First Coastal PCN

Care Co-ordinator

This job is now closed

Job summary

An exciting opportunity has become available for an enthusiastic and forward-thinking Care Co-Ordinator to join the First Coastal PCN in a new role that will be developed as it progresses. The successful candidate will be joining our Primary Care Community team, working with GPs, community teams, Care Co-Ordinators, Occupational Therapists, Physiotherapists, Social Prescribing Link Workers and Health & Wellbeing Coaches.

Our vision for the future is to create a patient care system that includes everyone and to inspire change by offering proactive, enhanced patient-centred care. A system where member practices work closely together and in collaboration with health and social care, voluntary sectors, community groups and local people to deliver efficient and timely personalised care. To be the voice of the people that live and work within the PCN and to invest in the future health of the First Coastal population.

Main duties of the job

The Care Coordinator's role will support the PCN leadership team and GPs in coordinating all key activity including improving access to services, providing advice and information, and ensuring health and care planning is timely, efficient, and patient-centred. The role will include supporting digital initiatives and includes responsibilities for the co-ordination of the patients journey through primary care.

The successful candidate will have great negotiation and communication skills and will have an understanding of primary care services & community health services.

The post holder will also be required to travel from practice to practice and to other venues during fulfilment of their duties. You will build relationships with professionals, care home leads, and act as a point of contact for the PCN.

About us

First Coastal PCN covers a population of approximately 84,000 patients this is made up of seven practices, Marsico Medical Practice (Mablethorpe), Hawthorn Medical Practice (Skegness), Beacon Medical Practice (Skegness), Merton Lodge (Alford), Spilsby Surgery, Stickney Surgery and Old Leake Medical Practice. These practices work together across coastal and rural divisions to deliver care to the local population.

As an organisation, we are serious about supporting a diverse workforce that reflects our local community and are very much focused on being an inclusive and compassionate place to work.

Date posted

25 October 2023

Pay scheme

Other

Salary

£25,147 to £27,596 a year

Contract

Permanent

Working pattern

Full-time, Part-time, Flexible working

Reference number

A3598-23-0007

Job locations

Marisco Medical Practice

Stanley Avenue

MABLETHORPE

Lincolnshire

LN12 1DP

Merton Lodge Surgery

33 West Street

Alford

Lincolnshire

LN139HT

Beacon Medical Practice

Churchill Avenue

Skegness

PE252RN

Hawthorn Medical Practice

Hawthorn Road

Skegness

Lincolnshire

PE253TD

The Surgery

Main Road

Stickney

Boston

Lincolnshire

PE228AA

Spilsby Surgery

Simpson Street

Spilsby

Lincolnshire

PE235LG

Health Centre

Church End

Old Leake

Boston

Lincolnshire

PE229LE

Job description

Job responsibilities

KEY RESPONSIBILITIES:

Care planning

Ensure every resident has a co-produced comprehensive care plan created within seven days of arriving as a resident.

Use provided templates and tools to undertake core assessment elements for inclusion in the care plan.

Holistically bring together all of a persons identified care and support needs and explore options to meet these within a single personalised care and support plan (PCSP), in line with PCSP best practice, based on what matters to the person.

Identify those elements of the care plan which require specialist input (pharmacist, dietician, nurse, medic etc.) and ensure that these are completed in timely manner.

Ensure end of life plans are correctly recorded and where appropriate have been shared with family members.

Identify where technology can be utilised to support continued independence or to aid remote monitoring of health and wellbeing.

Communicate effectively and sensitively and use language appropriate to a patient and carer/relatives condition and level of understanding.

Effectively use all methods of communication and be aware of and manage barriers to care.

Administration

Maintaining efficient clerical and office systems and providing administrative support to the team.

Be the main point of contact for the PCN, dealing with all communication in a professional, helpful manner.

Supporting new staff with system access and induction.

Receiving and actioning referrals.

Overall responsibility for arranging the weekly PCN-led MDT meetings.

Manage the meeting agenda items and take minutes.

Identify the patients needing to be prioritised for review that week.

Ensure all new residents are reviewed in the MDT within four weeks of arrival.

Ensure all residents returning to the home after an acute hospital admission are reviewed by the MDT within seven days of return.

Circulate relevant information to MDT members in advance of the meeting.

Ensure actions from the MDT are recorded and care plans are correctly updated.

Liaise with all clinical and non-clinical members in the MDT to ensure effective MDT function.

Chase progress against actions and ensure follow-up where necessary.

Manage reporting required and associated within the PCN contract for Enhanced Health in Care Homes support.

Stakeholder Relationships:

Work as part of the wider holistic team to provide cover and support as necessary.

To work with our clinical and digital system colleagues to implement and operate technology solutions which may include wearables or equipment to enable self-taking of health diagnostics e.g. blood pressure, weight etc.

Build and maintain relationships with internal and external staff; including care home staff and leads, GPs, pharmacists, community nursing team, therapists, dementia nurses etc.

As this is a new and evolving role, this is not an exhaustive list of duties and responsibilities, and the post holder may be required to undertake other duties that fall within the grade of the job, in discussion with their line manager.