Care Coordinator

Job description

Job responsibilities

Battersea Primary Care NetworkLtd

Care Coordinator

Main Responsibilities:

These may vary according to the current needs and priorities of the GP practices/PCN teams but may include any or all of the following:

1.Plan and carry out patient call and recall systems for public health programmes

(eg Covid vaccine programme, child immunisations, cervical screening), focusing particularly on vulnerable and hard to reach groups and patients with complex care needs

2.Setting up and running clinical searches in order to monitor and focus care of target groups

3.Manage a caseload of identified patients with complex care needs, supporting them and their clinical teams by:

coordinating their medical care when required

responding to queries and requests for assistance

sign-posting patients and carers to appropriate support services

working with clinicians to ensure all the contractual requirements for patients with complex care needs are met

assisting in the administration of MDT meetings and coordinating actions identified during these meetings

Care and Support Planning

Provide organisational and operational support for the setup of COVID vaccination clinics and other public health initiatives

Proactively identify and work with a cohort of people to support their personalised care requirements

Help people to manage their needs, answering their queries and supporting them to make and get to appointments.

Raise awareness of shared decision making and decision support tools and assist people to have shared decision-making conversations with their healthcare teams.

Ensure that people have good quality information to help them make choices about their care

Bring together a persons identified care and support needs and explore their options to meet these into a single personalised care and support plan, in line with person centred service plan (PCSP) best practice

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 care roles.

Support the coordination and delivery of MDTs within PCNs.

Youth Clinic Care Coordination

• Attending the case based discussion meetings twice a month on a Thursday (one face to face, one virtual)
• On the other Thursdays attending the online meetings with Clinical lead and Clinical Associate Psychologist to run through cases.
• To look after and update the spreadsheet with all of the youth clinic patients on it, liaising with the CAP and social prescribers
• To keep minutes from the cased based discussion meetings
• To collate, store and chase up all of the safeguarding forms and ensure the safeguarding spreadsheet is up to date
• Help CAP or the social prescribers to arrange appointments with young people or assist in arranging/co-ordinating MDT meetings with CAMHS/Schools etc when needed around complex cases
• To produce a one page quarterly newsletter with figures and some 'good news case studies' from the last 3 months and send it out to all practices. This will involve liaising with the whole team as well as Enable to get the data. It will also involved creating a database to ensure we are proactive in collecting data all the time so we can produce these rolling reports including things like satisfaction scores from social prescribers.
• Assist with sending out texts to patients when they have completed their time with the clinic in the form of a questionnaire
• Setting up appointments with families/young people with myself if they need to speak to a GP outside of their normal practice.

Clinical System / Medical Records

Ensure total familiarity with the clinical system;

Book appointments and recalls ensuring sufficient information is recorded;

Code and extract data from clinical correspondence and input into EMIS Electronic Patient Record

Run searches and produce reports as required with the support of practice IT teams

Ensure correspondence, reports, results etc. are dealt with in a timely manner as per practice protocol

Shared responsibility for target group disease register with clinical teams

Telephone System

Receive and make calls as required answering any queries that arise

Divert calls and take messages as appropriate ensuring accuracy

Other responsibilities

Towork at all times within the requirements of GDPR, maintaining patient confidentiality

Maintain accurate clinical records at all times

To participate in educational events as advised by the Practice

To attend various Practice meetings as requested

Any other tasks that may be required by the practice from time to time

Person Specification

Qualifications

Essential

• GCSE Grade A to C in English and Maths (or equivalent)

Desirable

• Care Certificate
• QCF Health and Social Care

Skills and Knowledge

Essential

• Excellent communication skills in person and over the telephone;
• Ability to provide information clearly, adapting as necessary to the needs of the patient to ensure they understand and can make informed decisions about their care;
• Able to listen with empathy and offer support where needed;
• An interest in working in primary care;
• Ability to use initial and work unsupervised to an excellent standard;
• Flexible and hard working;
• Able to use own judgement, resourcefulness and common sense;
• Be self-motivated and enthusiastic in supporting patients to ensure they receive the best, most appropriate care possible;
• Able to quickly build rapport and trust.

Desirable

• An apptitude for data gathering and reporting;
• Good working knowledge of Microsoft office (Word, Excel etc);
• Knowledge of EMIS;
• Knowledge of collaborative goal setting;
• Knowledge of the core concepts of personalised care, shared decision making, health behaviour change and motivation.

Experience

Essential

• Previous experience in primary care or other health care provider, with direct patient contact;
• Experience talking to patients over the telephone.

Desirable

• Experience of working in primary care;
• Experience of working in a GP practice;
• Experience of working as a care coordinator;
• Experience of booking/arranging appointments;
• Experience of working with social prescribers or similar.

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

Battersea Primary Care Network

Address

3 Austin Road

Battersea

London

Wandsworth

SW11 5JP

Employer's website

https://www.batterseapcn.nhs.uk/ (Opens in a new tab)