Job summary
Calder & Ryburn Primary Care Network (PCN) consists of four GP
practices and have a combined patient list of over 43000 patients. We have
grown as a collaborative PCN over the past five years and now have over 30
members of staff working across the PCN.
Calder & Ryburn PCN are looking for a self-motivated
individual to join our growing personalised care team to cover 12 months of
maternity leave. The team currently consists of care coordinators and social
prescribing link workers who all work in GP practices across the PCN.
Main duties of the job
Undertake work in line with PCN directed
priorities.
Proactively identify and work with a
cohort of people to support their personalised care requirements, using the
available decision support aids.
Ensure regular and consistent
communication with the referrer regarding patient progress and any
complications or guidance.
Raise awareness of health promotion and
NHS health checks in practices.
Support national screening programmes.
Monitor referrals to ensure tasks are
completed and care delivered by keeping in regular telephone contact.
Direct liaison with multi agencies to
coordinate care for patients.
Refer to PCN social prescribing link
workers where a patient is identified as potentially benefitting from this
service.
To support patient/carer contact roles
and collate patient and carer feedback on their experiences
Support
Quality and Outcome Frameworks and other DES/LES specifications.
Maintain and develop engagement with all
practice staff and encourage the best practice.
Act as the first port of call for
patients, in their caseload in relation to their care.
Bring together all of a persons
identified care and support needs and explore their options to meet these into
a single personalised care and support plan (PCSP), in line with PCSP best
practice.
Help people to manage their needs,
answering their queries and support them to make appointments.
Support
people to take up training, employment, and access appropriate benefits where
eligible.
About us
Pennine GP Alliance is a member-led organisation made up of 19 GP
practices in Calderdale who form 5 Primary Care Networks (PCNs), collectively
serving over 223,000 registered patients.
We work extremely closely with general practice but also in
partnership with other local healthcare providers with a purpose to ensure
viable GP services remain at the heart of local communities, providing
sustainable and high-quality patient-focused healthcare.
Join our team and experience a workplace that truly values growth,
collaboration, and impact. We take pride in fostering a supportive and
inclusive environment where every team member is encouraged to listen, learn,
and lead. Together were dedicated to delivering better outcomes for GP
practices, and ultimately for the people of Calderdale.
At our organisation, your professional growth matters we are
committed to providing the resources and opportunities you need for continuous
development, ensuring you thrive both in your role and your career.
We look forward to receiving your application to join our team of
over 100 employees.
Job description
Job responsibilities
Raise
awareness of shared
decision-making and decision support tools and assist people to be more
prepared to have a shared decision-making conversation.
Ensure
that people have good quality information to help them make choices about their
care.
Support
people to understand their level of knowledge, skills and confidence when
engaging with their health and wellbeing, including using the Patient
Activation Measure.
Assist
people to access self-management education courses, peer support or
interventions that support them in their health and wellbeing.
Explore
and assist people to access personal health budgets where appropriate.
Provide
coordination and navigation for people and their carers across health and care
services, alongside working closely with social prescribing link workers and
other primary care roles.
Support
the coordination and delivery of care home ~MDTs within PCNs ensuring the
enhances health in care homes model is delivered.
Supporting
residents in care homes/LD homes ensuring personalised care is delivered
through collaborative working between health, social care, voluntary, community
and social enterprise sector and care home partners.
In
the course of seeking treatment, patients entrust us with, or allow us to
gather, sensitive information in relation to their health and other matters.
They do so in confidence and have the right to expect staff will respect their
privacy and act appropriately.
In
the performance of the duties outlined in this job description the post-holder
may have access to confidential information relating to patients, their carers,
practice, or staff information. All such information from any source is to be
regarded as strictly confidential.
Information
relating to patients, carers, colleagues, or member practices may only be
divulged to authorised person in accordance with PGPA policies and procedures
relating to confidentiality and the protection of personal and sensitive data,
or under the guidance of your manager.
Where required competently carry out elements of the
health check (A full check involves measurement of body mass index and waist
circumference, pulse rate, blood pressure, height and weight, QRISK
measurement, blood glucose, blood lipid, smoking and alcohol) and where
required refer for further clinical advice.
To
maintain up to date knowledge of legislation, national and local policies and
issues in relation to the specific client group, mental health and community
care delivery.
To comply with the Professional Codes of
Conduct and to be aware of changes in these. To maintain up to date knowledge
of all relevant legislation and local policies and procedures implementing
this.
To
ensure that all duties are carried out to the highest standard and in
accordance with currently quality initiatives within the work area.
To
comply with all relevant organisations policies, procedures, and guidelines,
including those relating to Equal Opportunities, Health and Safety and
Confidentiality of Information and to be aware of any changes in these.
To comply at all times with the PGPAs Information
Governance related policies. Staff are required to respect the confidentiality
of information about staff, patients and PGPA business and in particular the
confidentiality and security of personal identifiable information in line with
the Data Protection Act. All staff is responsible for ensuring that any data
created by them is timely, comprehensive, accurate, and fit for the purposes
for which it is intended.
Job description
Job responsibilities
Raise
awareness of shared
decision-making and decision support tools and assist people to be more
prepared to have a shared decision-making conversation.
Ensure
that people have good quality information to help them make choices about their
care.
Support
people to understand their level of knowledge, skills and confidence when
engaging with their health and wellbeing, including using the Patient
Activation Measure.
Assist
people to access self-management education courses, peer support or
interventions that support them in their health and wellbeing.
Explore
and assist people to access personal health budgets where appropriate.
Provide
coordination and navigation for people and their carers across health and care
services, alongside working closely with social prescribing link workers and
other primary care roles.
Support
the coordination and delivery of care home ~MDTs within PCNs ensuring the
enhances health in care homes model is delivered.
Supporting
residents in care homes/LD homes ensuring personalised care is delivered
through collaborative working between health, social care, voluntary, community
and social enterprise sector and care home partners.
In
the course of seeking treatment, patients entrust us with, or allow us to
gather, sensitive information in relation to their health and other matters.
They do so in confidence and have the right to expect staff will respect their
privacy and act appropriately.
In
the performance of the duties outlined in this job description the post-holder
may have access to confidential information relating to patients, their carers,
practice, or staff information. All such information from any source is to be
regarded as strictly confidential.
Information
relating to patients, carers, colleagues, or member practices may only be
divulged to authorised person in accordance with PGPA policies and procedures
relating to confidentiality and the protection of personal and sensitive data,
or under the guidance of your manager.
Where required competently carry out elements of the
health check (A full check involves measurement of body mass index and waist
circumference, pulse rate, blood pressure, height and weight, QRISK
measurement, blood glucose, blood lipid, smoking and alcohol) and where
required refer for further clinical advice.
To
maintain up to date knowledge of legislation, national and local policies and
issues in relation to the specific client group, mental health and community
care delivery.
To comply with the Professional Codes of
Conduct and to be aware of changes in these. To maintain up to date knowledge
of all relevant legislation and local policies and procedures implementing
this.
To
ensure that all duties are carried out to the highest standard and in
accordance with currently quality initiatives within the work area.
To
comply with all relevant organisations policies, procedures, and guidelines,
including those relating to Equal Opportunities, Health and Safety and
Confidentiality of Information and to be aware of any changes in these.
To comply at all times with the PGPAs Information
Governance related policies. Staff are required to respect the confidentiality
of information about staff, patients and PGPA business and in particular the
confidentiality and security of personal identifiable information in line with
the Data Protection Act. All staff is responsible for ensuring that any data
created by them is timely, comprehensive, accurate, and fit for the purposes
for which it is intended.
Person Specification
Other requirements
Essential
- Flexibility to work outside core office hours.
- Disclosure Barring Service (DBS) check.
- Maintain confidentiality at all times.
- Full UK driving licence.
Qualifications
Essential
- ECDL or equivalent Diploma/HNC level (or relevant experience).
- NVQ Level 2 Business Administration (or relevant experience).
- Demonstrable commitment to professional and personal continuous development.
Desirable
- Training in motivational coaching and interviewing or equivalent.
- Knowledge of primary care IT Systems
- Qualified to NVQ Level 2 in Health and Social Care.
Skills
Essential
- Knowledge of the personalised care approach.
- Advanced experience of using word, excel and PowerPoint including ability to use word processing skills, emails and the internet to create simple plans and reports.
- Creative problem solver and willing to search for hard-to-find information.
- Meets DBS reference standards and has a clear criminal record in line with the law on spend convictions.
- Access to own transport and ability to travel across the locality on a regular basis.
- Continued commitment to improve skills and ability in new areas of work.
Desirable
- Knowledge of general practice clinical systems, such as, EMIS and SystmOne. Ability to read large amounts of information and extract the salient points.
- To analyse data and report on findings.
Experience
Essential
- Experience of working with healthcare profession and or previous experience in the NHS or social care of relevant field (including unpaid work )
- Experience of data collection and providing monitoring information to assess the impact of services.
- Experience of partnership/collaborative working and of building relationships across a variety of organisations.
- Experience of working with or in general practice.
- Working in a multi-disciplinary setting where influence and negotiation is required.
- Knowledge/familiarity with medical terminology.
Desirable
- Experience of supporting people, their families, and carers in a related role (including unpaid work).
- Experience in use of databases.
- Vulnerable adults awareness.
- Experience of care of the elderly.
Person Specification
Other requirements
Essential
- Flexibility to work outside core office hours.
- Disclosure Barring Service (DBS) check.
- Maintain confidentiality at all times.
- Full UK driving licence.
Qualifications
Essential
- ECDL or equivalent Diploma/HNC level (or relevant experience).
- NVQ Level 2 Business Administration (or relevant experience).
- Demonstrable commitment to professional and personal continuous development.
Desirable
- Training in motivational coaching and interviewing or equivalent.
- Knowledge of primary care IT Systems
- Qualified to NVQ Level 2 in Health and Social Care.
Skills
Essential
- Knowledge of the personalised care approach.
- Advanced experience of using word, excel and PowerPoint including ability to use word processing skills, emails and the internet to create simple plans and reports.
- Creative problem solver and willing to search for hard-to-find information.
- Meets DBS reference standards and has a clear criminal record in line with the law on spend convictions.
- Access to own transport and ability to travel across the locality on a regular basis.
- Continued commitment to improve skills and ability in new areas of work.
Desirable
- Knowledge of general practice clinical systems, such as, EMIS and SystmOne. Ability to read large amounts of information and extract the salient points.
- To analyse data and report on findings.
Experience
Essential
- Experience of working with healthcare profession and or previous experience in the NHS or social care of relevant field (including unpaid work )
- Experience of data collection and providing monitoring information to assess the impact of services.
- Experience of partnership/collaborative working and of building relationships across a variety of organisations.
- Experience of working with or in general practice.
- Working in a multi-disciplinary setting where influence and negotiation is required.
- Knowledge/familiarity with medical terminology.
Desirable
- Experience of supporting people, their families, and carers in a related role (including unpaid work).
- Experience in use of databases.
- Vulnerable adults awareness.
- Experience of care of the elderly.
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.
