Job summary
This is a hugely exciting opportunity to work innovatively with a
range of partner organisations to enhance the experience of patients within the
area, and work collaboratively with the clinical team to help design and refine
the way we improve care in care homes.
Main duties of the job
You will work as part of a multi-disciplinary team to
provide an Enhanced Health in Care Home service to care home residents.
About us
At
Hartlepool and Stockton Health GP Federation our guiding aim is to improve the
health and wellbeing of local people. Relationships are key to everything we do
and by working with our practice members and their Primary Care Networks, as
well as other local partners, we strive to provide excellent services that help
people to live their best lives.
As
part of this support, we are hosting this job advert on behalf one of our
member PCNs, BYTES Primary Care Network.
BYTES Primary Care Network is a group of GP practices including
Barwick, Yarm, Thornaby, Eaglescliffe and Stillington working together to
improve the provision of integrated healthcare services and address health
inequalities to over 53,000 patients across the network.
The address listed on the job advert is the lead practice, but the job will require you to move between practices and care homes within the PCN.
Job description
Job responsibilities
- Work as part of a multi-disciplinary team to provide an Enhanced Health in Care Home service to care home residents
- Attend weekly care home MDT meetings, this may also include help in planning the MDT meetings and ensuring that actions are recorded, coded appropriately, and completed.
- Liaise with all clinical and non-clinical members in the MDT to ensure effective MDT function.
- Support the Clinical Lead for this work stream through providing administrative support, where required.
- Manage reporting required and associated within the DES specifications for required services.
- The care-coordinator would deal with the daily queries received from the care homes, seeing the queries through to completion and linking in with the relevant clinicians to enable this completion which will include the GPs, pharmacy technicians, social prescribers, first contact practitioners and clinical pharmacists.
- Support the development of a PCN-wide Winter Pressures Plan for our care homes, supporting the rollout of Flu Vaccinations, Covid Vaccinations, and blood tests.
- Signpost practice team members, service users and carers to relevant services including Social Prescribing.
- Liaise with other stakeholders as needed for the collective benefit of patients including but not limited to Patients, GPs, Nurses, other practice staff and other healthcare professionals including pharmacists and pharmacy technicians from provider and commissioning organisations.
- Develop excellent working relationships with all partners, wider service networks including the voluntary sector, GP practices, adult social care, hospitals, community pharmacists and other members of the MDT
- Providing a point of contact for both staff and patients in coordinating care and will help to deal with incoming queries.
- Support patients to access personalised care and support plans, in line with best practice.
- Ensure regular and consistent communication with care homes regarding patient progress and any complications, including supporting the coordination of ward rounds.
- Provide these cohorts of people signposting to identified services to maintain their independence and improve their health and well being
For further details, please see the attached Job Description document.
Job description
Job responsibilities
- Work as part of a multi-disciplinary team to provide an Enhanced Health in Care Home service to care home residents
- Attend weekly care home MDT meetings, this may also include help in planning the MDT meetings and ensuring that actions are recorded, coded appropriately, and completed.
- Liaise with all clinical and non-clinical members in the MDT to ensure effective MDT function.
- Support the Clinical Lead for this work stream through providing administrative support, where required.
- Manage reporting required and associated within the DES specifications for required services.
- The care-coordinator would deal with the daily queries received from the care homes, seeing the queries through to completion and linking in with the relevant clinicians to enable this completion which will include the GPs, pharmacy technicians, social prescribers, first contact practitioners and clinical pharmacists.
- Support the development of a PCN-wide Winter Pressures Plan for our care homes, supporting the rollout of Flu Vaccinations, Covid Vaccinations, and blood tests.
- Signpost practice team members, service users and carers to relevant services including Social Prescribing.
- Liaise with other stakeholders as needed for the collective benefit of patients including but not limited to Patients, GPs, Nurses, other practice staff and other healthcare professionals including pharmacists and pharmacy technicians from provider and commissioning organisations.
- Develop excellent working relationships with all partners, wider service networks including the voluntary sector, GP practices, adult social care, hospitals, community pharmacists and other members of the MDT
- Providing a point of contact for both staff and patients in coordinating care and will help to deal with incoming queries.
- Support patients to access personalised care and support plans, in line with best practice.
- Ensure regular and consistent communication with care homes regarding patient progress and any complications, including supporting the coordination of ward rounds.
- Provide these cohorts of people signposting to identified services to maintain their independence and improve their health and well being
For further details, please see the attached Job Description document.
Person Specification
Experience
Desirable
- Experience providing advice/signposting to people
- Experience of preparing plans and reporting progress against these
- Experience of coordinating and liaising with multiple stakeholders or individuals to meet specified outcomes
- Experience of analysing and interpreting information and present results in a clear and concise manner
- Experience of collating and disseminating voluminous and sometimes complex information.
- Experience of organising recurrent events
- Evidence of administrative skills and robust record keeping
Knowledge and Skills
Desirable
- Willing to engage with the training programmes via the Personalised Care Institute for the new roles identified within primary care networks as part of the NHS Long Term Plan
- Demonstrable commitment to professional and personal development
- Understanding / experience of healthcare or care home provision
- Understanding of wider healthcare delivery including roles of core MDT members and role of primary care
- Understanding / experience of using tools to create individual and personalised plans
- Awareness of digital solutions to support independent living / remote healthcare monitoring
- Demonstrate understanding of, and contributes to, the Primary Care Network
- Demonstrate ability to motivate self to achieve goals
- Promotes diversity and equality and leads by example
- Ability to present plans, outcomes and learning to stakeholders
- Good communicator
- Professional, approachable, and respectful attitude to others
- Evidence of coaching approach to supporting individuals
- Can recognise personal limitations and refer to more appropriate colleague(s) when necessary
- Knowledge of SystmOne
- Demonstrates ability to improve quality within limitations of service
- An ability to provide constructive feedback and receive feedback in a professional manner. Recognises the roles of other colleagues and their role to person care
Person Specification
Experience
Desirable
- Experience providing advice/signposting to people
- Experience of preparing plans and reporting progress against these
- Experience of coordinating and liaising with multiple stakeholders or individuals to meet specified outcomes
- Experience of analysing and interpreting information and present results in a clear and concise manner
- Experience of collating and disseminating voluminous and sometimes complex information.
- Experience of organising recurrent events
- Evidence of administrative skills and robust record keeping
Knowledge and Skills
Desirable
- Willing to engage with the training programmes via the Personalised Care Institute for the new roles identified within primary care networks as part of the NHS Long Term Plan
- Demonstrable commitment to professional and personal development
- Understanding / experience of healthcare or care home provision
- Understanding of wider healthcare delivery including roles of core MDT members and role of primary care
- Understanding / experience of using tools to create individual and personalised plans
- Awareness of digital solutions to support independent living / remote healthcare monitoring
- Demonstrate understanding of, and contributes to, the Primary Care Network
- Demonstrate ability to motivate self to achieve goals
- Promotes diversity and equality and leads by example
- Ability to present plans, outcomes and learning to stakeholders
- Good communicator
- Professional, approachable, and respectful attitude to others
- Evidence of coaching approach to supporting individuals
- Can recognise personal limitations and refer to more appropriate colleague(s) when necessary
- Knowledge of SystmOne
- Demonstrates ability to improve quality within limitations of service
- An ability to provide constructive feedback and receive feedback in a professional manner. Recognises the roles of other colleagues and their role to person care
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.