Overview
The Complex Care Coordinator will support and coordinate health services across the PCN, working with the Complex Care Team to support patients with long term conditions and mental health issues. The post holder will work with patients, families, carers, and multidisciplinary teams to ensure care is joined up, personalised, and responsive. The role focuses on proactive case management, coordination of services, and navigation of the health and social care system to improve patient outcomes and reduce health inequalities. The role operates in the community across the PCN in partnership with primary and secondary care professionals.
Responsibilities
- Patient Care and Case Management: act as a central point of contact for patients with complex health and care needs; undertake holistic assessments; develop and maintain personalised care and support plans; monitor progress and adapt care plans; support patients to self-manage their conditions where possible.
- Care Coordination: liaise with GPs, practice nurses, mental health services, community teams, social care, and voluntary sector organisations to ensure integrated care; identify patients at high risk and coordinate interventions; manage transitions of care and referrals; signpost patients to the appropriate healthcare professionals; ensure timely access to mental health support; assist access to self-management education courses and personal health budgets where appropriate; support benefits access, employment and training as eligible; provide coordination and navigation across health and social care services with relevant primary care professionals; participate in MDT delivery within PCNs.
- Communication and Collaboration: work within a multidisciplinary team, contribute to case reviews and meetings; build relationships with community and voluntary sector partners; advocate for patients and provide information and guidance in clear, accessible language.
- Service Development and Quality: contribute to audits, data collection and evaluation; maintain accurate records in line with local policies and information governance standards.
About Us
Lincoln Healthcare Partnership (LHP) PCN is composed of two practices (Brayford Medical Practice and Heart of Lincoln Medical Group) in central Lincoln with a patient population of just under 40,000.
Details
- Date posted: 17 September 2025
- Pay scheme: Other
- Salary: £13.57 per hour
- Contract: Fixed term
- Duration: 16 months
- Working pattern: Full-time
- Reference number: A0720-25-0027
- Job locations: Lincoln Healthcare Partnership (PCN), Langton House, Lindum Business Park, Lincoln, LN6 3QX
Job Description
Job responsibilities
- Patient Care and Case Management: act as a central point of contact for patients with complex health and care needs; undertake holistic assessments; develop and maintain personalised care and support plans; monitor progress and adapt support as needs change; promote independence and wellbeing.
- Care Coordination: liaise with GPs, practice nurses, mental health services, community teams, social care, and voluntary sector organisations to ensure integrated care; identify high-risk patients; coordinate interventions; manage transitions of care; signpost to appropriate professionals; ensure timely access to mental health support; support access to self-management education courses and interventions; assist access to personal health budgets where appropriate; support benefits access and employment/training where eligible; coordinate navigation of health and social care services with primary care professionals; participate in MDT within PCNs.
- Communication and Collaboration: be part of a multidisciplinary team; build relationships with community and voluntary sector partners; advocate for patients; provide information, advice, and guidance in clear language.
- Service Development and Quality: contribute to audits and data collection; maintain records to policy and governance standards.
Person Specification
Essential qualifications and skills
- GCSE A* - C or equivalent in Maths and English
- Experience in care coordination or clinical administration
- Excellent communication skills (written and oral)
- Strong IT skills; competent in Office and Outlook; EMIS/Systmone/Vision user skills
- Effective time management; ability to work as part of a team and autonomously
- Good interpersonal skills; problem-solving and analytical abilities
- Ability to follow clinical policy and procedures
- Polite, confident, and flexible to work outside core office hours
- DBS check; driving licence and access to a vehicle
- Commitment to ongoing professional development; ability to work under pressure; empathetic and patient-focused
Desirable
- Experience of working in a primary care environment
- Experience with audits and leading audit programmes
- Experience with clinical risk management
Other Information
Disclosure and Barring Service Check: This post is subject to the Rehabilitation of Offenders Act and a DBS disclosure will be required. This post is within the Lincoln Healthcare Partnership PCN and the Heart of Lincoln Medical Group. The employer's website: https://newarkroadsurgery.co.uk/