Job summary
The
Care Coordinator is an important non-clinical role within the South Havering
Primary Care Network working closely with the Personalised Care Team comprising
of Social Prescribers, Health and Well-being Coaches as well as the PCNs full ARRS
(Additional Roles Reimbursement Scheme) Team, and working directly with GPs and
the practice colleagues to manage a caseload of patients, often living with or
at risk of frailty and those with long-term conditions.
Main duties of the job
1. To work with the GPs and other
primary care professionals within the Primary Care Network (PCN) to identify
and manage a caseload of patients who would benefit from support through care
coordination
2. To work closely and in partnership with the Social Prescribing Link Worker and
Health and Well-being Coaches to assist people to access self-management
education courses, peer support, health coaching and other interventions that
support them in their health and wellbeing, and increase their levels of
knowledge, skills and confidence in managing their health.
3. Work with patients, their
families and carers to improve their understanding of the patients condition
and support them to develop and review personalised care and support plans
4. Identify unpaid carers and help
them access services to support them and place them on the carers register
5. To support patients to utilise
decision aids, help create single personalised care and support plans, in line with
best practice
6. To support the PCN in the delivery of the DES specifications, such as
tackling health inequalities through targeted work with specific groups
identified
7. To help people to manage their
needs through answering queries, making, and managing appointments and ensuring
that people have good quality written or verbal information
8. To provide coordination and
navigation with the aid of digital tools
9. To support the coordination and
delivery of MDTs within the PCN
About us
South Havering Primary Care Network is a working collaboration of 17
general practices with a combined patient population of over 108,000 patients,
making the South PCN one of the largest PCNs in England, providing development
and progression opportunities for its workforce.South Havering PCN
works closely with and is supported by its GP Federation, Havering Health Ltd,
who are the employing body for members of the PCN. This is an exciting opportunity for an
enthusiastic individual with excellent interpersonal and communication skills
to join our ever-growing team of PCN colleagues to assist in the provision of
high-quality patient services and the delivery of the Network Contract DES. The
successful candidate will work alongside a team of clinical and non-clinical
healthcare professionals, supported and led by two Clinical Directors, the PCN
Manager and the PCN Project Manager in providing effective support to the PCN
practices on the delivery of services within South Havering PCN.
Job description
Job responsibilities
The
Care Coordinator is an important non-clinical role within the South Havering
Primary Care Network working closely with the Personalised Care Team comprising
of Social Prescribers, Health and Well-being Coaches as well as the PCNs full ARRS
(Additional Roles Reimbursement Scheme) Team, and working directly with GPs and
the practice colleagues to manage a caseload of patients, often living with or
at risk of frailty and those with long-term conditions. The Care Coordinator is
a crucial role within the MDT by championing a proactive approach to patients
care and is a single point of contact for patients and teams, including
clinical and non-clinical staff in primary care, care homes, local authority,
community services, secondary care and the voluntary sector.
Job description
Job responsibilities
The
Care Coordinator is an important non-clinical role within the South Havering
Primary Care Network working closely with the Personalised Care Team comprising
of Social Prescribers, Health and Well-being Coaches as well as the PCNs full ARRS
(Additional Roles Reimbursement Scheme) Team, and working directly with GPs and
the practice colleagues to manage a caseload of patients, often living with or
at risk of frailty and those with long-term conditions. The Care Coordinator is
a crucial role within the MDT by championing a proactive approach to patients
care and is a single point of contact for patients and teams, including
clinical and non-clinical staff in primary care, care homes, local authority,
community services, secondary care and the voluntary sector.
Person Specification
Experience
Essential
- At least 2 years' experience of working in health, social care or other support roles in direct contact with people, families or carers (in a paid or voluntary capacity)
- Experience of working within multi- professional team environments
- Ability to collect and record information and data, for record- keeping, monitoring and evaluation
Desirable
- Experience or training in person-centred care planning
- Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation
Experience
Essential
- At least 2 years' experience of working in health, social care or other support roles in direct contact with people, families or carers (in a paid or voluntary capacity)
- Experience of working within multi- professional team environments
- Ability to collect and record information and data, for record- keeping, monitoring and evaluation
Desirable
- Experience or training in person-centred care planning
- Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation
Qualifications
Essential
- Good standard of general education.
- Grade C GCSE English and Maths or equivalent qualifications.
- Excellent computer skills including email, word and excel
Desirable
- Has enrolled in, undertaking or qualified from appropriate training as set out by the Personalised Care Institute
Special Skills/Aptitudes
Essential
- Strong organisational skills including planning, prioritising, time management, report writing and record keeping
- Ability to recognise gaps in services and to identify and act on safety concerns
- Ability to recognise and work within limits of competence and seek advice when needed
- Evidence of good verbal and written communication skills
- Ability to build and maintain long- term-working relationships with colleagues
- A professional and compassionate attitude to patient care, providing support while maintaining professional boundaries
- Ability to work effectively under pressure, delivering against agreed objectives
- Ability to remain diplomatic when dealing with sensitive matters or having challenging discussions with patients or carers
- Ability to work safely unaided in home settings
- Willingness to take a pro-active and flexible approach to the role as it develops over time
Desirable
- Experience of using the EMIS computer system
- Up-to-date knowledge of the services and organisations available to support patients and carers
Person Specification
Experience
Essential
- At least 2 years' experience of working in health, social care or other support roles in direct contact with people, families or carers (in a paid or voluntary capacity)
- Experience of working within multi- professional team environments
- Ability to collect and record information and data, for record- keeping, monitoring and evaluation
Desirable
- Experience or training in person-centred care planning
- Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation
Experience
Essential
- At least 2 years' experience of working in health, social care or other support roles in direct contact with people, families or carers (in a paid or voluntary capacity)
- Experience of working within multi- professional team environments
- Ability to collect and record information and data, for record- keeping, monitoring and evaluation
Desirable
- Experience or training in person-centred care planning
- Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation
Qualifications
Essential
- Good standard of general education.
- Grade C GCSE English and Maths or equivalent qualifications.
- Excellent computer skills including email, word and excel
Desirable
- Has enrolled in, undertaking or qualified from appropriate training as set out by the Personalised Care Institute
Special Skills/Aptitudes
Essential
- Strong organisational skills including planning, prioritising, time management, report writing and record keeping
- Ability to recognise gaps in services and to identify and act on safety concerns
- Ability to recognise and work within limits of competence and seek advice when needed
- Evidence of good verbal and written communication skills
- Ability to build and maintain long- term-working relationships with colleagues
- A professional and compassionate attitude to patient care, providing support while maintaining professional boundaries
- Ability to work effectively under pressure, delivering against agreed objectives
- Ability to remain diplomatic when dealing with sensitive matters or having challenging discussions with patients or carers
- Ability to work safely unaided in home settings
- Willingness to take a pro-active and flexible approach to the role as it develops over time
Desirable
- Experience of using the EMIS computer system
- Up-to-date knowledge of the services and organisations available to support patients and carers
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.
