Primary Care Network Care Coordinator

Job description

Job responsibilities

Key Duties

• Utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care.
• Support patients to utilise decision aids in preparation for a shared decision-making conversation.
• Holistically bring together all of a persons identified care and support needs, and explore options to meet these within a personalised care and support plan (PCSP).
• Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care.
• Support people to take up training and employment, and to access appropriate benefits where eligible.
• Support people to understand their level of knowledge, skills and confidence (their Activation level) when engaging with their health and wellbeing, including through the use of the Patient Activation Measure.
• Assist patients to access self-management education courses, peer support or interventions that support them in their health and wellbeing and increase their activation level.
• Explore and assist patients to access personal health budgets where appropriate.
• Provide coordination and navigation for patients and their carers across health and care services, working closely with social prescribing link workers, health and wellbeing coaches, and other primary care professionals.
• Support the coordination and delivery of MDTs within the PCN.
• Work with the GPs and other primary care professionals within the PCN to identify and manage a caseload of patients, and where required and as appropriate, refer people back to other health professionals within the PCN.
• Raise awareness within the PCN of shared-decision making and decision support tools; and raise awareness of how to identify patients who may benefit from shared decision-making and support PCN staff and patients to be more prepared to have shared decision-making conversations.

Safeguarding

• Have basic safeguarding processes in place for vulnerable individuals.
• Provide opportunities for the patient to develop friendships and a sense of belonging, as well as to build knowledge, skills and confidence.

Health & Safety

The post-holder will assist in promoting and maintaining their own and others health, safety and security as defined in the practice Health & Safety Policy, including:

• Using personal security systems within the workplace according to practice guidelines.
• Identifying the risks involved in work activities and undertaking such 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.
• Reporting potential risks identified.

Equality and Diversity

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

• Acting in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with practice procedures and policies, and current legislation.
• Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues.

Person Specification

Experience

Essential

• Experience in working within a social care and/or health setting, working with multi-disciplinary teams.
• Demonstrable experience of effective planning and organisational skills to deliver targets to deadlines

Desirable

• Experience of working with people with diverse health and social care needs
• Patient clinical system knowledge
• Experience of using recognised assessment tools
• Experience of mental health either as a service user, carer, worker or volunteer
• Experience of multi-agency working and signposting to appropriate support

Qualifications

Essential

• Educated to GCSE or equivalent

Desirable

• NVQ 3 of equivalent and/or relevant basic/first level professional qualification

Knowledge and Skills

Essential

• Excellent verbal communication skills with the ability to communicate effectively at all levels inc. customers, patients and carers, specialist services, GPs and colleagues. Listening skills, displaying empathy.
• Good technical literacy of Microsoft Applications e.g. Word, Excel, and Access etc.
• A Creative, flexible and imaginative approach to working with people with diverse support needs
• Understanding of barriers people face to accessing services and how to overcome them
• Ability to support and motivate people to make sustained changes in their lives
• Able to work independently & prioritise own workload
• Ability to reflect on and share practice with peers
• Have access to a car and being in possession of a full current driving license and business insurance

Desirable

• Experience using clinical systems:- SytmOne and/or EMIS
• Knowledge of a range of community groups and services which support wellbeing
• Awareness of relevant Health and Social Care legislation and a developed knowledge of crisis intervention
• Knowledge of the safeguarding interventions and awareness of the Mental Capacity Act
• Awareness of data protection and confidentiality issues

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

Invicta Health CIC

Address

St. James Surgery

2 Harold Street

Dover

Kent

CT16 1SF

Employer's website

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