Care Coordinator, Shere Surgery

Job description

Job responsibilities

The post holder will ensure patients receive high quality care. They will manage a caseload of patients, whereby they will monitor and coordinate patients' treatment plans, educate them about their condition, connect them with health care providers, and evaluate their progress.

The post holder will be the first point of contact for patients and relatives in case their needs change or if something goes wrong with service delivery. Many elderly and disabled people have highly complex needs and would struggle to coordinate with all the relevant services directly. The care coordinator relieves them of this burden and ensures that there are no gaps in service provision.

The successful candidate will be based at Shere Surgery & Dispensary a rural practice in the picturesque village of Shere serving a population of approx. 8,000 patients. We are looking for an enthusiastic individual with strong communication skills to join our friendly team

Key Responsibilities:

· 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 person’s 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.

· 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 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 people to access self-management, peer support or interventions that support them in their health and wellbeing and increase their activation level

· provide coordination and navigation for people 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.

·

Wider Responsibilities:

· 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.

About East Guildford Primary Care Network:

We are 6 practices that span the rural areas around Guildford as well as central Guildford practices, covering over 50 000 patients. We meet together monthly as practice leads and practice managers to discuss development and plans. Our aim is to provide practices, through the scheme, with additional staff that can support practices and provide better care for our patients. 

Over the next few years, the number of roles is expanding significantly, and we are currently recruiting to add on to our current pharmacist with more pharmacists and also with several Physio First practitioners. We are planning on expanding our current team further in the coming years. 

We are a group of excellent, well run and committed practices and hope that these additions will build on our brilliant practice teams.

Procare Health Limited are the host employer. The successful applicant will be employed by Procare Health Ltd and seconded to the East Guildford Primary Care Network for the duration of the contract. A primary care network (PCN) consists of groups of general practices working together with a range of local providers, including primary care, community services, social care and the voluntary sector, to offer more personalised, coordinated health and social care to their local populations.

Procare Philosophy and Values Framework

The post holder will ensure that patients, services users, families and carers have a positive safe and high quality experience when accessing and receiving care, treatment, advice and support from Procare employees and will ensure learning is shared and embedded in situations where things did not go as well as they should have.

Patients are the most important people in the health service and are at the centre of primary and community health care services. As patients and carers are the ‘experts’ in how they feel and what it is like to live with or care for someone with an illness or condition, all Procare employees are guided by real experience of our services to guide quality and service improvements. Underpinning this philosophy is a Values Framework using the mnemonic ‘PATIENT’ with the expectation that all Procare employees demonstrate behaviours both during the recruitment and selection process and every day at work against each area in the Values Framework

Procare ‘PATIENT’ Values Framework:

· Person centred care with a client centred focus

· Achieves clinical excellence, and inspires others

· Teamwork, working together in an integrated environment because everybody matters

· Integrity, in all that we do

· Experiences, are used for quality improvement and continuous learning

· New ideas, for clinically and cost-effective care

· Takes care of self, our own personal wellbeing is paramount

Person Specification

Qualifications

Essential

• Good level of education including GCSEs or equivalent level of experience or qualification

Desirable

• Is enrolled in, undertaking or qualified from appropriate training as set out by the Personalised Care Institute 81

Experience

Essential

• Experience of Microsoft Office packages e.g. PowerPoint, Word, Excel and other IT skills acquired through training or practical skills

Desirable

• Experience of NHS working practices
• Customer Care background
• General office procedures

Knowledge and Skills

Essential

• Good communication skills
• Flexible to deal with changing priorities
• Present a professional approach at all times
• Efficient and self-motivated
• Personable and approachable
• Respect for all with a commitment to equality and diversity
• Disciplined and organised with the ability to work under pressure and manage own time
• Discreet when dealing with confidential information
• Able to work as part of a team co-operating to work together and willing to help and assist wherever possible and appropriate

Desirable

• Understanding of confidentiality and data protection issues
• Knowledge of NHS policies
• Knowledge of clinician work patterns and responsibilities
• Experience using EMIS Web

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

Procare Health Limited

Address

Shere Surgery & Dispensary

Gomshall Lane

Shere

Guildford

Surrey

GU5 9DR

Employer's website

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