Wellbeing Care Coordinator - WBC PCN

Job description

Job responsibilities

The Wellbeing Care Coordinator will have a key role in the Wellbeing Team for Wargrave, Belmont and Cantilupe (WBC) Primary Care Network supporting the networks population to live healthy, positive, and fulfilling lives.

The Wellbeing Team works with individuals in need of proactive support with the aim of encouraging independence, a healthy lifestyle, mental wellbeing, and social connectivity. We identify areas of health inequality within our locality and work with the primary care team, and community partners to engage with the population and understand existing gaps in provision. This includes increasing uptake in cancer screening and other health initiatives, early intervention to manage long term conditions, and supporting people to access health and community services.

As a member of the Wellbeing Team the Care Coordinator will work within our network of GP Practices to provide a central co-ordination role for patient care planning. The role will involve working one to one with patients who need extra support, helping them to be actively involved in managing their care and supported in making choices that are right for them.

The Care Coordinator will be an essential team member working with a Social Prescriber and Primary Care Team. They will provide a single point of access for staff and patients, providing feedback to the practices, troubleshooting, and escalating actions as necessary, providing advocacy for service users. The Care Coordinator will support the wider Primary Care Team in Health Inequalities projects, or other Primary Care Network strategic priorities.

Main Responsibilities

1. Facilitate and ensure the effective delivery of patient-centred, personalised health and social care plans for patients, monitoring progress and reporting outcomes, contributing to patient reviews and care planning within appropriate time frames.

2. Explain the management of a patients pathway to clinical staff, liaising between services and service users, contacting services using the appropriate procedures/referral mechanisms.

3. Work closely with all relevant care agencies (primary care, secondary care, community services, Mental Health, Social Services, Ambulance Service, Voluntary services and other relevant service providers) to ensure a coordinated delivery of the patients care plan, without requiring a further referral from the GP.

4. Maintain accurate records and statistical returns as required by the ICB, including providing patient-related information for entering into Clinical Reporting Systems, within the required time frame.

5. Ensure that a proper handover of care between different settings has taken place, including mutual transfer of all organisations communications & patient notes and ensuring care packages are set up.

6. Collect data on patients/carers for recognised outcome measure and document for service interpretation. Ensure all patient notes are updated to reflect any changes, including details on plans

7. Managing operational meeting processes, identifying patients for discussion and working closely with clinicians to define and lead the meetings. Organise and attend relevant meetings when required including multi-disciplinary team meetings, ensure a programme of regular meetings is established, ensuring that all necessary documentation is circulated in advance.

8. Ensure that meeting actions are recorded, disseminated and followed up in a timely way; ensure relevant practitioners are aware of meeting decisions and actions / outcomes, and chase for action resolution and update.

9. Network and develop strong relationships with all levels of the NHSs key local players including the ICB, GPs and other primary care contractors, Social Services, Mental Health Trusts, Community Trusts, and other providers including the voluntary sector.

10. Be a contact point for GPs / practices and establish systems and processes which will ensure a timely and appropriate response to queries from clinicians and other stakeholders.

*Please see full Job Description and Person Specification attached to this advert*

Person Specification

Qualifications

Essential

• GCSE English or equivalent level.
• GCSE Mathematics or equivalent level.

Desirable

• ECDL or equivalent level of keyboard/IT skills.

Skills

Essential

• Good interpersonal communication skills, both written and verbal.
• Ability to manage and prioritise own work to meet deadlines.
• Ability to work effectively as part of a team.
• Ability to communicate confidently with staff of all seniority levels
• Good level of accuracy and attention to detail.

Other Job Requirements

Essential

• Understanding of confidentiality and Data Protection.
• Required to travel to meetings and work from other locations as required in order to carry out work across the federation.

Experience

Essential

• Working knowledge of Microsoft office Word, Excel, Outlook and PowerPoint and using video calling software e.g. Microsoft teams.
• Experience of using IT systems such as EMIS.
• Knowledge of the personalised care approach.

Desirable

• Experience of working in a health or social care setting.
• Experience of partnership/collaborative working and of building relationships across a variety of organisations.
• Experience of providing one to one and/or group support.

Personal Qualities & Attributes

Essential

• Reliable, conscientious and flexible approach to work.
• Commitment to reducing health inequalities and proactively working to reach people from diverse communities.
• To be able to work independently on own initiative.
• Ability to maintain confidentiality.

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

Taurus Healthcare Limited

Address

Taurus Healthcare Ltd

Whitecross Road

Hereford

HR4 0DG

Employer's website

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