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Care Co-ordinator
The closing date is 30 October 2025
Care Coordinators play an important role in the PCN by identifying and supporting patients to manage their long-term health conditions. Care Coordinators work closely with GPs and practice teams to manage a caseload of patients, ensuring that appropriate support is made available to them and their carers; helping them understand and manage their condition and addressing their changing needs.
The role of Care Coordinator provides support to the practice by acting as a link between the reception team and clinicians to achieve the best outcome for the patient. The workload can include managing invites for health reviews, arranging appointments, and managing referrals to social prescribing link workers, health and wellbeing coaches and other professionals where appropriate.
The role also involves collaborative working with our PCN pharmacy service which can include project work such as identifying patients, arranging and analysing metrics required for the pharmacy team to assess their medication needs.
NB This is NOT a hands-on care role – it is an administrative role that includes patient contact mainly by phone.
Main duties of the job
- Contacting patients by telephone / email / text message / letter to make appointments for Health Care Assistants, Nurses, Nurse Practitioners, GPs as required for long term condition management as specified by practice.
- Support triage of information received via AccuRx or via other platforms.
- Administration support for the practice team.
- Use internal and external email and the internet to keep up to date and send and receive messages.
- Supporting patients with referral to external services such as Social Prescribing and befriending services.
- Respond, using a helpful and problem-solving approach, to all queries and requests for assistance from staff and other visitors.
About us
Drake Medical Alliance Limited is the incorporated vehicle for DMA PCN to employ ARRS and other staff under a standardised set of Terms and Conditions. It is owned and operated by the 5 GP Practices that make up DMA PCN.
Each Practice has a Care Co-ordinator that works in Practice for 4 days a week and in the PCN offices for one day a week. This job will mainly be based at Knowle House Surgery and Scott Business Park.
Job responsibilities
1. Main Duties Of Job
- Contacting patients by telephone / email / text message / letter to make appointments for Health Care Assistants, Nurses, Nurse Practitioners, GPs as required for long term condition management as specified by practice.
- Support triage of information received via AccuRx or via other platforms.
- Administration support for the practice team.
- Use internal and external email and the internet to keep up to date and send and receive messages.
- Supporting patients with referral to external services such as Social Prescribing and befriending services.
- Respond, using a helpful and problem-solving approach, to all queries and requests for assistance from staff and other visitors.
2. Technical and Administrative
- Use SystmOne to access patient records, book blood tests and arrange routine appointments with the appropriate clinician.
- Help people manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care.
- Provide expertise to address both the public health and social care needs of patients, including lifestyle advice, service information, and help in tackling local health inequalities.
- Ensure appropriate onward referral of urgent issues to an appropriate clinician.
- Support the coordination and delivery of multidisciplinary teams.
- Raise awareness of how to identify patients who may benefit from shared decision making and support PCN staff and patients in having these conversations.
- Maintain records of referrals and interventions to enable monitoring and evaluation of service.
- Ensure appropriate SNOMED codes are used to record activity.
3. Enable Access to Personalised Care and Support
- Have a positive, empathetic, and responsive conversation with the person, and their family and carer(s) about their needs.
- Work towards increasing patients’ understanding of how to manage and develop health and wellbeing through offering advice and guidance.
- Work with the wider PCN, MDTs and the social prescribing service to support personalised care and support.
- Support patients as guided by the practice to manage health inequalities.
4. Coordinate and Integrate Care
- Make and manage appointments for patients, related to primary, secondary, community, local authority, statutory, and voluntary organisations.
- Help people transition seamlessly between secondary and community care services, conduct follow-up appointments, and support people to navigate the wider health and care system.
- Refer onwards to social prescribing link workers and health and wellbeing coaches where required.
- Liaise with multidisciplinary professionals to ensure coordinated care and keep all parties updated.
- Participate in multidisciplinary team meetings in the PCN as appropriate.
- Identify when action or additional support is needed, alerting a named clinical contact and relevant professionals, and highlighting safety concerns.
- Record interventions used to support people, and how people are developing on their health and care journey.
- Demonstrate flexibility and be prepared to carry out other duties as reasonably required to deliver work in a timely and effective manner.
- Identify opportunities and gaps in the service and provide feedback for continuous improvement and business planning.
- Work in accordance with practice and PCN policies and procedures.
- Contribute to the wider aims and objectives of the PCN to improve and support primary care.
Person Specification
Skills
- Prioritise and work to deadlines.
- Work effectively and collaboratively as part of a team but also autonomously.
- High level and adaptable communication skills across a range of individuals of all ages, backgrounds and cultures with varying social and emotional needs.
- Understanding the impact of economic and environmental factors on people’s health and wellbeing.
- Promote and maintain good working relationships with external partners.
- Keep accurate records of discussions and clearly replicate discussions in writing.
- Work on own initiative but within constraints of the role.
- Full, valid driving licence and use of own car.
- Meet DBS standards and Criminal Record checks.
- Understanding of and commitment to equality, diversity and inclusion.
- Ability to competently use technology and IT systems including word processing, email and the internet to create simple personalised plans with individuals.
- Ability to work across multiple sites.
- Provide motivational coaching with the ability to inspire trust and confidence.
- Confident and comfortable with difficult situations.
- Patient, friendly and approachable.
- Able to work under pressure and emotionally resilient.
- Ability to work flexible hours which may include evenings or weekends.
- Ability to actively listen, empathise with people and provide non-judgemental support.
- Ability to respect and value individual lifestyles, backgrounds and cultures.
Qualifications
- Demonstrable commitment to personal and professional development.
- Proficient in the use of Microsoft Office applications.
Experience
- Experience of supporting people, their families and carers in a paid or unpaid capacity.
- Experience of working in a community setting.
- Experience of handling confidential information.
- Experience of collecting and recording information and data.
- Ability to identify risk to self and others, identifying and reporting safeguarding incidents.
- Experience of working in or with voluntary organisations or groups in a paid or unpaid capacity.
- Experience of working collaboratively with different organisations, building trust, confidence and partnerships.
- Experience of working with GPs and/or other Health or Social Care providers or knowledge of how systems work.
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 name
Drake Medical Alliance Primary Care Network