Job summary
Exciting opportunity to join an enthusiastic and
good-humoured Primary Care Network Team currently looking for like-minded Care Coordinators.
Passionate about making a difference in Primary Care, you will enjoy working as
part of a multi-disciplinary team across services supporting the ongoing
development and operation of our primary care services. You will coordinate our Frailty Care Team
Service and Enhanced Care in Care Homes, share oversight of the Enhanced Access
Service and occasionally the delivery of education events across the PCN providing
comprehensive, high-quality support.
This is a unique and exciting role and you will be an
integral part of our PCN team working closely with our practices and other
primary care professionals within the PCN to develop and proactively support
delivery of the comprehensive model of care to our patients that reflect local
priorities. You will be part of an exciting and innovative quality improvement
project providing support to our MDT in the beautiful rural setting of the
North Cotswolds.
Our care coordinators have background in primary
care as receptionist or administrative roles and this role is one where they
have advanced their career as a next step. The role involves having a specific
patient caseload for who you will coordinate their care, bringing a different
type of challenge to previous roles with increased opportunity to develop
patients relationships and increase job satisfaction.
Main duties of the job
The Care Coordinator will work with a multi-disciplinary team
in our Primary Care Network based in the North Cotswolds. To provide high quality administrative support to our clinical team who are providing case management for people with frailty who
may have multiple long-term conditions and are at risk of deteriorating health
that may result in declining clinical quality of life or avoidable hospital
admission, or unnecessary length of hospital stay.
Coordinate our Frailty Care Team
caseload in
line with the PCN Quality Improvement project approach. Process requests and maintain
accurate records utilising the two clinical systems and our monitoring tools.
Establish relationships with local
care home staff and coordinate the PCN care home support and coordinate
administration of the care home caseload. Producing the care home ward round planning list
liaising with care home staff and care home leads on a weekly basis. Develop a proactive system
for monitoring and delivering the requirements of the care home contract.
Coordinating the PCN Enhanced Access Clinics, including rota filling, coordination updating ledgers PCN SystmOne hub,. Provide data collection and activity reports
for the EA Clinics and coordinate any follow up actions after EA appointments.
Coordinate PCN SystmOne hub management of ledgers for ARRS staff rota management ensuring a comprehensive timely appointment
system.
Support
Education Lead with delivery of learning events for the PCN practices
About us
North Cotswold Primary Care
Network is an NHS collaboration between 5 GP practices, all with a CQC overall
good rating: - Chipping Campden Surgery, Cotswold Medical Practice, Mann
Cottage Surgery, Stow Surgery and The White House Surgery. Our surgery
teams are working closely with each other, enjoying the ability to share
expertise and resources, to develop new services, serving a population of over 33, 000 patients across
the second most rural PCN in the country. Our vision is to
continue to improve the quality of care that we provide in alignment with the
need of our patient population. As part of a PCN we are able to take advantage
of additional staff roles that are now available to support all of our patients.
Our Frailty Care Team is a multi-disciplinary team of ANPs, Clinical
Pharmacists, Pharmacy Technician, Community matrons, Health and Wellbeing
Coaches and Care Coordinators currently using a quality improvement approach to
improve care and services to the population on our frailty case load which
includes patients in care and nursing homes across the PCN locality. Our PCN Additional
Roles team also has a Mental Health Practitioner, First Contact Physiotherapist
and three Social Prescribing Link Workers.
This is an exciting opportunity to join our team and support the
patients in our locality, in care home settings and in their own homes.
Job description
Job responsibilities
The role
involves working closely with our Frailty Care Practitioners, Health and
Wellbeing Coaches and Frailty Matrons along GPs, Practice Managers and other primary care professionals within the
PCN to support the hub and proactively support delivery of the comprehensive
model of care to patients with frailty.
Coordinate
our Frailty Care Team caseload to ensure referrals from our five practices are prepared
for the allocation meeting and booked with the most appropriate frailty care
team member to bring together a patients identified care and support needs
ensuring timely support and coordination.
Provide
administrative resource and support to the Frailty Care Team, processing
requests and maintaining accurate records using our two clinical systems SystmOne
and EMIS and monitoring tools.
Provide
coordination and navigation for people and their carers across health and care
services, alongside working closely with Frailty Care Team Clinicians, PCN
Practices, Neighbourhood locality teams, Social Prescribing Link Workers, Care
Coordinators, Clinical teams and third sector services.
Support data
reporting and analysis including developing and presenting reports.
Take an
active role in MDTs to help coordinate care for patients with frailty and long
term conditions keeping accurate minutes and updating patient records.
Produce the care home ward round planning list liaising with
care home staff on a weekly basis.
Support the coordination and delivery
of MDTs participating in the development of Enhanced Care in Care Homes DES
liaising with PCN Leads to agree and co-ordinate visit schedules, working with
home within the Network to ensure patients are correctly registered with the
appropriate practice.
Specific
project work liaising with Frailty Team leads on implementation of shared
process, and collaboration opportunities to support improved patient care.
Support
communications with our member practices to raise awareness of the Frailty Care
Team, Enhanced Access Programme and Education events and its range of support
offers.
Coordinate
meetings and presentations as required.
Produce
appropriate support documentation and literature for a variety of audiences
from professionals to patients.
Collation of
agendas, production of minutes / action logs for PCN / MDT meetings and ensure
all actions are completed including follow up if necessary.
Collation
and management of shared documents on the appropriate platform ensuring the
latest versions are available and is made available in a timely manner.
Data
collection and activity reports for Enhanced Access Clinics (EA)
Managing
computer rotas and ledgers for ARRS team
Providing
support with rota filling and booking templates for Enhanced Access Clinics
Coordinating
follow up from EA appointments where required
Coordinate
collection of patient satisfaction data from EA clinic attendance
Please see attached job description for full details of the role.
Job description
Job responsibilities
The role
involves working closely with our Frailty Care Practitioners, Health and
Wellbeing Coaches and Frailty Matrons along GPs, Practice Managers and other primary care professionals within the
PCN to support the hub and proactively support delivery of the comprehensive
model of care to patients with frailty.
Coordinate
our Frailty Care Team caseload to ensure referrals from our five practices are prepared
for the allocation meeting and booked with the most appropriate frailty care
team member to bring together a patients identified care and support needs
ensuring timely support and coordination.
Provide
administrative resource and support to the Frailty Care Team, processing
requests and maintaining accurate records using our two clinical systems SystmOne
and EMIS and monitoring tools.
Provide
coordination and navigation for people and their carers across health and care
services, alongside working closely with Frailty Care Team Clinicians, PCN
Practices, Neighbourhood locality teams, Social Prescribing Link Workers, Care
Coordinators, Clinical teams and third sector services.
Support data
reporting and analysis including developing and presenting reports.
Take an
active role in MDTs to help coordinate care for patients with frailty and long
term conditions keeping accurate minutes and updating patient records.
Produce the care home ward round planning list liaising with
care home staff on a weekly basis.
Support the coordination and delivery
of MDTs participating in the development of Enhanced Care in Care Homes DES
liaising with PCN Leads to agree and co-ordinate visit schedules, working with
home within the Network to ensure patients are correctly registered with the
appropriate practice.
Specific
project work liaising with Frailty Team leads on implementation of shared
process, and collaboration opportunities to support improved patient care.
Support
communications with our member practices to raise awareness of the Frailty Care
Team, Enhanced Access Programme and Education events and its range of support
offers.
Coordinate
meetings and presentations as required.
Produce
appropriate support documentation and literature for a variety of audiences
from professionals to patients.
Collation of
agendas, production of minutes / action logs for PCN / MDT meetings and ensure
all actions are completed including follow up if necessary.
Collation
and management of shared documents on the appropriate platform ensuring the
latest versions are available and is made available in a timely manner.
Data
collection and activity reports for Enhanced Access Clinics (EA)
Managing
computer rotas and ledgers for ARRS team
Providing
support with rota filling and booking templates for Enhanced Access Clinics
Coordinating
follow up from EA appointments where required
Coordinate
collection of patient satisfaction data from EA clinic attendance
Please see attached job description for full details of the role.
Person Specification
Qualifications
Essential
- GCSE Grade A to C in English and Maths
- A Level/NVQ Level 3 or equivalent experience
- Personalised Care Institute Care course completion or commitment to enrol at earliest opportunity
- Demonstrable commitment to continuous professional and personal development
Desirable
- Training in motivational coaching and interviewing or equivalent experience
- Higher education level e.g. Undergraduate qualifications
Experience
Essential
- Experience of working within a healthcare setting
- Experience of supporting people, their families and carers in a related role
- Experience of coordinating multi-disciplinary teams and ability to develop and maintain effective working relationships with colleagues and other partners.
- Experience of planning and delivering projects on time
- Experience of working under pressure, to manage and prioritise workload effectively to meet deadlines.
- Excellent IT skills (including use of GP clinical systems, Microsoft Word, Excel and Power Point, email
- Experience of data collection and providing monitoring information
- Current and valid UK driving license with access to a car. Ability to travel round the PCN GP practices
Desirable
- Experience of working in GP practice or PCN
- Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
- Experience of GP IT systems to include System One and/ or EMIS Web
- Experience of collaborative working and building relationships across varied organisations
- Experience of working as part of a multidisciplinary team with clinicians, healthcare professionals and third sector providers
- Awareness of systems of support management of patients in primary care setting, delivering input and support in the context of pathways of care and the business of the organisation
Qualities and attitude
Essential
- Have a can-do attitude and enjoy developing solutions to any problems you encounter
- Self-driven with a positive outlook and clear focus on high quality patient service
- Highly organised and methodical, able to prioritise own work, schedule and own time, sometimes managing conflicting priorities with limited supervision
- Reliable, honest, tolerant and determined
- Able to both facilitate and embrace change, viewing it as an opportunity to learn and develop
- Able to coordinate and schedule competing priorities for a range of staff and external partners
- Able to get on with others and strong desire to be an integral team player in a multidisciplinary team
Desirable
- Ability to motivate and influence others especially related to implementation of changes where these may not be welcome
Person Specification
Qualifications
Essential
- GCSE Grade A to C in English and Maths
- A Level/NVQ Level 3 or equivalent experience
- Personalised Care Institute Care course completion or commitment to enrol at earliest opportunity
- Demonstrable commitment to continuous professional and personal development
Desirable
- Training in motivational coaching and interviewing or equivalent experience
- Higher education level e.g. Undergraduate qualifications
Experience
Essential
- Experience of working within a healthcare setting
- Experience of supporting people, their families and carers in a related role
- Experience of coordinating multi-disciplinary teams and ability to develop and maintain effective working relationships with colleagues and other partners.
- Experience of planning and delivering projects on time
- Experience of working under pressure, to manage and prioritise workload effectively to meet deadlines.
- Excellent IT skills (including use of GP clinical systems, Microsoft Word, Excel and Power Point, email
- Experience of data collection and providing monitoring information
- Current and valid UK driving license with access to a car. Ability to travel round the PCN GP practices
Desirable
- Experience of working in GP practice or PCN
- Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
- Experience of GP IT systems to include System One and/ or EMIS Web
- Experience of collaborative working and building relationships across varied organisations
- Experience of working as part of a multidisciplinary team with clinicians, healthcare professionals and third sector providers
- Awareness of systems of support management of patients in primary care setting, delivering input and support in the context of pathways of care and the business of the organisation
Qualities and attitude
Essential
- Have a can-do attitude and enjoy developing solutions to any problems you encounter
- Self-driven with a positive outlook and clear focus on high quality patient service
- Highly organised and methodical, able to prioritise own work, schedule and own time, sometimes managing conflicting priorities with limited supervision
- Reliable, honest, tolerant and determined
- Able to both facilitate and embrace change, viewing it as an opportunity to learn and develop
- Able to coordinate and schedule competing priorities for a range of staff and external partners
- Able to get on with others and strong desire to be an integral team player in a multidisciplinary team
Desirable
- Ability to motivate and influence others especially related to implementation of changes where these may not be welcome
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
North Cotswold Primary Care Network
Address
Four Shires Medical Centre
Stow Road
Moreton in Marsh
Gloucestershire
GL56 0DS