Ageing Well Care Co-ordinator

Havant and Waterlooville Primary Care Network; Havant; On-site; GBP 22,000 - 28,000; Part time

Job summary

A local healthcare provider is seeking an Ageing Well Care Co-ordinator to manage patient caseloads and facilitate access to care services. This role involves collaborating with healthcare professionals and supporting patients in managing their health. Candidates should possess relevant health or social care qualifications and strong communication skills. The position requires a 25-hour work week and is vital to enhancing patient care within the community.

Qualifications

• Understanding of personalised care principles.
• Ability to manage a caseload of patients effectively.
• Skilled in liaising with diverse health professionals.

Responsibilities

• Coordinate care for patients and families across services.
• Manage own workload to ensure patient needs are met.
• Support individuals to be active participants in their care.

Skills

Communication skills

Patient care coordination

Empathy

Analytical skills

Education

Relevant health or social care qualifications

Job description

Go back Havant and Waterlooville Primary Care Network

Ageing Well Care Co-ordinator

The closing date is 30 September 2025

CareCo-ordinators are key players in the PCNs vision to ensure that the patientswe care for have access to, and are able to access, a wide variety of careoptions and solutions, alongside the excellent primary care provided by its GPpractice.

This importantrole involves managing a caseload of patients and liaising withpatients/families to help them access the support they require to manage theirsituation and to understand what additional services may be available.

In addition tothe above, this role involves running computer searches and proactivelycontacting patients to discuss health and care issues.

The roleincludes proactive case finding and reviewing care provision for individualsand cohorts. You need to have anunderstanding and commitment to the core competencies of the care co-ordinatorrole: personalised care, relationships, communication and continuousprofessional development and to undertake appropriate training when required.

Thepost holder will have the confidence to work with clinical and non-clinicalcolleagues from Havant and Waterlooville PCN practices, PCN colleagues andcolleagues working in secondary care, community health, adult social care andthe voluntary sector.

Interviews will be held on Wednesday 15th October 2025.

Successful applicant will work 25 hours per week.

Main duties of the job

• Provide co-ordinationand navigation for people and their carers across health and care services,working closely with Ageing Well Social prescriber, Ageing Well Frailty Nursesand other primary care professionals.
• Manage ownworkload to ensure the needs to the individuals who use our services are met,taking the wider needs of the team into consideration.
• Where requiredand as appropriate, the Care Co-ordinator will refer people onto other health professionals.
• Providepersonalised support to individuals to support them to be active participantsin their own care solutions.
• Help people to managetheir needs through answering queries and ensuring that patients have goodquality written or verbal information to help them make choices about theircare.
• Supportingpersonal choice, while ensuring that individuals understand the accountability oftheir own actions and decisions.
• Workingin partnership with the wider Ageing Well Team of colleagues to connectpatients to other community cased care solutions and services.
• Supportthe co-ordination and delivery of MDTs within the Ageing Well Team and othercommunity providers.
• Communicateinformation in a way that makes it relevant and understandable for serviceusers and carers, working in line with Practice / PCN standards and operatingpolicies.
• Havesafeguarding processes in place for vulnerable individuals.

About us

Havantand Waterlooville Primacy Care Network (PCN) has five member practices in anarea to the south of Hampshire, stretching from Denmead Practice in theNorth-West to Bosmere Medical Practice to the south of Havant. Together ourpractices are responsible for 67,000 patients.

Primary Care Networks were establishedin 2019 to extend the range of staff roles and services available from GPsurgeries and, by working across a number of neighbouring practices, to shareexpertise and resources across a wider area.

Job responsibilities

Workclosely with the Ageing Well Team and other Primary and Secondary Careprofessionals to support patient care

Undertakeperson-centred assessments for patients allocated to you and use thisunderstanding to develop individual health and care plans that are importantand relevant to the patient. Where necessary, ensure that consultation withappropriate colleagues is undertaken.

Ensure that careplan reviews are held within the required time frames.

Providepersonalised support to individuals/families to support/empower them to beactive participants in their (or their family members) care

Help patients tomanage their needs through answering queries and ensuring patients (and whereappropriate their carer/s) have relevant written or verbal information that isunderstandable to them, to help them make choices about their care; supportpersonal choice while ensuring that individuals understand the accountabilityof their own actions and decisions

Ensure allinteractions with patients adhere to the principals of personalised care andare in line with practice/PCN standards and operational policies

Supportopportunities for patients to build knowledge, skills and confidence (activelyminimising dependency) and work in partnership with colleagues to connectpatients to relevant community-based care solutions or other services

Participate inrisk assessments and determine the appropriate course of action, taking intoconsideration a range of possible options. Where necessary, ensure thatconsultation with colleagues is undertaken.

Ensure thatappropriate action is taken to safeguarding adults and children.

Analytical and Judgement

Have an awareness of yourown competencies, knowledge base and experience, and ensure that you practicewithin this and seek support as required.

Review information in atimely fashion and propose actions to progress PCN agreed outcomes andobjectives

Awareness of safeguarding processes for vulnerableindividuals and escalate any concerns promptly.

Confidentiality

Inthe course of seeking treatment, patients entrust us with sensitive informationin relation to their health and other matters.They do so in confidence and have the right to expect that staff willrespect their privacy and act appropriately

Inthe performance of the duties outlined in this Job Description, the post-holderwill have access to confidential information relating to patients and theircarers and potentially network and practice staff and other healthcare workers. They may also have access to informationrelating to the network or member practices as business organisations.All such information from any source is to be regarded as strictlyconfidential.

Informationrelating to patients, carers, colleagues, other healthcare workers or thebusiness of the network or member practices may only be divulged to authorisedpersons in accordance with network policies and procedures relating toconfidentiality and the protection of personal and sensitive data

Health and Safety

The post-holder willassist in promoting and maintaining their own and others health, safety andsecurity as defined in the network / employing practice Health & SafetyPolicy, Health & Safety Manual, and Infection Control Policy and publishedprocedures.

This will include

Identifyingthe risks involved in work activities, reporting health and safety hazards andpotential risks and undertaking activities in a way that manages those risks

Makingeffective use of training to update knowledge and skills

Usingappropriate infection control procedures, maintaining work areas in a tidy andsafe way and free from hazards

Keepingown work areas and general / patient areas generally clean, assisting in themaintenance of general standards of cleanliness consistent with the scope ofthe role

Undertakingperiodic training as appropriate for the role

Equalityand Diversity

The post-holder will support the equality,diversity and rights of patients, carers and colleagues to include:

Actingin a way that recognises the importance of peoples rights, interpreting themin a way that is consistent with network and practices procedures andpolicies, and current legislation

Respectingthe privacy, dignity, needs and beliefs of patients, carers and colleagues

Behavingin a manner which is welcoming to, and of, the individual, is non-judgmentaland respects their circumstances, feelings, priorities and rights

Personal andProfessional Development

The post-holder will participate in anytraining/development programme implemented by the network and/or memberpractices as part of this employment, including:

Inductionprogramme from both the employing practice and the network

Participationin an annual individual performance review, including taking responsibility formaintaining a record of personal and/or professional development

Initialand ongoing training required to hold the position of Care Co-ordinator,including Shared Decision-Making learning modules supported by the NHSPersonalised Care Institute

AnnualCPR training/refresher

Annualmandatory training as required by the network and member practices.

The post-holder is expected to takeresponsibility for their own development, learning and performance and fordemonstrating skills and activities to others undertaking similar work.

Quality

The post-holder will strive to maintainquality within the surgery and the network, and will:

Alertother team members to issues of quality and risk

Assessown performance and take accountability for own actions, either directly orunder supervision

Contributeto the effectiveness of the team by reflecting on own and team activities andsuggesting ways to improve and enhance the teams performance

Workeffectively with staff in other agencies to meet patients/families/ carersneeds

Effectivelymanage own time, workload and resources

Communication

The post-holder should recognise the importance of effectivecommunication within the team and will strive to:

Communicate effectively, and in a timelymanner, with other team members, colleagues, patients and other agencies

Recognise peoples needs for alternativemethods of communication and respond accordingly

These duties will vary from time to time under thedirection of the post holders manager, the network manager and the networkclinical directors, dependent on current and evolving workload and staffinglevels.