Community Care Coordinator

Northamptonshire Healthcare NHS Foundation Trust; Northampton; Remote; GBP 28,000 - 31,000; Full time

Benefits offered by this job

Living wage employer

Flexible working

Job summary

Northamptonshire Healthcare NHS Foundation Trust is recruiting for a Community Coordinator in Northampton within the Age Well Teams. The post supports older people at home, coordinating holistic assessments and care plans to maintain independence and reduce isolation.

The role requires hands-on clinical care experience in a health setting, with a focus on frailty, coordination with GP practices and wider health and social care partners. Flexible hours and a DBS check are in scope.

Qualifications

• Previous experience in caring role/profession.
• Experience of care coordinator role in the community.

Responsibilities

• Liaise with GPs and practice teams to identify frail elderly patients and arrange support.
• Undertake initial home visits and assessments within a patient’s own home and make referrals.
• Conduct basic health checks such as weight, nutrition, and blood pressure monitoring.
• Support patients to remain independent at home and reduce crisis risk.
• Coordinate referrals to ensure timely, coordinated care within the locality.
• Attend PCN Frailty Clinics and work with families and support networks.
• Maintain case load and use clinical systems for documentation and audit.

Tools

Microsoft packages

Electronic diary management

S1 / EPR experience

Job description

Main area Community Nursing Grade NHS AfC: Band 4 Contract 12 months (Fixed term contract with possibility for extension) Hours Full time - 37.5 hours per week Job ref 270-TH458-AD

Site GP practices within PCN Town Northampton Salary £28,392 - £31,157 pro rata Salary period Yearly Closing 02/11/2026 23:59

Job overview

Northamptonshire has the ambition that our older population can be happy, healthy and able to maintain independence for as long as possible. Our older population tell us that it can be complicated and confusing to know where best to seek advice and support, that time is often needed to review wider health needs as opposed to ten-minute appointments and that social isolation and fear of ageing are major factors on wellbeing. We want to fix this to make sure that all of our older population have personalised and holistic support plans and have their own link person who will ensure timely support is available when needed. The bedrock of our change programme is to continue with the creation of local support teams matching the geographic areas covered by our Primary Care Networks (PCN). These teams combine staff from voluntary sector, adult social care and health, linked to a team of specialists, and led by the Frailty Specialist GP in each PCN.

For this role we are seeking to appoint to PCNs in the Northampton area (MWEB and Royal Parks) and there is a need to work on Mondays and Thursdays as part of the working pattern to be agreed with the successful candidate.

Main duties of the job

• Liaise with GPs and practice teams to identify persons who are elderly, frail or who have long term health needs and support
• Arrange, coordinate and undertake initial home visits and assessments of need within a patient's own home, making relevant referrals
• Undertake basic health checks such as weight, nutrition, blood pressure monitoring
• Support persons within the community to be able to remain as independent as possible within their own home and reduce the risk of crisis support.
• Tasks may include but not limited to assessment and provision of Iow level mobility aids, house clearance and cleaning, provision of items to meet basic needs such as emergency food parcels, supporting individuals with housing, finances, medication and follow up appointments.
• Coordinate and attend PCN Frailty Clinics.
• Work alongside families and a person's wider support network, ensuring their choices, needs and support within their own home are met as a long- term plan.
• Helping persons to access existing groups and events taking place within their communities.
• Document and monitor aspects of patient co-ordination and service delivery, supporting data collection and audit using the practices clinical system as well as organisational data Systems
• Maintain an individual case load whilst working cohesively alongside other Age Well partner organisations, supporting a collaborative approach

Working for our organisation

NHFT is an NHS Community and Mental Health Foundation Trust, providing physical, mental health and specialty services in hospital settings and in the community. We provide over 200 services across the county - as well as some specialist services in bordering and nearby counties. We work together with our partners to ensure that everyone who comes through our doors receives compassionate, person-centred care, regardless of their background or circumstances.

NHFT promotes a culture of learning, to improve the care and safety of our patients and colleagues. We have achieved our 'outstanding' rating by encouraging opportunity, innovation, development and growth across our workforce.

At NHFT we believe that work should be rewarded in every sense which is why we are proud to an accredited living wage employer.

We aim to support financial wellbeing and create an environment where are people feel valued and able to thrive.

Detailed job description and main responsibilities

As a Community Coordinator in one of the local Age Well Teams you will be responsible for undertaking comprehensive holistic assessments of identified frail older people, usually in their own homes, to create personalised care plans which will assist the person to live well in their own environment, manage their long-term conditions, reduce isolation and improve their general wellbeing and quality of life. Candidates therefore need a range of experience, including hands on clinical care in a health setting, as a Health Care Assistant or similar, and be passionate about providing effective support to our older population within the community. A good understanding of services available both within the community and hospital and an interest in frailty so patients can be supported is essential. As a Community Coordinator you Will co-ordinate referrals to ensure patients within the locality receive excellent and timely support. The ability to develop close working relationships with other health and social care partners is an essential aspect of this role. Every team member will have direct access to their local Befriending lead, and lead support workers for Falls and for Dementia. Through additional training if required you will identify low level equipment needs and instruct for these to be provided and identify how technology can be used to maintain independence and help self management of long term conditions and instruct for digital solutions to be provided.

Person specification

Experience

• Previous experience in caring role/profession
• Experience of care coordinator role in the community

IT

• Intermediate level of IT skills, including Microsoft packages
• Electronic diary management skills
• Enhanced IT skills with appropriate qualification to evidence
• S1 or equivalent EPR experience

Qualifcation

We are an equal opportunities employer, which aims to employ a workforce that reflects the diverse communities we serve. We welcome applications from all suitably qualified persons from all backgrounds.

All roles are subject to the home office immigration rules and therefore eligibility must meet certain requirements for any sponsorship to be considered.

At NHFT we support many of our colleagues to work flexibly and we will consider requests for flexible working from day one. For this role, we are open to discussing a range of options including flexible hours, agile/home working, compressed hours and part time hours.

Applicants who have a disability and meet the essential criteria for the job will be considered under the Guaranteed Interview Scheme.

All posts that are engaged in a regulated activity will be subject to a Disclosure and Barring Service (DBS) check and a DBS re-check on a three yearly basis whilst employed in such a role. Staff employed in these posts will therefore be asked to register with the DBS Automatic Update Service upon receipt of their DBS certificate and must update yearly , the annual fee will be reimbursed subject to Trust policy. For further information please visit: DBS Update Service: applicant guide - GOV.UK (www.gov.uk)

Please note that all new starters to the trustare subject to a probationary period.

Employer certification / accreditation badges

This post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 and it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service.

Name Lauren Steele Job title Ageing Well Team Service Manager Email address [e-mail] Telephone number 07729101961 Additional information

Angelique Smit [e-mail]