PCN LTC (Home Visiting) Care Coordinator/Healthcare Assistant

Job description

Job responsibilities

Job Overview

Describe the role in up to four-sentences, what does success in the position look like, why does the role exist and how does it fit into the Group overall aims and objectives. Avoid jargon.

The Healthcare Assistant (HCA) will work across the Primary Care Network (PCN) to support GP practices in delivering high-quality, patient-centred care by working collaboratively with multidisciplinary teamsincluding GPs, paramedics, nurses, pharmacists, social prescribers, and other ARRS-funded rolesto improve patient access and outcomes. The role involves supporting clinical teams, undertaking delegated clinical tasks, promoting health and wellbeing, and contributing to the smooth running of practice and PCN services. Working autonomously within the PCN Home Visiting teams, the HCA will carry out long-term condition and dementia reviews for care home residents and housebound patients, ensuring personalised care plans remain up to date, while also performing general HCA duties such as health checks, phlebotomy, chaperoning, and wound care.

Key Responsibilities and Duties

List the key essential responsibilities and duties of this job, in order of importance. For some more complex roles more explanation and sub-headings will be needed. Use complete sentences, starting with a verb, in the present tense, in gender neutral language. Do not list all day-to-day responsibilities. Avoid jargon.

Clinical Duties

Perform clinical observations including blood pressure, temperature, pulse, oxygen saturation, height, and weight.

Carry out venepuncture/phlebotomy in line with local protocols.

Perform ECG recordings and ensure accurate documentation.

Conduct NHS Health Checks, including lifestyle assessment and risk-factor screening along with onward referral.

Conduct physical health checks for patients on the SMI register.

Carry out wound care, dressings, and simple procedures under supervision.

Undertake urine testing, specimen collection, and preparation.

Administer vaccines (if suitably trained and competence signed off).

Assist with chronic disease reviews (e.g., diabetes, hypertension) under nurse/GP supervision.

Support the management of long-term conditions by providing lifestyle advice.

Support clinicians with minor procedures and examinations.

Perform point-of-care testing and ensure equipment is properly maintained.

Undertake home visits for patients who have failed to attend the practice and who are therefore hard to reach

Conduct LTC reviews (e.g., blood pressure checks, lifestyle assessments, symptom monitoring) following agreed PCN protocols.

Support dementia reviews and liaise with relevant clinicians regarding any concerns.

Assist in maintaining and updating personalised care plans for patients in care homes and those who are housebound.

Work as part of the PCN Home Visiting Team to deliver proactive, preventative care.

Patient Support & Health Promotion

Guide and support patients in improving their health and wellbeing.

Provide lifestyle advice on smoking cessation, weight management, diet, and exercise.

Educate patients about preventive healthcare and self-management.

Signpost patients to appropriate PCN services such as social prescribing, mental health support, and community resources.

Administrative & Operational Duties

Accurately record patient information in clinical systems (SystmOne).

Maintain stock levels, clinical supplies, and equipment cleanliness.

Ensure safe infection control practices and compliance with PCN policies.

Support annual recall programmes (e.g., immunisations, health checks).

Work flexibly across multiple practices within the PCN when required.

Professional Responsibilities

Work within scope of practice and professional boundaries at all times.

Attend mandatory training and engage in ongoing learning and development.

Participate in team meetings and contribute to service improvement within the PCN.

Uphold patient confidentiality, safeguarding policies, and GDPR requirements.

Promote equality, diversity, and inclusion in patient care.

Key Results/Outcomes

List, using complete sentences, the responsibilities the role has for achieving specific key results and outcomes. Be clear about what success will look like in each area. Avoid jargon.

Improved Access to Long-Term Condition Reviews

Increase the number of completed LTC reviews (e.g., BP checks, lifestyle assessments) for housebound and care home patients within agreed PCN targets.

Maintain accurate and timely updates to personalised care plans following each review.

High-Quality Clinical Support

Deliver safe and effective HCA clinical duties, including phlebotomy, wound care, and observations.

Support the completion of NHS Health Checks, contributing to PCN prevention targets.

Achieve and maintain competency sign-off for all delegated clinical tasks.

Enhanced Patient Experience & Wellbeing

Demonstrate consistent delivery of patient-centred care, reflected in positive patient feedback and minimal complaints.

Provide clear health and lifestyle advice, supporting improved self-management of long-term conditions.

Ensure patients feel supported and informed regarding their health plans.

Effective Collaboration within the Multidisciplinary Team

Actively contribute to MDT discussions, escalating concerns appropriately to clinicians.

Share relevant patient information efficiently and accurately to support continuity of care.

Develop strong working relationships across PCN practices, improving coordination and workflow.

Safe and Efficient Home Visiting & Care Home Support

Complete scheduled home visits and care home reviews reliably, ensuring consistent punctuality and documentation.

Support early identification of deteriorating patients, escalating findings promptly to senior clinicians.

Help reduce avoidable hospital admissions by contributing to proactive care approaches. Accurate and Compliant Record-Keeping

Maintain detailed and accurate entries in clinical systems (SystmOne).

Ensure 100% compliance with data protection, confidentiality, and safeguarding policies.

Complete all required templates, coding, and documentation to PCN standards.

Continuous Professional Development

Complete mandatory training and engage in ongoing learning to support the evolution of the role.

Demonstrate increasing autonomy and competence as new responsibilities are adopted.

Take part in supervision, appraisal, and reflective practice sessions.

Line Management Responsibilities

Detail any line management responsibilities including the number of staff and specific roles managed, describe the type of management required on a day-to-day basis.

N/A

Freedom to Act

What decisions can the role make without reference upwards? be clear what this involves and how much autonomy there is.

Actions must be within set guidelines and requirements as defined by the Lead for the role.

Person Specification

Qualifications

Essential

• GCSE grade A to C in English and Maths or equivalent
• NVQ3 Health & Social Care or equivalent
• Trained in giving vaccines

Desirable

• Phlebotomy qualification
• Enrolled in undertaking or qualified from appropriate training as set out by the Personalised Care Institute

Additional Criteria

Essential

• Willingness to undertake further training
• Take responsibility for own development and learning
• Full, clean driving licence

Desirable

• Disseminate learning and information to other team members in order to share good practice

Experience

Essential

• Knowledge of medical terminology
• Proficient in use of Microsoft packages such as Word and Excel
• Excellent interpersonal and communication skills with the ability to apply different communication methods depending on the needs of the patient.
• Ability to empathise listen clarify identify and resolve agreed actions over the phone or face to face.
• Ability to provide quality care
• Good organisation skills
• Able to work autonomously under own initiative when necessary
• Able to build good working relationships
• Able to manage and prioritise workloads
• Working to deadlines
• Understanding of equality and diversity
• Minimum of 2 years working within a healthcare setting
• Experience of working in a busy and demanding environment
• Experience working with confidential information

Desirable

• Knowledge of QOF
• Knowledge of personal care
• Knowledge of local and national promotion strategies, health policies and public health issues
• Knowledge of patient group directions and associated policy
• Knowledge of clinical governance issues in primary care
• Use of clinical computer systems Sytmone
• Ability to communicate at all levels
• Identify possible quality and development opportunities
• Experience of working in primary care
• Experience of working in a GP practice
• Previous experience in the care of the elderly, complex patients and patients with learning difficulties
• Experience of working in Community health 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

Coast & Country Primary Care Network

Address

c/o Holsworthy Medical Centre

Dobles Lanes

Holsworthy

Devon

EX22 6GH

Employer's website

https://coastandcountrypcn.gpweb.org.uk/ (Opens in a new tab)