Havering Health Ltd

PCN Aligned Community Team (PACT) Care Coordinator

The closing date is 24 June 2025

Job summary

Are you motivated with excellent organisation and communication skills? Do you have an interest in frailty? Do you have a passion for innovation and networking?

Havering Liberty Primary Care Network is looking to appoint a Care Coordinator who has an interest in working with older housebound individuals living with frailty or complex needs to live longer and healthier lives. The post holder will be part of a team of ACPs, Care Coordinators and General Practice Assistants within the PCN who are pioneering a new approach to neighbourhood integration, reaching out to, and working with, existing teams in a coordinated and purposeful way the Havering Liberty PCN-Aligned Community Team (PACT).

Main duties of the job

The PACT service is a collaboration with the Havering Place based Partnership aligning with its priorities of Age Well and Die Well. The service has been coproduced with service users, their loved ones, and staff. The PACT team aims to support older housebound individuals living with frailty or complex needs by:

  • providing a single point of contact for individuals and their carers
  • proactively undertaking comprehensive geriatric assessment to identify holistic needs and develop high quality, personalised, anticipatory care to promote rehabilitation and prevent deterioration
  • using networking skills to bring diverse stakeholders together to develop a single, integrated, community team around each individual patient, including specialist community services, social prescribers, voluntary sector organisations and GPs
  • supporting the transition from hospital to home through consultation and collaboration with acute care partners

The poster holder and PACT colleagues will be supported to take a quality improvement approach to monitoring outcomes, learning in real time, and developing adaptations to service provision, to continually improve the model.

About us

Havering Liberty Primary Care Network

We are a collaborative neighbourhood healthcare network of five General Practices serving the population with an extended multi-disciplinary team seeking to provide accessible, patient-centred, and high-quality primary care services that promote the health and well-being of our community and our workforce.

The Leadership Team of Havering Liberty PCN is headed by the Clinical Director. This team includes the Strategy and Transformation Manager and the PCN Operations Manager and Digital Facilitator working in collaboration with Leads for each practice within the PCN. The PCN receives support from Havering Health Ltd, its GP Federation, which employs the PCN workforce. The GP Federation plays a crucial role in providing innovative, high-quality, and responsible healthcare services to the residents of Havering.

Details

Date posted

11 June 2025

Pay scheme

Other

Salary

£25,000 to £30,000 a year Depends on experience

Contract

Fixed term

Duration

1 years

Working pattern

Full-time, Flexible working

Reference number

B0167-25-0012

Job locations

170 Rush Green Road

Rush Green

Romford

Essex

RM7 0JU


Job description

Job responsibilities

Aim of the role:

The post holder will be expected to support their team to achieve the PCNs Values in their day to day work.

Patient centred care and health equity

Sustainability and efficiency

Collaboration and team working

Quality and excellence

Inclusivity and respect

Accountability and integrity

The post holder will support the work of the PCN aligned community team (PACT) in Havering Liberty Primary Care Network.

In line with the Havering Place based Partnerships priorities of Age Well and Die Well, the PACT team aims to support older housebound individuals living with frailty or complex needs to live longer and healthier lives. PACT aims to achieve this by:

  • providing a single point of contact for individuals and their carers
  • proactively undertaking comprehensive geriatric assessment to identify holistic needs and develop high quality, personalised, anticipatory care
  • coordinating the provision of holistic, integrated care, through collaboration with other services/professionals, e.g. specialist community teams, social prescribers, voluntary sector organisations, GPs
  • supporting the transition from hospital to home through consultation and collaboration with acute care partners

Key Responsibilities:

The post holder will work alongside other PCN colleagues to support the work of the Advanced Clinical Practitioners (ACPs) and the PCN in delivering the PACT service. They will assist coordination of all key activity including access to services, advice, information, and ensuring health and care planning is timely, efficient, and patient-centred. The post holder will be based at a primary care site and may visit patients in their own homes.

The post holder will:

work closely and in partnership with the ACPs, Leadership and GP practices

  • support the PACT team through processing referrals, answering queries, making, and managing appointments.
  • contribute to public health campaigns through advice or direct care.
  • provide cross-cover to our other PCN non-clinical, non-leadership ships roles at times of annual leave and sickness.
  • provide administrative support to the PACT team and GP practices.
  • be able to deal with unpredictable work patterns and proactively deal with issues without reference to others.

Administrative Skills:

  • Manage and maintain an efficient administrative system on behalf of others.
  • Undertake word processing of all documents to a high standard, in an agreed style and using an appropriate referencing system.
  • Utilise advanced level IT skills to create reports and presentations.
  • Develop and maintain filing systems (electronic and paper) to ensure effective access to relevant information.
  • Prioritise own workload on a day-to-day basis to ensure that deadlines are met.
  • Coordinate administrative arrangements relating to reporting requirements, to include the collation and presentation of documentation, preparing evidence and ensuring information is up to date.
  • Oversee the facilitation and administration of meetings, including the production of agendas, coordination of papers and minute taking, ensuring that key documents are available within defined timescales.
  • Update databases for sharing of appropriate information with internal and external stakeholders.
  • Establish and maintain electronic and manual filing systems.
  • Type medical or other reports under supervision
  • Input generic data into organisational systems or in-house records.
  • Use the patient records system to enter client related information and care events.
  • Prepare monthly team reports on service activity.
  • Cover other services, where necessary, which may require working on other sites.

Education and Development:

It is the responsibility of the employee to comply with all organisational and statutory mandatory requirements (eg. health and safety, infection control, equality and diversity, confidentiality, safeguarding adults and children, information governance) and to complete the required training.

Engages in annual appraisal, developing objectives to inform a Personal Development Plan, which may include 360-degree appraisal and use of patient feedback.

Undertake education and training that is appropriate to the role of care coordinator, as identified in Professional Development Plan.

Contribute to the training of staff, using informal and formal teaching sessions.

Contribute to the development and updating of resource and teaching packs for use by patients and/or staff in the clinical and education settings.

Communication:

Communicate effectively with a range of people, either in person or on the telephone, promptly and in a professional and courteous manner whilst recognising barriers to communication.

Ensure that complex calls from anxious and distressed clients/loved ones are passed to appropriate person to deal with effectively and appropriately, or escalated to senior staff member if appropriate

Respond to enquiries, and take appropriate action on behalf of the service, either by telephone, personal contact or correspondence, within agreed time limits.

Communicate with other health care professionals and address interface issues within primary, community and secondary care to ensure consistent and accurate transfer of information relating to patient care.

  • Facilitate the smooth running of the service, dealing sensitively with any complaints, problems or issues arising, highlighting and referring problems as appropriate to the ACPs or PCN Operations Manager.
  • Take clear messages and pass them promptly to the appropriate member of the team using own judgement on urgency.
  • Demonstrate effective communication skills and promote a positive image of the team with service users, carers, professionals and external agencies from a variety of disciplines, both within and outside the PCN.
  • Respond to frequent enquiries made by clients/staff, either in person or on the telephone, promptly and in a professional and courteous manner in line with local policy.
  • Work competently within current procedures for own working practices and, where appropriate, contribute to the development and implementation of changes to improve own working practices/service, policies, procedures and guidelines.
  • Employ excellent written and verbal communication skills.

Clinical Governance

Contribute to the review of incidents and complaints, where appropriate

Be responsible for ensuring that accurate legible records are kept in accordance with local policies and legal requirements.

Report all complaints and incidents in accordance with local procedures and ensure that the line manager is informed.

Cooperate with any investigation within the organisation

Use audit and other measurement approaches to provide data to commissioners regarding the performance of the service

Quality Improvement

  • Propose and implement changes to working practices to reflect the needs of the Service.

Participate in project work and/or QI initiatives for the PACT service

Support the ACPs to collect performance data from service users, e.g. support service users to complete patient reported outcome measures

  • Participate in audits and surveys as necessary. Provide support in the development of audit reports

To continually explore advanced digital options for data sharing and access to patient clinical information to ensure prompt and effective patient care across the interface.

To understand and implement all relevant and local policies and procedures

Raise quality issues and related risks with team manager or senior manager.

Evaluate the quality of own work, making improvements when necessary.

Equality and Diversity

To be aware of any religious/cultural needs of service users and ensure this is reflected in the care that is provided.

To access independent telephone interpreting where appropriate to facilitate safe and effective care

To treat service users, relatives and carers with dignity and respect at all times.

Physical Skills

The post holder will have standard keyboard skills for use when working on the PC.

Other Duties

There may be a requirement to undertake other duties as may reasonably be required to support the practices/PCN. These may be based at other locations

Confidentiality

In the performance of the duties outlined in this Job Description, the post-holder will have access to confidential information relating to patients and their carers, practice staff and other healthcare workers. They may also have access to information relating to the Company as a business organisation. All information is to be regarded as strictly confidential.

Maintains confidentiality of any information concerning patients in accordance with current policy on information governance.

Demonstrates respect for privacy and confidentiality in all interactions with patients and the public.

Job description

Job responsibilities

Aim of the role:

The post holder will be expected to support their team to achieve the PCNs Values in their day to day work.

Patient centred care and health equity

Sustainability and efficiency

Collaboration and team working

Quality and excellence

Inclusivity and respect

Accountability and integrity

The post holder will support the work of the PCN aligned community team (PACT) in Havering Liberty Primary Care Network.

In line with the Havering Place based Partnerships priorities of Age Well and Die Well, the PACT team aims to support older housebound individuals living with frailty or complex needs to live longer and healthier lives. PACT aims to achieve this by:

  • providing a single point of contact for individuals and their carers
  • proactively undertaking comprehensive geriatric assessment to identify holistic needs and develop high quality, personalised, anticipatory care
  • coordinating the provision of holistic, integrated care, through collaboration with other services/professionals, e.g. specialist community teams, social prescribers, voluntary sector organisations, GPs
  • supporting the transition from hospital to home through consultation and collaboration with acute care partners

Key Responsibilities:

The post holder will work alongside other PCN colleagues to support the work of the Advanced Clinical Practitioners (ACPs) and the PCN in delivering the PACT service. They will assist coordination of all key activity including access to services, advice, information, and ensuring health and care planning is timely, efficient, and patient-centred. The post holder will be based at a primary care site and may visit patients in their own homes.

The post holder will:

work closely and in partnership with the ACPs, Leadership and GP practices

  • support the PACT team through processing referrals, answering queries, making, and managing appointments.
  • contribute to public health campaigns through advice or direct care.
  • provide cross-cover to our other PCN non-clinical, non-leadership ships roles at times of annual leave and sickness.
  • provide administrative support to the PACT team and GP practices.
  • be able to deal with unpredictable work patterns and proactively deal with issues without reference to others.

Administrative Skills:

  • Manage and maintain an efficient administrative system on behalf of others.
  • Undertake word processing of all documents to a high standard, in an agreed style and using an appropriate referencing system.
  • Utilise advanced level IT skills to create reports and presentations.
  • Develop and maintain filing systems (electronic and paper) to ensure effective access to relevant information.
  • Prioritise own workload on a day-to-day basis to ensure that deadlines are met.
  • Coordinate administrative arrangements relating to reporting requirements, to include the collation and presentation of documentation, preparing evidence and ensuring information is up to date.
  • Oversee the facilitation and administration of meetings, including the production of agendas, coordination of papers and minute taking, ensuring that key documents are available within defined timescales.
  • Update databases for sharing of appropriate information with internal and external stakeholders.
  • Establish and maintain electronic and manual filing systems.
  • Type medical or other reports under supervision
  • Input generic data into organisational systems or in-house records.
  • Use the patient records system to enter client related information and care events.
  • Prepare monthly team reports on service activity.
  • Cover other services, where necessary, which may require working on other sites.

Education and Development:

It is the responsibility of the employee to comply with all organisational and statutory mandatory requirements (eg. health and safety, infection control, equality and diversity, confidentiality, safeguarding adults and children, information governance) and to complete the required training.

Engages in annual appraisal, developing objectives to inform a Personal Development Plan, which may include 360-degree appraisal and use of patient feedback.

Undertake education and training that is appropriate to the role of care coordinator, as identified in Professional Development Plan.

Contribute to the training of staff, using informal and formal teaching sessions.

Contribute to the development and updating of resource and teaching packs for use by patients and/or staff in the clinical and education settings.

Communication:

Communicate effectively with a range of people, either in person or on the telephone, promptly and in a professional and courteous manner whilst recognising barriers to communication.

Ensure that complex calls from anxious and distressed clients/loved ones are passed to appropriate person to deal with effectively and appropriately, or escalated to senior staff member if appropriate

Respond to enquiries, and take appropriate action on behalf of the service, either by telephone, personal contact or correspondence, within agreed time limits.

Communicate with other health care professionals and address interface issues within primary, community and secondary care to ensure consistent and accurate transfer of information relating to patient care.

  • Facilitate the smooth running of the service, dealing sensitively with any complaints, problems or issues arising, highlighting and referring problems as appropriate to the ACPs or PCN Operations Manager.
  • Take clear messages and pass them promptly to the appropriate member of the team using own judgement on urgency.
  • Demonstrate effective communication skills and promote a positive image of the team with service users, carers, professionals and external agencies from a variety of disciplines, both within and outside the PCN.
  • Respond to frequent enquiries made by clients/staff, either in person or on the telephone, promptly and in a professional and courteous manner in line with local policy.
  • Work competently within current procedures for own working practices and, where appropriate, contribute to the development and implementation of changes to improve own working practices/service, policies, procedures and guidelines.
  • Employ excellent written and verbal communication skills.

Clinical Governance

Contribute to the review of incidents and complaints, where appropriate

Be responsible for ensuring that accurate legible records are kept in accordance with local policies and legal requirements.

Report all complaints and incidents in accordance with local procedures and ensure that the line manager is informed.

Cooperate with any investigation within the organisation

Use audit and other measurement approaches to provide data to commissioners regarding the performance of the service

Quality Improvement

  • Propose and implement changes to working practices to reflect the needs of the Service.

Participate in project work and/or QI initiatives for the PACT service

Support the ACPs to collect performance data from service users, e.g. support service users to complete patient reported outcome measures

  • Participate in audits and surveys as necessary. Provide support in the development of audit reports

To continually explore advanced digital options for data sharing and access to patient clinical information to ensure prompt and effective patient care across the interface.

To understand and implement all relevant and local policies and procedures

Raise quality issues and related risks with team manager or senior manager.

Evaluate the quality of own work, making improvements when necessary.

Equality and Diversity

To be aware of any religious/cultural needs of service users and ensure this is reflected in the care that is provided.

To access independent telephone interpreting where appropriate to facilitate safe and effective care

To treat service users, relatives and carers with dignity and respect at all times.

Physical Skills

The post holder will have standard keyboard skills for use when working on the PC.

Other Duties

There may be a requirement to undertake other duties as may reasonably be required to support the practices/PCN. These may be based at other locations

Confidentiality

In the performance of the duties outlined in this Job Description, the post-holder will have access to confidential information relating to patients and their carers, practice staff and other healthcare workers. They may also have access to information relating to the Company as a business organisation. All information is to be regarded as strictly confidential.

Maintains confidentiality of any information concerning patients in accordance with current policy on information governance.

Demonstrates respect for privacy and confidentiality in all interactions with patients and the public.

Person Specification

Experience

Essential

  • Working in a busy office environment
  • Working remotely
  • Significant administrative experience
  • Creating and maintaining office systems
  • Handling sensitive and confidential information

Desirable

  • Working in an NHS environment
  • Working in a patient facing role in primary care
  • Experience of using EMIS

Demonstration of PCN Values

Essential

  • Patient centred care and health equity
  • Sustainability and efficiency
  • Collaboration and team working
  • Quality and excellence
  • Inclusivity and respect
  • Accountability and integrity

Skills

Essential

  • Establish and maintain good working relationships
  • Excellent interpersonal skills
  • Team Player
  • Clear communication skills including excellent writing, data entry and presentation skills
  • Able to construct and deliver clear information/instructions to others
  • Able to multi-task
  • Able to work without supervision and use own initiative
  • Organise and prioritise own workload
  • English language competency sufficient to communicate effectively with all staff and clients
  • Demonstrates attention to detail, accuracy and numeracy skills

Desirable

  • Advanced level IT skills

Other

Essential

  • Able to travel efficiently throughout the area of South Havering PCN
  • Commitment to continuing professional development

Desirable

  • Standard driving skills and access to own vehicle for work purposes

Qualifications

Essential

  • NVQ level 2 or equivalent standard of literacy and numeracy

Knowledge

Essential

  • NHS Priorities and Issues
  • Good working knowledge of Outlook, Word, Excel, Power point, Access
  • Update and maintain efficient administration systems
  • Maintain confidentiality/data protection
  • Able to use own initiative and make decisions on behalf of others
  • Able to analyse systems to improve services
Person Specification

Experience

Essential

  • Working in a busy office environment
  • Working remotely
  • Significant administrative experience
  • Creating and maintaining office systems
  • Handling sensitive and confidential information

Desirable

  • Working in an NHS environment
  • Working in a patient facing role in primary care
  • Experience of using EMIS

Demonstration of PCN Values

Essential

  • Patient centred care and health equity
  • Sustainability and efficiency
  • Collaboration and team working
  • Quality and excellence
  • Inclusivity and respect
  • Accountability and integrity

Skills

Essential

  • Establish and maintain good working relationships
  • Excellent interpersonal skills
  • Team Player
  • Clear communication skills including excellent writing, data entry and presentation skills
  • Able to construct and deliver clear information/instructions to others
  • Able to multi-task
  • Able to work without supervision and use own initiative
  • Organise and prioritise own workload
  • English language competency sufficient to communicate effectively with all staff and clients
  • Demonstrates attention to detail, accuracy and numeracy skills

Desirable

  • Advanced level IT skills

Other

Essential

  • Able to travel efficiently throughout the area of South Havering PCN
  • Commitment to continuing professional development

Desirable

  • Standard driving skills and access to own vehicle for work purposes

Qualifications

Essential

  • NVQ level 2 or equivalent standard of literacy and numeracy

Knowledge

Essential

  • NHS Priorities and Issues
  • Good working knowledge of Outlook, Word, Excel, Power point, Access
  • Update and maintain efficient administration systems
  • Maintain confidentiality/data protection
  • Able to use own initiative and make decisions on behalf of others
  • Able to analyse systems to improve services

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

Havering Health Ltd

Address

170 Rush Green Road

Rush Green

Romford

Essex

RM7 0JU


Employer's website

http://haveringhealth.co.uk/ (Opens in a new tab)

Employer details

Employer name

Havering Health Ltd

Address

170 Rush Green Road

Rush Green

Romford

Essex

RM7 0JU


Employer's website

http://haveringhealth.co.uk/ (Opens in a new tab)

Employer contact details

For questions about the job, contact:

Oluwole Oladele

oluwole.oladele@nhs.net

Details

Date posted

11 June 2025

Pay scheme

Other

Salary

£25,000 to £30,000 a year Depends on experience

Contract

Fixed term

Duration

1 years

Working pattern

Full-time, Flexible working

Reference number

B0167-25-0012

Job locations

170 Rush Green Road

Rush Green

Romford

Essex

RM7 0JU


Supporting documents

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