Care Coordinator - Multi-Disciplinary Team

Job description

Job responsibilities

About the Role

The Care Coordinator - Multi-Disciplinary Team position represents an exciting opportunity to join SHaR PCN's innovative Personalised Care Team. This permanent, 22.5-hour role is fundamental to our mission of delivering coordinated, patient-centred care across our seven GP practices in Ryedale and South Hambleton.

Key Purpose

You'll ensure patient health and care planning is timely, efficient, and genuinely patient-centred by coordinating multidisciplinary team meetings and facilitating seamless communication among healthcare professionals. Your role directly supports the NHS Long Term Plan's commitment to making personalised care standard practice throughout the health and social care system.

Principal Responsibilities

MDT Meeting Coordination You'll organise and manage regular multidisciplinary team meetings, ensuring all relevant patient information, clinical notes, and reports are readily available for discussion. Your meticulous attention to detail will ensure meeting outcomes are accurately documented and disseminated to all identified care providers, with treatment plans properly recorded for future reference.

Patient Pathway Management Working autonomously, you'll coordinate complex patient journeys through primary and secondary care, communicating sensitive information to diverse healthcare professionals. You'll negotiate with various departments, seek professional advice when needed, and maintain comprehensive attendance records of MDT participation.

Personalised Care Planning You'll be actively involved in introducing, developing, and reviewing personalised care and support plans (PCSP). Working holistically, you'll bring together all identified care and support needs, exploring options within a single, comprehensive plan based on what matters most to the individual patient.

Care Coordination and Navigation Providing coordination and navigation support for patients and their carers across health and care services, you'll work closely with social prescribing link workers, health and wellbeing coaches, and other primary care professionals. You'll help patients manage their needs through answering queries, managing appointments, and ensuring they receive high-quality information to make informed care choices.

Quality Improvement and Development You'll identify health inequalities and provide feedback on engagement enhancement opportunities. Supporting the PCN's implementation of new care models, you'll provide regular updates and feedback, helping adapt and improve services to better meet patient needs.

Key Tasks and Competencies

Administrative Excellence Proficiency in healthcare databases and IT systems is essential for effective data management and reporting. You'll provide comprehensive administrative support to the MDT, including typing meeting minutes, following up on action points, and ensuring compliance with healthcare regulations.

Relationship Building Developing close working relationships with Personalised Care Team members, you'll negotiate with all parties involved in care issues to establish productive working relationships and improve patient journey coordination.

Communication and Documentation Your role requires exceptional verbal and written communication skills for effective collaboration with healthcare professionals and maintaining accurate patient records. You'll recognise patients' needs for alternative communication methods and respond appropriately.

Professional Development Working with a named clinical point of contact, you'll undertake continual personal and professional development, actively participating in reviewing and developing the role whilst adhering to organisational policies including confidentiality, safeguarding, information governance, and health and safety requirements.

Working Environment

This role operates within an integrated neighbourhood team consisting of various health and care professionals. You'll contribute to the wider PCN aims and objectives whilst maintaining flexibility and demonstrating willingness to undertake additional duties within the role's general character and responsibility level.

Impact and Outcomes

Your contribution as Care Coordinator will directly enhance existing skill mix, resulting in improved patient lives, timelier access to services, and increased patient confidence and skills in managing their own health and wellbeing. You'll address wider determinants of health including housing, debt, stress, and loneliness whilst supporting GP and staff workloads.

Location & Travel Requirements

While based at Easingwold Health Centre, you'll be required to travel flexibly across all seven of our GP practices (Pickering, Kirkbymoorside, Helmsley, Terrington, Stillington, Tollerton, and Millfield) to deliver services and support patients in their local communities. This role therefore requires a current full driving licence and sole use of your own vehicle.

Person Specification

Experience

Essential

• - Experience working in health, social care and other support roles in direct contact with people, families or carers (paid or voluntary capacity)
• - Experience supporting people, their families and carers in a related role
• - Experience working with vulnerable people, complying with best practice and relevant legislation
• - Demonstrable commitment to professional and personal development
• - Proficient in MS Office and web-based services

Desirable

• - Direct experience working as a care coordinator in adult health and social care, learning support or public health/health improvement
• - Experience working within multi professional team environments
• - Experience or training in personalised care and support planning
• - Experience of data collection and using tools to measure service impact

Qualifications

Essential

• - NVQ Level 3 in adult care - advanced level or equivalent qualifications (or working towards)
• - Enrolled in, undertaking or qualified in appropriate training as set out in the Personalised Care Institute core curriculum

Desirable

• - Additional healthcare-related qualifications
• - Formal training in care coordination or similar roles

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

South Hambleton and Ryedale Primary Care Network

Address

Easingwold Health Centre

Crabmill Lane

Easingwold

YO61 3BU

Employer's website

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