Neighbourhood Dementia Support & Development Coordinator

Job description

Job responsibilities

• Proactively identify and work with a cohort of people to support their personalised care requirements.
• Support the Practice to establish preferred means of communication and coding to comply with relevant guidance.
• Establish who is the persons main support and support the practice to ensure this is documented.
• Identify barriers to accessing health and care services, and plan actions to overcome and support access to services.
• Work with Practices, people and their families and carers or other support services to prepare for the Annual Health Check (AHC).
• Review attendance to appointments and follow up those which have not attended or not been supported to attend and support to reschedule as appropriate.
• Bring together a persons identified care and support needs and support them to explore their options with the clinicians to produce a single personalised care and support plan.
• Help patients and their carers prepare for conversations they have with Primary Care professionals, ensuring that their changing needs are addressed.
• Develop plans to meet the additional health needs of people with Dementia who come from ethnic communities that experience health inequalities.
• Support the coordination and delivery of Multi-disciplinary Team Meetings within PCNs and with Admiral Nurses and CNWL.
• Identify unpaid carers and help them access services to support them.
• Identify and raise any issues or concerns relating to care provision.
• Work independently on a day-to-day basis, making decisions within scope of role and actively seek supervision where required.
• Act as a Dementia Champion and support Personalised care
• Enhance staff education and training for Dementia by working closely with Public Health colleagues to develop a train the trainer model

Communication and Record Keeping

• Develop strong working relationships with GPs, practice, Memory Clinic, Admiral Nurses and community teams relevant to your role.
• Ensure that all relevant professionals are kept up to date so that any issues or concerns can be appropriately addressed and supported.
• Proactively conduct follow-ups on communications from out of hospital and in-patient services.
• Actively participate in multidisciplinary team meetings in the North Neighbourhood when appropriate.
• Keep accurate and up-to-date records of contacts, adhering to information governance and data protection guidance.
• Maintain records of referrals and interventions to enable monitoring and evaluation of the service.

Service Development

• Actively seek feedback from people, their families, and carers about the impact of the care coordination.
• Act as a Champion for dementia and a point of contact for Dementia across the North Neighbourhood
• Identify any issues and report to the North Neighbourhood Senior Leadership team to enable learning and action.
• Provide feedback to continually improve the service and develop the role.
• Support the induction of new in post Dementia Support Coordinator.
• To contribute to and participate in the development and maintenance of mechanisms to audit the quality of care and clinical effectiveness of clinical services.
• Link with other people who have similar roles in other areas.
• Review the Right Care Dementia scenario and apply approaches where appropriate and seek service improvements.

General

• Duty of Care: Put the interest and needs of the patients first and foremost.
• Contribute to the development of policies and plans relating to equality, diversity, and reduction of health inequalities.
• Adhere to policies and procedures, including confidentiality, safeguarding, lone working, information governance, equality, diversity and inclusion training and health and safety.
• Undertake continual personal and professional development, providing evidence of learning where required.
• Take an active part in regular appraisals.

Collaborative Working Relationships

• Foster and maintain strong links with all services across the PCN and neighbouring networks.
• Explores the potential for collaborative working and takes opportunities to initiate and sustain such relationships.
• Demonstrates use of appropriate communication to gain the co-operation of relevant stakeholders (including patients, senior and peer colleagues, and other professionals, other NHS/private organisations e.g. CCGs).
• Can recognise personal limitations and refer to more appropriate colleagues when necessary.

Liaises with other stakeholders as needed for the collective benefit of patients including but not limited to:

• Patients and their representatives.
• Other healthcare professionals includingcommunity pharmacists, pharmacy technicians,social prescribers, first contact physiotherapists, physicians associate and paramedics.
• PCN Board of Directors
• CNWL Clinical Lead for Dementia
• Carers Network Hillingdon
• GP Practice Safeguarding Leads.
• Hillingdon Memory Assessment Service
• Community Mental Health Teams
• Wider community and secondary care services
• Neighbourhood Teams
• Dementia leads at acute hospitals and key ward managers
• Admiral Nurses
• Social Prescribing Link Workers
• Voluntary, Community and Social Enterprise providers of dementia services
• Social Care Services
• Community pharmacists and support staff

Person Specification

Qualifications

Essential

• GCSE grade A-C in Maths & English or skills level 2 in Maths & English (or equivalent)

Experience

Essential

• Experience of working with or caring for people with dementia
• Knowledge of national priorities to improve outcomes for people with dementia
• Experience of working in health, social care, and 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
• Experience or training in personalised care and support planning
• Experience of providing motivational coaching to support peoples behaviour change
• Knowledge of Safeguarding Children and Vulnerable Adults policies and processes
• Able to work without day-to-day supervision
• Ability to identify risk and assess / manage risk when working with individuals
• Ability to recognise and work within limits of competence and seek advice when needed
• Can communicate complex and sensitive information, both verbally and in writing
• Excellent interpersonal, influencing and negotiating skills
• Work effectively independently and as a team member
• Able to build effective working relationship with people, families and professionals.
• Ability to produce timely and informative reports
• Ability to organise, plan and prioritise
• Committed to the delivery of fair and equitable services
• Positive attitude
• Committed to collaborative working
• Good understanding of equality of opportunity
• Ability to provide service supporting people from all backgrounds and communities
• DBS reference standards and criminal record checks
• Willingness to work flexible hours when required to meet work demands
• Ability to travel across the locality on a regular basis
• Ability to use Microsoft Office applications Word, Outlook

Desirable

• Knowledge of how the NHS works, including primary care and PCNs
• Experience of data collection

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

The Confederation, Hillingdon CIC

Address

1A, Civic Centre, High Street

Uxbridge

Middlesex

UB8 1UW

Employer's website

https://www.theconfederationhillingdon.org.uk (Opens in a new tab)