Care Coordinator

Job summary

The role is to work closely with our Practice Pharmacy Team and the overall clinical team within the Practice to identify and manage our registered patients, making sure that appropriate support is made available to them and the appropriate management of health care and disease management. This could involve support for chronic disease management, screening programs or software systems which are used to support patients.

Main duties of the job

Care coordinators will:

a. Proactively identify and work with a cohort of people to support their care requirements, using the available decision support aids.

b. Bring together all of 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 best practice.

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

d. Raise awareness of shared decision making and decision support tools and assist people to be more prepared to have a shared decision making conversation.

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

f. Assist people to access self-management, peer support or interventions that support them in their health and wellbeing.

g. Explore and assist people to access personal health budgets where appropriate.

h. Provide coordination and navigation for people and their carers across health and care services, alongside working closely with social prescribing link workers, health and wellbeing coaches and other primary care roles.

About us

Large dynamic and people focused GP practices based in Ashford Middlesex

11 GPs, 3 Nurse Practitioners, 2 Paramedics, Nurses and HCA team.

4 Pharmacists and 3 Pharmacy technicians filtering patient enquiries.

• In-house Physiotherapy, Podiatry, Acupuncture and Phlebotomy services
• Docman team that triage letters, scanning, coding, MREs
• EMIS web clinical system, also Front Desk for appointments and Docman for paperwork
• Well maintained large premises catering for 16,600 patients
• Regular team meetings, clinical and educational, in protected time.

Active engagement in local ICB and GP Federation directorship