Job summary
This
role is intended to become an integral part of the PCNs multidisciplinary
team, working alongside social prescribing link workers and health and
wellbeing coaches to provide an all-encompassing approach to personalised care
and promoting and embedding the personalised care approach across the PCN. There may be a need to work remotely depending on the requirements of the role.
Please note that the role of a care coordinator is not a clinical role.
Main duties of the job
Patient Care and Support
Take referrals for individuals or proactively identify people who could benefit from care coordination support.
Develop an in-depth knowledge of the local health and care infrastructure.
Connect patients with appropriate support and services tailored to their needs.
Support people to develop and implement personalised care and support plans.
Make and manage appointments for patients.
Identify when additional support is needed and alert appropriate clinical contacts.
Coordination and Communication
Regularly liaise with multidisciplinary professionals involved in a person's care.
Facilitate a coordinated approach to patient care, ensuring all parties are kept informed.
Actively participate in PCN multidisciplinary team meetings as appropriate.
Establish strong working relationships with GPs, practice teams, and other PCN staff.
Highlight any safety concerns to relevant professionals.
Administration and Development
Maintain comprehensive records of referrals and interventions.
Identify opportunities and gaps in service delivery and provide feedback.
Contribute to the development of policies related to equality, diversity, and health inequality reduction.
Work in accordance with practices' and PCN's policies and procedures.
Undertake continual personal and professional development.
Contribute to the wider aims and objectives of the PCN.
About us
Nexus MK PCN is a collection of five practices serving a population of 50,000+ patients in the Milton Keynes area
Nexus MK PCN is comprised of Oakridge Park Medical Centre, Wolverton Health Centre, Sovereign Medical Centre, Purbeck Health Centre and The Stonedean Practice. Each of the five practices in Nexus MK have signed up to the Network Contract DES which details their core services and entitlements.
Nexus MK is a patient focused multi-disciplinary team providing healthcare excellence to meet the needs of our diverse community, whilst also supporting healthy lifestyles through motivation and self-education, and always ensuring the right care is provided at the right time and in the right place.
Job description
Job responsibilities
Key Responsibilities
- Help people manage their needs by answering queries, making and managing appointments, and providing high-quality information to support informed care choices.
- Work collaboratively with GPs and other primary care professionals to proactively identify and manage a caseload of patients, which may include those with long-term health conditions, referring to other PCN health professionals where appropriate.
- Support the coordination and delivery of multidisciplinary teams within the PCN.
- Develop communication channels between GPs, patients, their families/carers, and other agencies.
- Maintain accurate records of referrals and interventions to enable service monitoring and evaluation.
- Contribute to risk and impact assessments, monitoring, and service evaluations.
Job description
Job responsibilities
Key Responsibilities
- Help people manage their needs by answering queries, making and managing appointments, and providing high-quality information to support informed care choices.
- Work collaboratively with GPs and other primary care professionals to proactively identify and manage a caseload of patients, which may include those with long-term health conditions, referring to other PCN health professionals where appropriate.
- Support the coordination and delivery of multidisciplinary teams within the PCN.
- Develop communication channels between GPs, patients, their families/carers, and other agencies.
- Maintain accurate records of referrals and interventions to enable service monitoring and evaluation.
- Contribute to risk and impact assessments, monitoring, and service evaluations.
Person Specification
Experience
Essential
- Experience of working within multi-professional team environments.
- Understanding of the wider determinants of health and their impact on communities and individuals.
- Commitment to equality, diversity, and inclusion.
- Strong organisational skills including planning, prioritizing, time management, and record keeping.
- Knowledge of NHS structure, including primary care and PCNs.
Desirable
- Experience in a care coordinator role, adult health and social care, learning support, or public health.
- Experience working in health, social care, or support roles with direct contact with people, families, or carers.
- Experience working with elderly or vulnerable people, following best practices and relevant legislation.
- Knowledge of Safeguarding Children and Vulnerable Adults policies and processes.
Qualifications
Essential
- Proficient in MS Office and web-based services.
Desirable
- NVQ Level 3 in adult care (advanced level) or equivalent qualifications or working toward these
Other Requirements
Essential
- Meets DBS reference standards and criminal record checks.
Person Specification
Experience
Essential
- Experience of working within multi-professional team environments.
- Understanding of the wider determinants of health and their impact on communities and individuals.
- Commitment to equality, diversity, and inclusion.
- Strong organisational skills including planning, prioritizing, time management, and record keeping.
- Knowledge of NHS structure, including primary care and PCNs.
Desirable
- Experience in a care coordinator role, adult health and social care, learning support, or public health.
- Experience working in health, social care, or support roles with direct contact with people, families, or carers.
- Experience working with elderly or vulnerable people, following best practices and relevant legislation.
- Knowledge of Safeguarding Children and Vulnerable Adults policies and processes.
Qualifications
Essential
- Proficient in MS Office and web-based services.
Desirable
- NVQ Level 3 in adult care (advanced level) or equivalent qualifications or working toward these
Other Requirements
Essential
- Meets DBS reference standards and criminal record checks.
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.
