
Help patients transition seamlessly between services
and support them to navigate through the health and care system.
Refer onwards to Health visitors, mental health
workers, prevention care, voluntary sector workers and health and wellbeing
coaches where required.
Actively participate in multidisciplinary team
meetings in the PCN and individual practices as and when appropriate.
Identify when action or additional support is
needed, alerting a named clinical contact in addition to relevant
professionals, and highlighting any safety concerns.
Keep accurate and up-to-date records of contacts,
appropriately using GP and other records systems relevant to the role, adhering
to information governance and data protection legislation;
Work sensitively with patients to capture key
information, while tracking of the impact of care coordination on their health
and wellbeing;
Record and collate information according to agreed
protocols and contribute to evaluation reports required for the monitoring and
quality improvement of the service.
This role will involve working closely with our
Somerset NHS Foundation Trust partners.
Professional development
Work within a clinical team point for advice and
support.
Undertake continual personal and professional
development, taking an active part in reviewing and developing the role and
responsibilities, and provide evidence of learning activity as required;
Adhere to organisational policies and procedures,
including confidentiality, safeguarding, lone working, information governance,
equality, diversity and inclusion training and health
and safety.
Miscellaneous
Establish strong working relationships with GPs and
practice teams and hub teams and work collaboratively with other care coordinators,
social prescribing link workers and health and wellbeing coaches, supporting
each other, respecting each others views and meeting regularly as a team;
Act as a champion for personalised care and shared
decision making within the PCN;
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;
Identify opportunities and gaps in the service and
provide feedback to continually improve the service and contribute to service
planning;
Contribute to the development of policies and plans
relating to equality, diversity and reduction of health inequalities;
Work in accordance with the PCNs policies and
procedures
Duties may vary from time to time without changing
the general character of the post or the level of responsibility
Contribute to the wider aims and objectives of the
PCN to improve and support primary care.
To support in the delivery of the PCN Network DES,
enhanced services and other service requirements on behalf of the PCN
Person Specification
Qualifications
Essential
- Care Coordinator qualifications e.g. Shared Decision Making, Core Skills/or a willingness to undergo training
- High level of written and verbal communication skills
- -5 GCSEs including English & Math
- Ability to use Microsoft Office applications Word, Excel, PowerPoint, Outlook
- -ECDL or equivalent
Communication Skills
Essential
- Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders
- Ability to actively listen, empathise with people and provide personalised support in a non-judgemental way
Experience
Essential
- Experience of working in health, social care and other support roles in direct contact with children, families or carers (in a paid or voluntary capacity)
- Experience of working within multi- professional team environments
- Experience of supporting people, their families and carers in a related role
- Experience of data collection and using tools to measure the impact of service
Knowledge
Essential
- Knowledge of the personalised care approach
- Understanding of, and commitment to, equality, diversity and inclusion
- Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers
- Strong organisational skills, including planning, prioritising, time management and record keeping
- Knowledge of how the NHS works, including primary care and PCNs
- Ability to recognise and work within limits of competence and seek advice when needed
- Understanding of the needs of children with mental and emotional needs/ children with disabilities long term conditions particularly in relation to promoting their independence
- Basic knowledge of long term conditions and the complexities involved: medical, physical, emotional and social
- Knowledge of, and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
Person Specification
Qualifications
Essential
- Care Coordinator qualifications e.g. Shared Decision Making, Core Skills/or a willingness to undergo training
- High level of written and verbal communication skills
- -5 GCSEs including English & Math
- Ability to use Microsoft Office applications Word, Excel, PowerPoint, Outlook
- -ECDL or equivalent
Communication Skills
Essential
- Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders
- Ability to actively listen, empathise with people and provide personalised support in a non-judgemental way
Experience
Essential
- Experience of working in health, social care and other support roles in direct contact with children, families or carers (in a paid or voluntary capacity)
- Experience of working within multi- professional team environments
- Experience of supporting people, their families and carers in a related role
- Experience of data collection and using tools to measure the impact of service
Knowledge
Essential
- Knowledge of the personalised care approach
- Understanding of, and commitment to, equality, diversity and inclusion
- Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers
- Strong organisational skills, including planning, prioritising, time management and record keeping
- Knowledge of how the NHS works, including primary care and PCNs
- Ability to recognise and work within limits of competence and seek advice when needed
- Understanding of the needs of children with mental and emotional needs/ children with disabilities long term conditions particularly in relation to promoting their independence
- Basic knowledge of long term conditions and the complexities involved: medical, physical, emotional and social
- 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.
