Job summary
The Integrated
Neighbourhood Team Coordinator plays a vital role in facilitating all Community
based activities within health and social care. They are non-clinical staff
members, who work closely alongside existing services including health, social
care and Voluntary, Community and Social Enterprise (VCSE) organisations.
The
Coordinators are the glue that holds together the collaborative working of the
other services, acting as point of liaison between the partners that make up
the Neighbourhood Teams. The role of the Coordinators exists to ensure that the
benefits of integrated working are maximised, while also making it as easy as
possible for a member of the public to navigate.
There are seven whole time equivalents roles (37.5 hours) to cover the whole of our Wakefield District. Six of the roles will be based across the district in Community Hubs and one role will be in the Acute Trust.
Main duties of the job
The day-to-day role of the Integrated Neighbourhood Team Coordinator can be split into three areas:
- Supporting the integrated working of health and social care with shared team of system partners e.g. convening MDT panels
- Becoming a local expert (one amongst many in the community) understanding the strengths and challenges of the Neighbourhood
- Holding a caseload of people who they directly support to navigate the health and care system and access local groups and services
About us
We provide care and support to over a million people in
Wakefield and Kirklees in their homes, community settings and across our
three hospital sites at Pontefract, Dewsbury and Pinderfields (Wakefield).
Always striving for excellence, we are at the forefront of
innovation and research, and we invest in teaching and the development of our
workforce.
We live by our values of caring, improving, being respectful
and maintaining high standards. We listen and learn because we aim to make Mid
Yorkshire the best place to work and receive care.
We value diversity and welcome talent and enthusiasm
irrespective of age, disability, neurodivergence, sex, gender identity and
gender expression, race or ethnicity, religion or belief, sexual orientation,
or other personal circumstances including providing unpaid carers support to
someone with a health and care need. As ethnic minority groups, members of the
LGBTQ+ community, and people with a disability/neurodivergence are currently
under-represented across the organisation, we encourage applications from
members of these groups. We have policies and procedures to ensure all
applicants are treated fairly and consistently.
We are proud of our staff networks - who offer valuable
guidance and feedback from those with lived experience.
We have a clear vision and you could be part of this! If
you share our values and you want to make a difference to the lives of our
patients and their families and carers, we would love to hear from you.
Job description
Job responsibilities
- Proactively coordinating
services across boundaries to ensure people are kept in the community through
reducing the need for formal health and social care provision
- Facilitate and coordinate an
integrated health and social care approach within Neighbourhood Teams, including
providing administrative support for/ chairing MDT meetings for services
- Take ownership of the Neighbourhood
Teams Anticipatory Care cohort, ensuring that:
- A personalised care plan is
in place for each individual
- Responsibility to maintain
and keep up to date records of individuals identified as being part of the
cohort e.g care treatment and advice
- The Neighborhood Team has
access to the appropriate services and expertise to support their Anticipatory
Care cohorts. Escalating any issues to the appropriate channels.
- Make contact and build
relationships with a wide range of local community and voluntary sector
organisations in order to effectively signpost people to these organisations as
the need arises
- Identify gaps in community
provision and escalate identified gaps to the appropriate channels
- To champion and coordinate a
personalised case management approach by accessing multiple services to ensure appropriate
care packages are in place
- Dealing with highly complex
personalised care packages. E.g Assessment of care needs with clinicians to
determine the appropriate health and social care support
- Gather information and
intelligence at the earliest opportunity and present this to clinicians to give
them confidence and aid their decisions are helping prevent any unnecessary
admissions to hospital
- Promote access to relevant
services and cascade information that aids the support of person discharge as well as following this
up in the community by either a phone call or face to face visit
- Link people directly into
relevant health, social and VCSE services as well as signposting and linking
people into services to support them in the community
- Provide people with choice
and ensure people and their carers have access to the most appropriate services
at the right time in the right place
- Monitor people and work
with services to reduce the risk of deterioration and help prevent unnecessary
hospital admissions
- Support the role of the key
worker in the community and implement a monitored support plan
- To make recommendations regarding referrals, using triage protocols to
ensure that people are seen by the most appropriate team / service at the right
time to meet their needs. Whilst recognising the need to involve, or seek
advice from, more experienced colleagues as necessary when the decision is of a
clinical nature
- Responsible for the coordination and to liaise with all relevant
statutory and VCSE sector services including the local authority responsible
for a persons care to arrange the necessary support
- Responsible for tracking people through the health and social care
system to ensure a smooth hand over to a named care manager / service
- Contribute to the integration of health and social care by maintaining
up to date recording systems for all agencies within the neighbourhood team
- Responsible for providing information to any member of the neighbourhood
team in order to ease processes and communication in agreement with data
protection protocol
- Responsible for providing information to support overall Integrated care
programme evaluation
- To record and maintain people interventions on relevant systems (e.g.
EMIS, EPR and Liquid Logic amongst others) and contribute to report generation
and analysis from the data
- To be customer focused when representing the service and ensuring that
the reception people are given is supportive, welcoming and helpful
- To work within the relevant legal frameworks and have an understanding
of the Data Protection Act and how this relates to the management of confidential
information in accordance with health and social care policy.
- To independently plan and organise own work using own initiative, whilst
being able to work as a valuable member of a team
- Able to manage own diary and workload autonomously
- Assist in the orientation and local inductions of new starters
- To undertake general administrative duties to support the role
- To participate in individual appraisal and supervision, contributing to
the identification of training opportunities
- To work effectively as part of a team and to provide cover when required
and to be flexible regarding working hours to meet the needs of the service
- To undertake supervisory responsibilities including supervision and
Professional Development Reviews
- To use effective communication skills when liaising with professionals
and members of the public over the telephone or in person
- To liaise with a range of professionals within community and hospital
settings, including VCSE organisations.
- Visit service users either in a hospital in-patient setting, in the
persons home environment or GP practice to gather initial information and to
follow up to assess progress on intervention
- To work autonomously as well as part of a
team, this will require lone working in both hospital and community settlings
including service users home environments. To
receive and deliver complex, sensitive
or contentious information, where persuasive skills are required in discussing
medical intervention plans.
Job description
Job responsibilities
- Proactively coordinating
services across boundaries to ensure people are kept in the community through
reducing the need for formal health and social care provision
- Facilitate and coordinate an
integrated health and social care approach within Neighbourhood Teams, including
providing administrative support for/ chairing MDT meetings for services
- Take ownership of the Neighbourhood
Teams Anticipatory Care cohort, ensuring that:
- A personalised care plan is
in place for each individual
- Responsibility to maintain
and keep up to date records of individuals identified as being part of the
cohort e.g care treatment and advice
- The Neighborhood Team has
access to the appropriate services and expertise to support their Anticipatory
Care cohorts. Escalating any issues to the appropriate channels.
- Make contact and build
relationships with a wide range of local community and voluntary sector
organisations in order to effectively signpost people to these organisations as
the need arises
- Identify gaps in community
provision and escalate identified gaps to the appropriate channels
- To champion and coordinate a
personalised case management approach by accessing multiple services to ensure appropriate
care packages are in place
- Dealing with highly complex
personalised care packages. E.g Assessment of care needs with clinicians to
determine the appropriate health and social care support
- Gather information and
intelligence at the earliest opportunity and present this to clinicians to give
them confidence and aid their decisions are helping prevent any unnecessary
admissions to hospital
- Promote access to relevant
services and cascade information that aids the support of person discharge as well as following this
up in the community by either a phone call or face to face visit
- Link people directly into
relevant health, social and VCSE services as well as signposting and linking
people into services to support them in the community
- Provide people with choice
and ensure people and their carers have access to the most appropriate services
at the right time in the right place
- Monitor people and work
with services to reduce the risk of deterioration and help prevent unnecessary
hospital admissions
- Support the role of the key
worker in the community and implement a monitored support plan
- To make recommendations regarding referrals, using triage protocols to
ensure that people are seen by the most appropriate team / service at the right
time to meet their needs. Whilst recognising the need to involve, or seek
advice from, more experienced colleagues as necessary when the decision is of a
clinical nature
- Responsible for the coordination and to liaise with all relevant
statutory and VCSE sector services including the local authority responsible
for a persons care to arrange the necessary support
- Responsible for tracking people through the health and social care
system to ensure a smooth hand over to a named care manager / service
- Contribute to the integration of health and social care by maintaining
up to date recording systems for all agencies within the neighbourhood team
- Responsible for providing information to any member of the neighbourhood
team in order to ease processes and communication in agreement with data
protection protocol
- Responsible for providing information to support overall Integrated care
programme evaluation
- To record and maintain people interventions on relevant systems (e.g.
EMIS, EPR and Liquid Logic amongst others) and contribute to report generation
and analysis from the data
- To be customer focused when representing the service and ensuring that
the reception people are given is supportive, welcoming and helpful
- To work within the relevant legal frameworks and have an understanding
of the Data Protection Act and how this relates to the management of confidential
information in accordance with health and social care policy.
- To independently plan and organise own work using own initiative, whilst
being able to work as a valuable member of a team
- Able to manage own diary and workload autonomously
- Assist in the orientation and local inductions of new starters
- To undertake general administrative duties to support the role
- To participate in individual appraisal and supervision, contributing to
the identification of training opportunities
- To work effectively as part of a team and to provide cover when required
and to be flexible regarding working hours to meet the needs of the service
- To undertake supervisory responsibilities including supervision and
Professional Development Reviews
- To use effective communication skills when liaising with professionals
and members of the public over the telephone or in person
- To liaise with a range of professionals within community and hospital
settings, including VCSE organisations.
- Visit service users either in a hospital in-patient setting, in the
persons home environment or GP practice to gather initial information and to
follow up to assess progress on intervention
- To work autonomously as well as part of a
team, this will require lone working in both hospital and community settlings
including service users home environments. To
receive and deliver complex, sensitive
or contentious information, where persuasive skills are required in discussing
medical intervention plans.
Person Specification
Skills and Abilities
Essential
- To make independent decisions based using a range of facts and situations that require analysis
- Well established verbal and written communication skills with team/clients/relatives
- Ability to deal with highly distressing/sensitive information e.g Advanced Care Planning for end of life patients
- Ability to deal with health and social care conflict in community environment, using tact and persuasive skills
- Demonstrate a caring manner with an understanding of how to deal with challenging behaviours
- Driving Licence with access to car
- Highly organised, able to work to strict deadlines and ensure quality standards are met
- Ability to engage and motivate others and self
- Flexibility and able to adapt to change
- Proven ability of working on own initiative
- Able to work as part of a team
- Able to prioritise workload
- Ability to establish effective working relationships
- Planning and organising a range of complex activities
Desirable
- Ability to deal with irate and worried people accessing the service
- Time management skills or experience of working with a busy/demanding environment
- Supervisory or office management skills
Qualifications
Essential
- NVQ Level 3 qualification in a health or social care setting or equivalent level/experience
- 4 GCSEs, grade C or above
Desirable
- NVQ Level 4 qualification in a health or social care setting or equivalent level/experience
Experience
Essential
- Experience of scheduling/co-ordination activities and/or resources such as care planning
- Experience of working with confidential material e.g working on SystmOne
- Experience of working within a Multi-disciplinary team (MDT) setting
- Experience of building effective working relationships
- Experience of working within a Community /Neighbourhood setting and or interest specialist groups e.g Cardiac/Diabetes
- Well-developed experience working in patient or customer care setting
- Experience of working with computer software programmes such as Microsoft Office, e-mail and internet
Desirable
- Experience of working with patients requiring health or social care
- Experience with NHS software systems
- Experience of working within General Practice or hospital environment
- Experience of local needs assessment within communities
- Experience of monitoring and evaluating care plans
- Experience of writing reports and case studies
Knowledge and Awareness
Essential
- An understanding of health and social care issues for vulnerable adults and how these relate to health inequalities
- An understanding of the principles of Multidisciplinary Team (MDT) working
- Sensitive to confidential environment
- Understanding and knowledge of work policies and procedures (Data Protection Act)
- Awareness of own limitations.
Desirable
- Understanding of NHS Confidentiality issues
- Awareness of Health & Safety issues
- Awareness of Moving & Handling issues.
- Understanding and knowledge of work policies and procedures (Caldicott)
- Knowledge of medical terminology
- A sound knowledge of principles and practice of health and wellbeing and preventive approaches
- Knowledge of Primary Care Networks and non-clinical roles
- Knowledge of local voluntary and community, and statutory services relating to vulnerable adults
- Knowledge of Trust/Patient Access Policy/Medical Records Policies
Person Specification
Skills and Abilities
Essential
- To make independent decisions based using a range of facts and situations that require analysis
- Well established verbal and written communication skills with team/clients/relatives
- Ability to deal with highly distressing/sensitive information e.g Advanced Care Planning for end of life patients
- Ability to deal with health and social care conflict in community environment, using tact and persuasive skills
- Demonstrate a caring manner with an understanding of how to deal with challenging behaviours
- Driving Licence with access to car
- Highly organised, able to work to strict deadlines and ensure quality standards are met
- Ability to engage and motivate others and self
- Flexibility and able to adapt to change
- Proven ability of working on own initiative
- Able to work as part of a team
- Able to prioritise workload
- Ability to establish effective working relationships
- Planning and organising a range of complex activities
Desirable
- Ability to deal with irate and worried people accessing the service
- Time management skills or experience of working with a busy/demanding environment
- Supervisory or office management skills
Qualifications
Essential
- NVQ Level 3 qualification in a health or social care setting or equivalent level/experience
- 4 GCSEs, grade C or above
Desirable
- NVQ Level 4 qualification in a health or social care setting or equivalent level/experience
Experience
Essential
- Experience of scheduling/co-ordination activities and/or resources such as care planning
- Experience of working with confidential material e.g working on SystmOne
- Experience of working within a Multi-disciplinary team (MDT) setting
- Experience of building effective working relationships
- Experience of working within a Community /Neighbourhood setting and or interest specialist groups e.g Cardiac/Diabetes
- Well-developed experience working in patient or customer care setting
- Experience of working with computer software programmes such as Microsoft Office, e-mail and internet
Desirable
- Experience of working with patients requiring health or social care
- Experience with NHS software systems
- Experience of working within General Practice or hospital environment
- Experience of local needs assessment within communities
- Experience of monitoring and evaluating care plans
- Experience of writing reports and case studies
Knowledge and Awareness
Essential
- An understanding of health and social care issues for vulnerable adults and how these relate to health inequalities
- An understanding of the principles of Multidisciplinary Team (MDT) working
- Sensitive to confidential environment
- Understanding and knowledge of work policies and procedures (Data Protection Act)
- Awareness of own limitations.
Desirable
- Understanding of NHS Confidentiality issues
- Awareness of Health & Safety issues
- Awareness of Moving & Handling issues.
- Understanding and knowledge of work policies and procedures (Caldicott)
- Knowledge of medical terminology
- A sound knowledge of principles and practice of health and wellbeing and preventive approaches
- Knowledge of Primary Care Networks and non-clinical roles
- Knowledge of local voluntary and community, and statutory services relating to vulnerable adults
- Knowledge of Trust/Patient Access Policy/Medical Records Policies
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
Additional information
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
