Practice Care Coordinator

Job description

Job responsibilities

The role is intended to support the practice and PCN in achieving the DES requirements which includes working with multidisciplinary teams, 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.

Our Care Coordinator will:

Work with people, their families and carers, to improve their understanding of their condition.

Support people to develop and review personalised care and support plans to manage their needs and achieve better healthcare outcomes.

Help people to manage their needs by providing a contact to answer queries, make and manage appointments, and ensure that people have good quality written or verbal information to help them make choices about their care.

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 co-ordination and navigation for people and their carers across health and care services. Helping to ensure patients receive a joined-up service and the appropriate support from the right person at the right time.

Work collaboratively with GPs and other primary care professionals to proactively identify and manage a caseload, which may include patients with long-term health conditions, and where appropriate, refer back to other health professionals.

Support the co-ordination and delivery of multidisciplinary teams.

Raise awareness of how to identify patients who may benefit from shared decision making and support staff and people to be more prepared to have shared decision-making conversations.

Explore and assist people to access a personal health budget where appropriate.

Work with people, their families, carers and healthcare team members to encourage effective help-seeking behaviours.

Support the developing communication channels between GPs, people and their families and carers and other agencies.

Identify carers and help them access services to support them.

Conduct follow-ups on communications from out of hospital and in-patient 2services.

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.

Contribute to risk and impact assessments, monitoring and evaluations of the service.

Work with commissioners, integrated locality teams and other agencies to support and further develop the role.

Person Specification

Knowledge and skills

Essential

• Excellent communication skills, verbal and written with the ability to adjust communication style and content to suit the audience.
• Can demonstrate a planned and organised approach with the ability to prioritise their own workload and meet strict deadlines.
• Excellent timekeeping.
• Administrative duties including preparation for meetings and writing minutes.
• Has attention to detail, able to work accurately, identifying errors quickly and easily.
• Self motivated and is able to work proactively and autonomously .
• Excellent IT skills

Desirable

• Able to demonstrate a good understanding of medical terminology and long term conditions.
• Ability to run reports

Qualifications

Essential

• GCSE grade A to C or equivalent in English and Maths

Experience

Essential

• Experience of working in primary care, ideally general practice at a senior/mid administration level.
• Willing to undertake appropriate training as required.

Desirable

• Experience of working with clinical systems, ideally Systm One
• Experience of working with people who may face health inequalities
• Experience of working in a health care or other support roles which are in direct contact with people, families or carers.

Personal qualities

Essential

• Highly motivated and enthusiastic.
• Flexible and adaptable to role development.
• Ability to work under pressure and to meet deadlines.
• Ability to work in a fast paced environment of change to meet the needs of primary care.

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

Moorlands Surgery

Address

139a Willow Road

Darlington

Co Durham

DL3 9JP

Employer's website

http://www.moorlandssurgerydarlington.nhs.uk/ (Opens in a new tab)