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The Welby Group

Care Coordinator: Frailty Team (Trent Care Network)

The closing date is 18 July 2025

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Job summary

We are pleased to offer an exciting opportunity for a Care Coordinator to join the Frailty Team within Trent Primary Care Network (PCN). This is a newly created role designed to support the proactive, person-centred care of our most vulnerable patients, particularly those living with frailty or complex long-term conditions.

Working closely with our multidisciplinary team (MDT), you will coordinate care plans, improve communication between services, and act as a key point of contact for patients and carers. You will work both in the community and across our PCN practices, making a real difference to peoples lives.

Main duties of the job

Main Duties and Responsibilities

  • Act as the first point of contact for frail and vulnerable patients and their families.

  • Support patients in navigating health, social care, and voluntary sector services.

  • Schedule and coordinate assessments, reviews, and follow-up appointments.

  • Maintain accurate and up-to-date patient records in line with GDPR and clinical protocols.

  • Participate in multidisciplinary team (MDT) meetings and contribute to personalised care plans.

  • Identify patients who may benefit from proactive care planning and coordination.

  • Help improve access to services and ensure patients receive the right care at the right time.

  • Promote self-management and patient engagement in care decisions.

About us

What We Offer

  • NHS Pension Scheme with 23.7% employer contribution.

  • 33 days' annual leave (pro rata) including bank holidays.

  • Employee Assistance Programme (EAP) for wellbeing and support.

  • Regular staff social events and monthly recognition awards.

  • Sick pay scheme and free on-site parking.

  • Supportive induction and mentorship.

  • Ongoing professional development and training opportunities.

About Us

Trent PCN is a forward-thinking and friendly network of GP practices committed to delivering high-quality, patient-centred care. Our Frailty Team plays a crucial role in improving health outcomes for those most in need. You'll be joining a supportive, collaborative environment where innovation and compassion are valued equally.

How to Apply

To apply, please send your CV and a covering letter outlining your suitability for the role.

Details

Date posted

25 June 2025

Pay scheme

Other

Salary

Depending on experience

Contract

Fixed term

Duration

18 months

Working pattern

Part-time, Flexible working, Compressed hours

Reference number

A3638-25-0023

Job locations

Cleveland Surgery

Vanessa Drive

Gainsborough

Lincolnshire

DN21 2UQ


Job description

Job responsibilities

Main Duties and Responsibilities

  • Act as the first point of contact for frail and vulnerable patients and their families.

  • Support patients in navigating health, social care, and voluntary sector services.

  • Schedule and coordinate assessments, reviews, and follow-up appointments.

  • Maintain accurate and up-to-date patient records in line with GDPR and clinical protocols.

  • Participate in multidisciplinary team (MDT) meetings and contribute to personalised care plans.

  • Identify patients who may benefit from proactive care planning and coordination.

  • Help improve access to services and ensure patients receive the right care at the right time.

  • Promote self-management and patient engagement in care decisions.

Job description

Job responsibilities

Main Duties and Responsibilities

  • Act as the first point of contact for frail and vulnerable patients and their families.

  • Support patients in navigating health, social care, and voluntary sector services.

  • Schedule and coordinate assessments, reviews, and follow-up appointments.

  • Maintain accurate and up-to-date patient records in line with GDPR and clinical protocols.

  • Participate in multidisciplinary team (MDT) meetings and contribute to personalised care plans.

  • Identify patients who may benefit from proactive care planning and coordination.

  • Help improve access to services and ensure patients receive the right care at the right time.

  • Promote self-management and patient engagement in care decisions.

Person Specification

Experience

Essential

  • Experience working in a health, social care, or community setting.
  • Excellent interpersonal and communication skills, both written and verbal.
  • Strong organisational skills with the ability to prioritise and manage workload effectively.
  • Comfortable using clinical systems and IT platforms (e.g., EMIS, SystmOne, MS Office).
  • A caring and compassionate approach, with a strong focus on patient needs.
  • Ability to work both independently and as part of a wider team.

Desirable

  • Understanding of frailty, long-term conditions, and complex patient needs.
  • Previous experience working in a PCN or multidisciplinary healthcare environment.

Qualifications

Desirable

  • NVQ Level 3 in Health and Social Care (or equivalent qualification).
Person Specification

Experience

Essential

  • Experience working in a health, social care, or community setting.
  • Excellent interpersonal and communication skills, both written and verbal.
  • Strong organisational skills with the ability to prioritise and manage workload effectively.
  • Comfortable using clinical systems and IT platforms (e.g., EMIS, SystmOne, MS Office).
  • A caring and compassionate approach, with a strong focus on patient needs.
  • Ability to work both independently and as part of a wider team.

Desirable

  • Understanding of frailty, long-term conditions, and complex patient needs.
  • Previous experience working in a PCN or multidisciplinary healthcare environment.

Qualifications

Desirable

  • NVQ Level 3 in Health and Social Care (or equivalent qualification).

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

The Welby Group

Address

Cleveland Surgery

Vanessa Drive

Gainsborough

Lincolnshire

DN21 2UQ


Employer's website

https://www.thewelbypractice.co.uk/ (Opens in a new tab)

Employer details

Employer name

The Welby Group

Address

Cleveland Surgery

Vanessa Drive

Gainsborough

Lincolnshire

DN21 2UQ


Employer's website

https://www.thewelbypractice.co.uk/ (Opens in a new tab)

Employer contact details

For questions about the job, contact:

Grace Bowker

Grace.Bowker@nhs.net

Details

Date posted

25 June 2025

Pay scheme

Other

Salary

Depending on experience

Contract

Fixed term

Duration

18 months

Working pattern

Part-time, Flexible working, Compressed hours

Reference number

A3638-25-0023

Job locations

Cleveland Surgery

Vanessa Drive

Gainsborough

Lincolnshire

DN21 2UQ


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