Job summary
30 hours per week.
A Health Coach Coordinator
will play an important role within a PCN to proactively identify & work with all
patients across the PCN with hypertension through lifestyle advice, behaviour
change support, collaborative events and project work.
Health Coach
Coordinators will review patients within the identified cohort assessing needs
and help them access the services and support they require to understand and
manage their own health and wellbeing, referring to social prescribing link
workers, & other professionals where appropriate. Their aim is to help people
improve their quality of life.
The aim of this
role is to achieve the following outputs and evaluate the outcomes:
No. of people receiving health coaching.
No. of people who quit smoking at 4,12 & 52
weeks.
No. of people with a reduction in BMI greater than 2.
No. of people with a reduction of blood pressure.
Changes in blood pressure medication.
The role will include offering Stop Smoking
Support, BP monitoring & weight management support. Working collaboratively
on new and existing projects with health professionals and the community to
raise awareness and achieve the outcomes.
Main duties of the job
Work with people, their families and carers to
improve their understanding of the patients condition and support them to
develop and review personalized care support to manage their needs and achieve
better healthcare outcomes.
Assist people to access self-management education
courses, peer support, health coaching and other interventions that support
them in their health and wellbeing, and increase their levels of knowledge,
skills and confidence in managing their health.
Provide coordination and navigation for people and
their carers across health and care services, working closely with social
prescribing link workers, health and wellbeing coaches, and other primary and
secondary care professionals; helping to ensure patients receive a joined-up
service and the most appropriate support.
Work alongside multidisciplinary teams with the PCN.
Work with people, their families,
carers and healthcare team members to encourage effective help-seeking behaviours.
Maintain records of referrals and
interventions to enable monitoring and
evaluation of the service;
Support practices to keep care records up to date by
identifying and updating missing or out-of-date information about the persons circumstances.
About us
The Chippenham, Corsham and Box Primary Care Network (CCB PCN) provides
proactive and coordinated care across the local population of 61,000 people. We
have a strong focus on health promotion and personalised care, supporting
people to make informed decisions about their health and social care. We are a dynamic, friendly and supportive PCN
with much experience in training GPs and other healthcare professionals.
Job description
Job responsibilities
1. Enable access to personalised care and support
a.
Take referrals for individuals or proactively
identify people who could benefit from support within the remit of the service.
b.
Have a positive, empathetic and responsive
conversation with the person and their family and carer(s) about their needs.
c.
Work towards increasing patients understanding of
how to manage and develop health and wellbeing through offering advice and guidance.
d.
Develop an in-depth knowledge of
the local health and care infrastructure and know how and when to enable people
to access support and services that are right for them.
e.
Use tools to measure peoples levels of knowledge,
skills and confidence in managing their health and to tailor support to them accordingly.
f.
Review and update personalised care
and support plans at regular intervals where required
g.
Undertake telephone assessments,
home visits and face-to-face appointments.
h.
Ensure personalised care and support plans are
communicated to the GP and any other professionals involved in the persons
care and uploaded to the relevant online care records, with activity recorded
using the relevant SNOMED codes.
i.
To focus on hypertension within the identified
population, and other contributing health conditions.
j.
Refer to other health services both in primary and
secondary care as appropriate.
k. Regularly liaise
with the range of multidisciplinary professionals and colleagues involved in
the persons care, facilitating a coordinated approach and ensuring everyone is
kept up to date so that any issues or concerns can be appropriately addressed
and supported.
l.
Actively participate in multidisciplinary team
meetings in the PCN as and when appropriate.
m.
Identify when action or additional
support is needed, alerting a named clinical contact in addition to relevant
professionals, and highlighting any safety concerns.
n.
Record what interventions are used to support
people, and how people are developing on their health and care journey,
o.
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.
p.
Work sensitively with people, their families and
carers to capture key information, while tracking the impact of health coaching
on their health and wellbeing.
q.
Record and collate information according to agreed
protocols and contribute to
evaluation reports required for the monitoring and quality improvement of the service.
Job description
Job responsibilities
1. Enable access to personalised care and support
a.
Take referrals for individuals or proactively
identify people who could benefit from support within the remit of the service.
b.
Have a positive, empathetic and responsive
conversation with the person and their family and carer(s) about their needs.
c.
Work towards increasing patients understanding of
how to manage and develop health and wellbeing through offering advice and guidance.
d.
Develop an in-depth knowledge of
the local health and care infrastructure and know how and when to enable people
to access support and services that are right for them.
e.
Use tools to measure peoples levels of knowledge,
skills and confidence in managing their health and to tailor support to them accordingly.
f.
Review and update personalised care
and support plans at regular intervals where required
g.
Undertake telephone assessments,
home visits and face-to-face appointments.
h.
Ensure personalised care and support plans are
communicated to the GP and any other professionals involved in the persons
care and uploaded to the relevant online care records, with activity recorded
using the relevant SNOMED codes.
i.
To focus on hypertension within the identified
population, and other contributing health conditions.
j.
Refer to other health services both in primary and
secondary care as appropriate.
k. Regularly liaise
with the range of multidisciplinary professionals and colleagues involved in
the persons care, facilitating a coordinated approach and ensuring everyone is
kept up to date so that any issues or concerns can be appropriately addressed
and supported.
l.
Actively participate in multidisciplinary team
meetings in the PCN as and when appropriate.
m.
Identify when action or additional
support is needed, alerting a named clinical contact in addition to relevant
professionals, and highlighting any safety concerns.
n.
Record what interventions are used to support
people, and how people are developing on their health and care journey,
o.
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.
p.
Work sensitively with people, their families and
carers to capture key information, while tracking the impact of health coaching
on their health and wellbeing.
q.
Record and collate information according to agreed
protocols and contribute to
evaluation reports required for the monitoring and quality improvement of the service.
Person Specification
Experience
Essential
- Ability to actively listen, empathise with people and provide personalised support in a non-judgmental way
- Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity
- Commitment to reducing health
- inequalities and proactively working to reach people from diverse communities
- Ability to support people in a way that inspires trust and confidence, motivating
- others to reach their potential
- Ability to communicate effectively, both verbally and in writing, with people, their
- families, carers, community groups, partner agencies and stakeholders
- Ability to identify risk and assess / manage
- risk when working with individuals
- Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role e.g. when there is a mental health need requiring a
- qualified practitioner
- Ability to work from an asset-based
- approach, building on existing community and personal assets
- Ability to maintain effective working relationships and to promote collaborative
- practice with all colleagues
- Ability to demonstrate personal
- accountability, emotional resilience and work well under pressure
- Ability to organise, plan and prioritise on own initiative, including when under
- pressure and meeting deadlines
- High level of written and verbal communication skills
- Ability to work flexibly and enthusiastically
- within a team or on own initiative
- Ability to provide motivational coaching to support peoples behaviour change
- Knowledge of, and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
- 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 services
- Knowledge of the personalised care
- approach
- Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers
- Understanding of, and commitment to, equality, diversity and inclusion
- 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
- Basic knowledge of long-term conditions
- and the complexities involved: medical, physical, emotional and social
- Understanding of the needs of older people / children & young adults/ adults with disabilities / long term conditions particularly in relation to
- promoting their independence
- Meets DBS reference standards and criminal record checks
- Willingness to work flexible hours when required to meet work demands
- Access to own transport
- Ability to travel across the locality on a regular basis
Desirable
- Experience of working directly in a care coordinator role, adult health, children & young adults and social care, learning support or public health /health improvement.
- Experience of working in health, social care and other support roles in direct contact with people, families or carers (in a paid or voluntary capacity).
- Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation.
- Knowledge of Safeguarding Children and Vulnerable Adults policies and processes.
- Proficient speaker of another language to aid communication with people in the community for whom English is a second language.
Qualifications
Essential
- Demonstrable commitment to professional and personal development is enrolled in, undertaking or qualified from appropriate training as set out in the core curriculum by the Personalised Care Institute.
- Proficient in MS Office and web-based services.
Desirable
- Qualifications and training NVQ Level 3 in adult care - advanced level or equivalent qualifications or working towards.
Person Specification
Experience
Essential
- Ability to actively listen, empathise with people and provide personalised support in a non-judgmental way
- Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity
- Commitment to reducing health
- inequalities and proactively working to reach people from diverse communities
- Ability to support people in a way that inspires trust and confidence, motivating
- others to reach their potential
- Ability to communicate effectively, both verbally and in writing, with people, their
- families, carers, community groups, partner agencies and stakeholders
- Ability to identify risk and assess / manage
- risk when working with individuals
- Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role e.g. when there is a mental health need requiring a
- qualified practitioner
- Ability to work from an asset-based
- approach, building on existing community and personal assets
- Ability to maintain effective working relationships and to promote collaborative
- practice with all colleagues
- Ability to demonstrate personal
- accountability, emotional resilience and work well under pressure
- Ability to organise, plan and prioritise on own initiative, including when under
- pressure and meeting deadlines
- High level of written and verbal communication skills
- Ability to work flexibly and enthusiastically
- within a team or on own initiative
- Ability to provide motivational coaching to support peoples behaviour change
- Knowledge of, and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety
- 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 services
- Knowledge of the personalised care
- approach
- Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers
- Understanding of, and commitment to, equality, diversity and inclusion
- 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
- Basic knowledge of long-term conditions
- and the complexities involved: medical, physical, emotional and social
- Understanding of the needs of older people / children & young adults/ adults with disabilities / long term conditions particularly in relation to
- promoting their independence
- Meets DBS reference standards and criminal record checks
- Willingness to work flexible hours when required to meet work demands
- Access to own transport
- Ability to travel across the locality on a regular basis
Desirable
- Experience of working directly in a care coordinator role, adult health, children & young adults and social care, learning support or public health /health improvement.
- Experience of working in health, social care and other support roles in direct contact with people, families or carers (in a paid or voluntary capacity).
- Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation.
- Knowledge of Safeguarding Children and Vulnerable Adults policies and processes.
- Proficient speaker of another language to aid communication with people in the community for whom English is a second language.
Qualifications
Essential
- Demonstrable commitment to professional and personal development is enrolled in, undertaking or qualified from appropriate training as set out in the core curriculum by the Personalised Care Institute.
- Proficient in MS Office and web-based services.
Desirable
- Qualifications and training NVQ Level 3 in adult care - advanced level or equivalent qualifications or working towards.
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.
