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Havant and Waterlooville Primary Care Network

Ageing Well Care Co-ordinator

The closing date is 30 September 2025

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Job summary

Care Co-ordinators are key players in the PCNs vision to ensure that the patients we care for have access to, and are able to access, a wide variety of care options and solutions, alongside the excellent primary care provided by its GP practice.

This important role involves managing a caseload of patients and liaising with patients/families to help them access the support they require to manage their situation and to understand what additional services may be available.

In addition to the above, this role involves running computer searches and proactively contacting patients to discuss health and care issues.

The role includes proactive case finding and reviewing care provision for individuals and cohorts. You need to have an understanding and commitment to the core competencies of the care co-ordinator role: personalised care, relationships, communication and continuous professional development and to undertake appropriate training when required.

The post holder will have the confidence to work with clinical and non-clinical colleagues from Havant and Waterlooville PCN practices, PCN colleagues and colleagues working in secondary care, community health, adult social care and the voluntary sector.

Interviews will be held on Wednesday 15th October 2025.

Successful applicant will work 25 hours per week.

Main duties of the job

  • Provide co-ordination and navigation for people and their carers across health and care services, working closely with Ageing Well Social prescriber, Ageing Well Frailty Nurses and other primary care professionals.
  • Manage own workload to ensure the needs to the individuals who use our services are met, taking the wider needs of the team into consideration.
  • Where required and as appropriate, the Care Co-ordinator will refer people onto other health professionals.
  • Provide personalised support to individuals to support them to be active participants in their own care solutions.
  • Help people to manage their needs through answering queries and ensuring that patients have good quality written or verbal information to help them make choices about their care.
  • Supporting personal choice, while ensuring that individuals understand the accountability of their own actions and decisions.
  • Working in partnership with the wider Ageing Well Team of colleagues to connect patients to other community cased care solutions and services.
  • Support the co-ordination and delivery of MDTs within the Ageing Well Team and other community providers.
  • Communicate information in a way that makes it relevant and understandable for service users and carers, working in line with Practice / PCN standards and operating policies.
  • Have safeguarding processes in place for vulnerable individuals.

About us

Havant and Waterlooville Primacy Care Network (PCN) has five member practices in an area to the south of Hampshire, stretching from Denmead Practice in the North-West to Bosmere Medical Practice to the south of Havant. Together our practices are responsible for 67,000 patients.

Primary Care Networks were established in 2019 to extend the range of staff roles and services available from GP surgeries and, by working across a number of neighbouring practices, to share expertise and resources across a wider area.

Details

Date posted

05 September 2025

Pay scheme

Other

Salary

£27,000 to £30,000 a year Full time Equivalent

Contract

Permanent

Working pattern

Part-time

Reference number

A5217-25-0006

Job locations

Bosmere Medical Centre

Solent Road

Havant

Hampshire

PO9 1DQ


Job description

Job responsibilities

Patient-facing

Work closely with the Ageing Well Team and other Primary and Secondary Care professionals to support patient care

Undertake person-centred assessments for patients allocated to you and use this understanding to develop individual health and care plans that are important and relevant to the patient. Where necessary, ensure that consultation with appropriate colleagues is undertaken.

Ensure that care plan reviews are held within the required time frames.

Provide personalised support to individuals/families to support/empower them to be active participants in their (or their family members) care

Help patients to manage their needs through answering queries and ensuring patients (and where appropriate their carer/s) have relevant written or verbal information that is understandable to them, to help them make choices about their care; support personal choice while ensuring that individuals understand the accountability of their own actions and decisions

Ensure all interactions with patients adhere to the principals of personalised care and are in line with practice/PCN standards and operational policies

Support opportunities for patients to build knowledge, skills and confidence (actively minimising dependency) and work in partnership with colleagues to connect patients to relevant community-based care solutions or other services

Participate in risk assessments and determine the appropriate course of action, taking into consideration a range of possible options. Where necessary, ensure that consultation with colleagues is undertaken.

Ensure that appropriate action is taken to safeguarding adults and children.

Analytical and Judgement

Have an awareness of your own competencies, knowledge base and experience, and ensure that you practice within this and seek support as required.

Review information in a timely fashion and propose actions to progress PCN agreed outcomes and objectives

Awareness of safeguarding processes for vulnerable individuals and escalate any concerns promptly.

Confidentiality

In the course of seeking treatment, patients entrust us with sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately

In the performance of the duties outlined in this Job Description, the post-holder will have access to confidential information relating to patients and their carers and potentially network and practice staff and other healthcare workers. They may also have access to information relating to the network or member practices as business organisations. All such information from any source is to be regarded as strictly confidential.

Information relating to patients, carers, colleagues, other healthcare workers or the business of the network or member practices may only be divulged to authorised persons in accordance with network policies and procedures relating to confidentiality and the protection of personal and sensitive data

Health and Safety

The post-holder will assist in promoting and maintaining their own and others health, safety and security as defined in the network / employing practice Health & Safety Policy, Health & Safety Manual, and Infection Control Policy and published procedures.

This will include

Identifying the risks involved in work activities, reporting health and safety hazards and potential risks and undertaking activities in a way that manages those risks

Making effective use of training to update knowledge and skills

Using appropriate infection control procedures, maintaining work areas in a tidy and safe way and free from hazards

Keeping own work areas and general / patient areas generally clean, assisting in the maintenance of general standards of cleanliness consistent with the scope of the role

Undertaking periodic training as appropriate for the role

Equality and Diversity

The post-holder will support the equality, diversity and rights of patients, carers and colleagues to include:

Acting in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with network and practices procedures and policies, and current legislation

Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues

Behaving in a manner which is welcoming to, and of, the individual, is non-judgmental and respects their circumstances, feelings, priorities and rights

Personal and Professional Development

The post-holder will participate in any training/development programme implemented by the network and/or member practices as part of this employment, including:

Induction programme from both the employing practice and the network

Participation in an annual individual performance review, including taking responsibility for maintaining a record of personal and/or professional development

Initial and ongoing training required to hold the position of Care Co-ordinator, including Shared Decision-Making learning modules supported by the NHS Personalised Care Institute

Annual CPR training/refresher

Annual mandatory training as required by the network and member practices.

The post-holder is expected to take responsibility for their own development, learning and performance and for demonstrating skills and activities to others undertaking similar work.

Quality

The post-holder will strive to maintain quality within the surgery and the network, and will:

Alert other team members to issues of quality and risk

Assess own performance and take accountability for own actions, either directly or under supervision

Contribute to the effectiveness of the team by reflecting on own and team activities and suggesting ways to improve and enhance the teams performance

Work effectively with staff in other agencies to meet patients/families/ carers needs

Effectively manage own time, workload and resources

Communication

The post-holder should recognise the importance of effective communication within the team and will strive to:

Communicate effectively, and in a timely manner, with other team members, colleagues, patients and other agencies

Recognise peoples needs for alternative methods of communication and respond accordingly

Duties will vary from time to time under the direction of the post holders manager, the network manager and the network clinical directors, dependent on current and evolving workload and staffing levels.

Job description

Job responsibilities

Patient-facing

Work closely with the Ageing Well Team and other Primary and Secondary Care professionals to support patient care

Undertake person-centred assessments for patients allocated to you and use this understanding to develop individual health and care plans that are important and relevant to the patient. Where necessary, ensure that consultation with appropriate colleagues is undertaken.

Ensure that care plan reviews are held within the required time frames.

Provide personalised support to individuals/families to support/empower them to be active participants in their (or their family members) care

Help patients to manage their needs through answering queries and ensuring patients (and where appropriate their carer/s) have relevant written or verbal information that is understandable to them, to help them make choices about their care; support personal choice while ensuring that individuals understand the accountability of their own actions and decisions

Ensure all interactions with patients adhere to the principals of personalised care and are in line with practice/PCN standards and operational policies

Support opportunities for patients to build knowledge, skills and confidence (actively minimising dependency) and work in partnership with colleagues to connect patients to relevant community-based care solutions or other services

Participate in risk assessments and determine the appropriate course of action, taking into consideration a range of possible options. Where necessary, ensure that consultation with colleagues is undertaken.

Ensure that appropriate action is taken to safeguarding adults and children.

Analytical and Judgement

Have an awareness of your own competencies, knowledge base and experience, and ensure that you practice within this and seek support as required.

Review information in a timely fashion and propose actions to progress PCN agreed outcomes and objectives

Awareness of safeguarding processes for vulnerable individuals and escalate any concerns promptly.

Confidentiality

In the course of seeking treatment, patients entrust us with sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately

In the performance of the duties outlined in this Job Description, the post-holder will have access to confidential information relating to patients and their carers and potentially network and practice staff and other healthcare workers. They may also have access to information relating to the network or member practices as business organisations. All such information from any source is to be regarded as strictly confidential.

Information relating to patients, carers, colleagues, other healthcare workers or the business of the network or member practices may only be divulged to authorised persons in accordance with network policies and procedures relating to confidentiality and the protection of personal and sensitive data

Health and Safety

The post-holder will assist in promoting and maintaining their own and others health, safety and security as defined in the network / employing practice Health & Safety Policy, Health & Safety Manual, and Infection Control Policy and published procedures.

This will include

Identifying the risks involved in work activities, reporting health and safety hazards and potential risks and undertaking activities in a way that manages those risks

Making effective use of training to update knowledge and skills

Using appropriate infection control procedures, maintaining work areas in a tidy and safe way and free from hazards

Keeping own work areas and general / patient areas generally clean, assisting in the maintenance of general standards of cleanliness consistent with the scope of the role

Undertaking periodic training as appropriate for the role

Equality and Diversity

The post-holder will support the equality, diversity and rights of patients, carers and colleagues to include:

Acting in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with network and practices procedures and policies, and current legislation

Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues

Behaving in a manner which is welcoming to, and of, the individual, is non-judgmental and respects their circumstances, feelings, priorities and rights

Personal and Professional Development

The post-holder will participate in any training/development programme implemented by the network and/or member practices as part of this employment, including:

Induction programme from both the employing practice and the network

Participation in an annual individual performance review, including taking responsibility for maintaining a record of personal and/or professional development

Initial and ongoing training required to hold the position of Care Co-ordinator, including Shared Decision-Making learning modules supported by the NHS Personalised Care Institute

Annual CPR training/refresher

Annual mandatory training as required by the network and member practices.

The post-holder is expected to take responsibility for their own development, learning and performance and for demonstrating skills and activities to others undertaking similar work.

Quality

The post-holder will strive to maintain quality within the surgery and the network, and will:

Alert other team members to issues of quality and risk

Assess own performance and take accountability for own actions, either directly or under supervision

Contribute to the effectiveness of the team by reflecting on own and team activities and suggesting ways to improve and enhance the teams performance

Work effectively with staff in other agencies to meet patients/families/ carers needs

Effectively manage own time, workload and resources

Communication

The post-holder should recognise the importance of effective communication within the team and will strive to:

Communicate effectively, and in a timely manner, with other team members, colleagues, patients and other agencies

Recognise peoples needs for alternative methods of communication and respond accordingly

Duties will vary from time to time under the direction of the post holders manager, the network manager and the network clinical directors, dependent on current and evolving workload and staffing levels.

Person Specification

Experience

Essential

  • Minimum 2 years experience of working with healthcare
  • professionals and / or previous experience in the NHS or
  • social care or relevant field

Desirable

  • Experience of working in a multi-disciplinary
  • setting

Qualifications

Essential

  • Educated to A-Level / NVQ level 3 or equivalent
  • Willing to undertake relevant training programme/s

Desirable

  • Educated to diploma level BTEC / HNC /
  • HND or equivalent
Person Specification

Experience

Essential

  • Minimum 2 years experience of working with healthcare
  • professionals and / or previous experience in the NHS or
  • social care or relevant field

Desirable

  • Experience of working in a multi-disciplinary
  • setting

Qualifications

Essential

  • Educated to A-Level / NVQ level 3 or equivalent
  • Willing to undertake relevant training programme/s

Desirable

  • Educated to diploma level BTEC / HNC /
  • HND or equivalent

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

Havant and Waterlooville Primary Care Network

Address

Bosmere Medical Centre

Solent Road

Havant

Hampshire

PO9 1DQ


Employer's website

https://www.facebook.com/HavantandWaterloovillePCN (Opens in a new tab)

Employer details

Employer name

Havant and Waterlooville Primary Care Network

Address

Bosmere Medical Centre

Solent Road

Havant

Hampshire

PO9 1DQ


Employer's website

https://www.facebook.com/HavantandWaterloovillePCN (Opens in a new tab)

Employer contact details

For questions about the job, contact:

PCN Operations Manager

Gemma Jones

gemma.jones21@nhs.net

Details

Date posted

05 September 2025

Pay scheme

Other

Salary

£27,000 to £30,000 a year Full time Equivalent

Contract

Permanent

Working pattern

Part-time

Reference number

A5217-25-0006

Job locations

Bosmere Medical Centre

Solent Road

Havant

Hampshire

PO9 1DQ


Supporting documents

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