Senior Care Coordinator

Job description

Job responsibilities

The Senior Care Coordinator is a key leadership role within the Primary Care Network (PCN), responsible for overseeing the coordination of care for patients in the community with complex, long-term, or high-risk health needs. The post holder will be required to work in different practices within the area so will require a degree of flexibility, access to a car to deliver a range of duties, including home visits. This is a very patient facing role, to support those in the community, especially vulnerable patients or those with complex health issues.

The role also involves helping to reduce health inequalities, particularly for people with long-term conditions such as learning disabilities, dementia, frailty and cancer. Using a holistic approach, the Senior Care Coordinator will support patients to understand and manage their own health needs and to navigate the different health and social care services, by linking patients in with the right service at the right time.

In addition to managing a caseload, the post holder will provide operational leadership and line management to Care Coordinators and other relevant ARRS roles within the Personalised Care Team. The Senior Care Coordinator will support service delivery, ensure quality standards are met, and contribute to the strategic development of personalised care across the PCN.

The role requires close working relationships with GPs, practice managers, nursing teams, social prescribers, community services, and wider multidisciplinary teams to ensure integrated, patient-centred care.

Key Responsibilities

Clinical & Patient Care Coordination

Proactively identify and coordinate care for patients with complex needs, frailty, multiple long-term conditions, and high service utilisation.

Undertake comprehensive assessments and support the development of personalised care and support plans within appropriate time frames

Act as a key point of contact for patients and families, supporting navigation across health, social care, and voluntary sector services to ensure they are accessing the right care, at the right time, both clinically and socially

Monitor and review patient progress, liaise with all clinical and non-clinical members in the MDT to ensure effective MDT function as required

Ensure safeguarding concerns are recognised and escalated appropriately

Work closely with all relevant care agencies (primary care, secondary care, community services, mental health, social services, ambulance services, voluntary sector and any other relevant service providers) to ensure a coordinated patient care pan, without requiring further referral from the GP.

Leadership & Line Management Responsibilities

Provide direct line management to Care Coordinators and relevant ARRS staff within the Personalised Care Team.

Conduct supervision, appraisals, and performance management in line with PCN and NHS policies.

Provide mentorship, coaching, and professional support to team members.

Support induction, training, and ongoing development of new staff.

Manage team workload allocation to ensure safe, effective, and equitable service delivery across practices.

Lead regular team meetings and contribute to MDT meetings across the network.

Escalate operational issues and risks to the PCN Manager.

Service Development & Quality Improvement

Support the PCN Manager in delivering contractual requirements, including IIF, QOF, and Enhanced Services related to personalised care.

Ensure compliance with data protection, information governance, and safeguarding requirements.

Promote a culture of continuous improvement and patient-centred care.

Represent the Personalised Care Team at PCN meetings, practice meetings, and external stakeholder forums when required.

Communication & Partnership Working

Build strong working relationships across PCN practices.

Excellent communication skills with patients and relatives/carers, both via telephone and face to face consultations.

Develop excellent working relationships with all partners wider service networks including the voluntary sector, GP practices, adult social care, hospitals, community pharmacists, district nurses and other members of the MDT to ensure effective patient centred approach for patients

Support cross-practice coordination and shared learning

Facilitate effective communication between ARRS staff and practices.

Other responsibilities

To act at all times in an anti-discriminatory manner

To be able to plan and respond to workload according to operational priorities

To undertake any training required to maintain competency including mandatory training

To contribute to, and work within a safe environment

The Senior Care Coordinator must at all times carry out duties and responsibilities with due regard to the GP Practices equal opportunity policies and procedures

The Senior Care Coordinator is expected to take responsibility for self-development on a continuous basis, undertaking any on-the-job training as required

The Senior Care Coordinator must be aware of individual responsibilities under the Health and Safety at Work Act and identify and report as necessary any untoward the accident, incident or potentially hazardous environment.

Health and Safety/Risk Management

The post holder must at all times comply with the organisation and practices health and safety policies, in particular by following agreed safe working procedures and reporting incidents using the organisations Incident reporting system.

Will comply with the Data Protection Act (1984), The General Data Protection Regulations (2018) and the Access to Health Records Act (1990)

Comply with all necessary training requirements relevant to the role as identified by the organisation

Equality and Diversity

The post-holder must co-operate with all policies and procedures designed to ensure equality of employment. Co-workers, patients and visitors must be treated equally irrespective of gender, ethnic origin, age, disability, sexual orientation, religion etc.

Respect for Patient Confidentiality

The post-holder should always respect patient confidentiality and not divulge patient information unless sanctioned by the requirements of the role

Special Working Conditions

The post-holder is required to travel independently between practice sites (including home visits registered at network practices) and to attend meetings etc hosted by other agencies

Person Specification

Qualifications

Essential

• GCGSE Grades A to C in English and Maths

Desirable

• Personalised Care Institute Care co-ordinator accredited training - Level 3 occupational standard

Experience

Desirable

• Experience of working in a primary care setting
• Experience in dealing with complex and vulnerable patients
• Experience managing or leading a small team
• Experience conducting staff appraisals and providing regular supervision

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

Elm Lane & Chapeltown Surgery

Address

104 Elm Lane

Sheffield

S5 7TW

Employer's website

https://www.elmlanesurgery.com/ (Opens in a new tab)