Job summary
The CVD
Health & Prevention Coordinator will play a key role in delivering
neighbourhood-based cardiovascular disease prevention and management programmes
across the South East Neighbourhood of Hillingdon.
Main duties of the job
This is a
predominantly field-based role, working across community settings,
outreach venues and GP practices. The post holder will lead and coordinate
initiatives to identify, support and manage patients at risk of, or living
with, cardiovascular disease, including hypertension, atrial fibrillation,
diabetes, coronary heart disease and stroke.
The role
combines clinical support and care coordination, focusing on case
finding, health promotion, referral facilitation and personalised care
planning, with a strong emphasis on addressing health inequalities through
community engagement.
About us
The Confederation, Hillingdon
CIC works with General Practice and other healthcare providers to deliver its
vision for Hillingdon to deliver the best primary care outcomes for patients
in the whole of London. We are a not-for-profit community interest
company. The Confederation works to develop and support individual GP
practices, PCNs and Neighbourhoods and their changing needs. We deliver
excellent clinical services ourselves, both at scale and complementary to
General Practice. We are the provider representative voice for local
General Practice in the wider NHS and other Partners. We are of the NHS
but independent, innovative and transformational.
The Confederation determines
to develop as an attractive place to work, providing rewarding roles and
opportunities to grow in order to attract and retain great staff that in turn
delivers our vision.
Our Values
- We work together to make a difference for patients
- We care enough to go the extra mile
- We support, trust, and empower
- We sincerely value each other
- We support primary care to own its destiny
Job description
Job responsibilities
Clinical Support
- Undertake targeted case finding and
screening for CVD, including NHS Health Checks, blood pressure, atrial
fibrillation and diabetes risk assessment, in line with agreed protocols.
- Conduct or assist with clinical risk assessments (for example blood pressure monitoring, risk scoring) and refer
appropriately
- Accurately record findings in
clinical systems and ensure appropriate communication of results, escalation of
concerns and onward referral.
- Work with neighbourhood partners to
identify barriers to access, using population health data to improve detection,
prevalence and optimisation of care.
- Deliver health promotion advice on
lifestyle, smoking cessation, weight management, physical activity and mental
wellbeing, signposting to relevant services as required.
Care Coordination and Addressing Health Inequalities
- Support patients, families and
carers to understand conditions and develop personalised care and support
plans.
- Improve health literacy and
engagement, particularly within underserved or disengaged communities.
- Build and maintain relationships
with community groups and leaders where language, culture or access present
barriers.
- Attend and support community outreach and engagement events, including evenings and weekends, delivering
screening and health education.
Administrative and Operational Duties
- Contribute to neighbourhood KPIs
and service delivery targets.
- Maintain high-quality, up-to-date
clinical records and support data quality improvements.
- Access and interpret data from
systems such as EMIS and WSIC for reporting, audit and service evaluation.
- Contribute to the development and
improvement of assessment tools, service pathways, or quality improvement
initiatives aligned with evidence and NICE guidance.
- Support audit, evaluation and
reporting requirements to monitor service impact and outcomes.
Job description
Job responsibilities
Clinical Support
- Undertake targeted case finding and
screening for CVD, including NHS Health Checks, blood pressure, atrial
fibrillation and diabetes risk assessment, in line with agreed protocols.
- Conduct or assist with clinical risk assessments (for example blood pressure monitoring, risk scoring) and refer
appropriately
- Accurately record findings in
clinical systems and ensure appropriate communication of results, escalation of
concerns and onward referral.
- Work with neighbourhood partners to
identify barriers to access, using population health data to improve detection,
prevalence and optimisation of care.
- Deliver health promotion advice on
lifestyle, smoking cessation, weight management, physical activity and mental
wellbeing, signposting to relevant services as required.
Care Coordination and Addressing Health Inequalities
- Support patients, families and
carers to understand conditions and develop personalised care and support
plans.
- Improve health literacy and
engagement, particularly within underserved or disengaged communities.
- Build and maintain relationships
with community groups and leaders where language, culture or access present
barriers.
- Attend and support community outreach and engagement events, including evenings and weekends, delivering
screening and health education.
Administrative and Operational Duties
- Contribute to neighbourhood KPIs
and service delivery targets.
- Maintain high-quality, up-to-date
clinical records and support data quality improvements.
- Access and interpret data from
systems such as EMIS and WSIC for reporting, audit and service evaluation.
- Contribute to the development and
improvement of assessment tools, service pathways, or quality improvement
initiatives aligned with evidence and NICE guidance.
- Support audit, evaluation and
reporting requirements to monitor service impact and outcomes.
Person Specification
Qualifications
Essential
- Minimum GCSE Grade C or equivalent in English and Maths
- Care coordination training course or be willing to complete one before taking referrals.
Experience
Essential
- Experienced Care Coordinator with EMIS experience
- Good IT Skills
- Ability to actively listen, empathise with people and provide personalised support in a non-judgemental way
- Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity
- Commitment to reducing health inequalities and proactively working to reach people from diverse communities
- Ability to support people in a way that inspires trust and confidence, motivating others to reach their potential
- Ability to communicate effectively, both verbally and in writing, with people, their families, carers, partner agencies and stakeholders
- Ability to identify risk and assess/manage risk when working with individuals
- Strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role, e.g. when there is a mental health need requiring a qualified practitioner
- Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
- Ability to demonstrate personal accountability, emotional resilience and work well under pressure
- Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
- Demonstrable commitment to professional and personal development
- Excellent interpersonal, influencing and negotiating skills
- Excellent written and verbal communication skills
Desirable
- Ability to provide motivational coaching to support people's behaviour change
Person Specification
Qualifications
Essential
- Minimum GCSE Grade C or equivalent in English and Maths
- Care coordination training course or be willing to complete one before taking referrals.
Experience
Essential
- Experienced Care Coordinator with EMIS experience
- Good IT Skills
- Ability to actively listen, empathise with people and provide personalised support in a non-judgemental way
- Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity
- Commitment to reducing health inequalities and proactively working to reach people from diverse communities
- Ability to support people in a way that inspires trust and confidence, motivating others to reach their potential
- Ability to communicate effectively, both verbally and in writing, with people, their families, carers, partner agencies and stakeholders
- Ability to identify risk and assess/manage risk when working with individuals
- Strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role, e.g. when there is a mental health need requiring a qualified practitioner
- Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
- Ability to demonstrate personal accountability, emotional resilience and work well under pressure
- Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
- Demonstrable commitment to professional and personal development
- Excellent interpersonal, influencing and negotiating skills
- Excellent written and verbal communication skills
Desirable
- Ability to provide motivational coaching to support people's behaviour change
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.
