Care Coordinator

NHS; Southend-on-Sea; On-site; GBP 25,000 - 30,000; Full time

Job summary

A leading healthcare organization is seeking a dedicated Care Coordinator to join their team. This full-time role involves supporting patient care planning across the primary care network, ensuring effective communication and coordination among healthcare providers. The ideal candidate will have a strong background in health and social care, excellent communication skills, and the ability to work autonomously within a multidisciplinary team. This position offers a supportive environment and opportunities for professional development.

Benefits

33 days' annual leave

Support with training & development

Reimbursement for parking/travel expenses

Qualifications

• Experience in health or social care environment.
• Ability to manage own time and prioritize caseload.

Responsibilities

• Coordinate patient journeys through primary care.
• Support delivery of personalized health and social care plans.

Skills

Communication

Teamwork

Patient Care

Education

GCSE or equivalent

NVQ 3 in Health and Social Care

Tools

Microsoft Office

SystmOne

Job description

Southend West Central PCNhas an opportunity for a care co-ordinator to join our primary care network on a full time basis for 37.5 hours per week, to support ourGP practices across, to assist in re-shaping primary care across our communities.

The role involves working very closely with the practices and the multidisciplinary team (MDT) within the PCN, and is pivotal in ensuring that all patients receive the best possible care and service.

Main duties of the job

The main duties of the role include:

• supporting the clinical directors in coordinating all key activity, including access to services, advice, and information, as well as ensuring that health and care planning is timely, efficient, and patient-centred.
• responsibility for the co-ordination of the patients' journeys through primary care.

Please see full job description attached.

About us

GP Healthcare Alliance is a company, originally formed as a GP federation, made up of 18 practices who work together to provide healthcare for our practices and patients.

GP Healthcare Alliance headlines:

• Over 8 years delivering NHS contracts at scale across Essex
• Serving close to 300,000 patients across 4 PCN's.
• Delivering weekend wound care services
• We deliveredhot hubsduring the Coronavirus pandemic's first wave, and continue to deliver Covid vaccinations and booster campaigns
• Our online training academy is due to be launched soon
• We care! Our charity work includes collaborating with the Rotary Clubs to collect food bank donations as well as collecting used bras for breast cancer research and compiling Christmas gift boxes for the homeless
• At an inspection of our head offices this year, we were ratedoutstandingby the CQC for being such awell ledorganisation!

GPHA values staff and can offer:

• A supportive & friendly working environment;
• 33 days' annual leave per year, including bank holidays (pro rata);
• Support with training & development;
• Reimbursement for parking/travel expenses for attending meetings/off site sessions.

Job responsibilities

The post holder is a member of the Primary Care Network(PCN) Additional Roles team providing a central co-ordination role for patientcare planning across the network practices. The Care Coordinator will workautonomously within the community and will have a key role in supportingdelivery of the new Network Contract DES Service Specifications.

The Care Coordinators role will support the PCN incoordinating all key activity for patients including access to services,advice, and ensure that personalised care planning is patient centred. Theyfocus delivery of the Comprehensive Model for Personalised Care to reflectlocal priorities, health inequalities and population health riskstratification.

This role will work within our network providing acentral co-ordination role for patient care planning. Co-ordinate care packagesfor patients as identified by the healthcare professional across health, socialcare, and mental health as appropriate, providing a single-point of access forstaff and service users, actively managing patients care plan delivery.

Care Coordinators, review patients needs and help themaccess the services and support they require to understand and manage their ownhealth and wellbeing, referring to social prescribing link workers and otherhealth care professionals where appropriate.

JobResponsibilities:

Provide coordination and navigation for peopleand their carers across health and care services, helping to ensure patientsreceive a joined-up service and the most appropriate support.

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

Explain the management of a patients pathway toclinical staff, liaising between services and service users, contactingservices using the appropriate procedures/referral mechanisms.

Work closely with all relevant care agencies(primary care, secondary care, community services, Mental Health, SocialServices, Ambulance Service, Voluntary Services, and other relevant serviceproviders) to ensure a coordinated patient care plan, without requiring afurther referral from the GP.

Collect data on patients/carers for recognisedoutcome measure and document for service interpretation. Ensure all patientnotes are updated/read coded to reflect any changes, including details on theircare plans.

Developing and maintaining the PCN Directory ofServices which contains a centralised contact list for relevant care providersincluding secondary, community and diagnostic providers to support referrals.

Act as the single point of contact for the PCNand establish systems and processes which will ensure a timely and appropriateresponse to queries from clinicians and other stakeholders.

Ensure regular and consistent communication withthe referrer regarding patient progress and any complications or guidance.

Raise awareness of health promotion and NHShealth checks in practices and with members of the local community.

Monitor referrals to ensure tasks are completedand care delivered by keeping in regular telephone contact.

Refer to PCN social prescribing link workers wherea patient is identified as potentially benefitting from this service.

Bring together all a persons identified careand support needs and explore their options to meet these into a singlepersonalised care and support plan, in line with best practice.

Raise awareness of shared decision-making anddecision support tools, assist people to be more prepared to have a shareddecision-making conversation.

Support the coordination and delivery of the PCNled Multi-disciplinary Team (MDT) meetings including collating patients fordiscussion, capturing minutes/actions, and updating care plans accordingly.

Working with the health care professionals wholead the care home weekly ward rounds to identify patients for acute androutine review.

Arranging care home ward rounds with therelevant healthcare professionals and care home managers.

Establishing processes for patients to bereviewed during the care home ward round.

Ensuring that all care home residents have apersonalised care plan in place and that this is reviewed appropriately in linewith the patients health needs.

Scoping and arranging community outreachsessions with the PCN team and linking in with the Digital and CommunicationsManager for promotion of the events and capturing case studies as a result.

Liaising with local community providers toschedule and coordinate the community outreach sessions including forwardplanning dates across the network, booking venues and arranging the teamsrotas accordingly.

Participate in community outreach events toraise awareness of national/local health campaigns to promote health andwellbeing to the local population.

Help people transition seamlessly betweenservices and support them to navigate through the health and care system.

Utilise population health intelligence toproactively identify and work with a cohort of patients to deliver personalisedcare.

Support patients to utilise decision aids inpreparation for a shared decision-making conversation.

Holistically bring together all a personsidentified care and support needs and explore options to meet these within asingle personalised care and support plan.

Help people to manage their needs throughanswering queries, making, and managing appointments, and ensuring that peoplehave a good quality written or verbal to help them make choices about theircare.

Raising awareness within the PCN and its memberpractices of shared decision-making and decision support tools.

Explore and assist people to access personalhealth budgets where appropriate.

Utilising SystmOne to set up searches, datacollection and creating rotas for the clinical team.

Reviewing and maintaining the clinical stockincluding protective personal equipment, stationary and medical equipment.Ordering as necessary.

Obtaining and sharing a calendar of nationalhealth campaigns and sourcing resources as appropriate.

Supporting the PCNs protected learning sessionswith arranging speakers, caterers, issuing certificate of attendance andgeneral on the day facilitation.

Supporting the PCNs Patient Participation Group(PPG) with taking minutes, following up actions, distributing meeting papersand working with the team to create a forward planner of agenda items fordiscussion.

Person Specification

Qualifications

• Educated to GCSE or equivalent.
• NVQ 3 or equivalent in Health and Social Care.

Experience

• Working within a health or social care environment.
• Experience of working with patients / clients.
• Knowledge of the needs of vulnerable adults, safeguarding and the associated legislative framework.
• Understanding of basic health and social care terminology.
• Proven ability to recognise and manage risk.
• Ability to communicate confidently with staff of all seniority levels.
• Experience of working flexibly and effectively within a multidisciplinary team
• Experience of having to prioritise caseload/manage own time effectively
• Experience of data collection and providing monitoring information to assess the impact of services.
• Ability to work on own initiative without direct supervision, understanding where clinical input is needed.
• Competent in the use of Microsoft Office packages and experience of using Microsoft Excel, Word, and Outlook.
• Experience of working in Primary Care.
• Experience of health and social care assessments.
• Experience of using GP Clinical Systems (i.e., SystmOne).

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.