Long Term Conditions Care Co-Ordinator

NHS; Carlisle; On-site; GBP 25,000 - 32,000; Full time

Job summary

A healthcare provider in Carlisle is seeking a Long-term Condition Care Co-ordinator to manage patient care and coordinate services across health and social care settings. The ideal candidate should have a strong understanding of NHS processes and excellent communication skills. This role focuses on patient engagement and support for individuals with long-term conditions, requiring strong organisational abilities and a commitment to empathetic care.

Qualifications

• Understanding of wider determinants of health.
• Knowledge of NHS workings, including primary care and PCNs.
• Ability to actively listen and provide personalised support.

Responsibilities

• Coordinate navigation of care across health and care services.
• Review patient needs and access care services.
• Conduct follow-ups on hospital communications and maintain referral records.

Skills

Knowledge of personalised care approach

Strong organisational skills

Excellent communication skills

Ability to empathise

Education

Educated to GCSE Level

Job description

Job Summary

Long-term Condition Care Co-ordinator – Join Warwick Square Group Practice as part of Carlisle Primary Care Network (PCN). You will proactively identify and support people with long-term conditions, coordinating navigation of care across health and care services.

Responsibilities

You will work closely with GPs, practice teams and Long-Term Conditions Nurses to manage a caseload of patients, acting as a central point of contact. Your duties include:

• Review patient needs, access care services and support carers.
• Carry out observations and investigations such as phlebotomy, blood pressure, weight management and diabetic foot checks.
• Provide personalised care and support plans, update records and communicate with clinicians and other professionals.
• Coordinate appointments across primary, secondary, community and voluntary organisations.
• Conduct follow-ups on hospital and in-patient communications, maintain referral records and support patient transition.
• Identify risk, manage safety concerns and act as a champion for personalised care and shared decision-making within the PCN.

Key Duties

• Enable access to personalised care and support.
• Take referrals and proactively identify people who could benefit from support through care coordination.
• Have positive, empathetic and responsive conversations with patients and carers.
• Work towards increasing patient understanding of managing health and wellbeing through advice and guidance.
• Develop an in-depth knowledge of local health and care infrastructure.
• Use tools to measure patients’ knowledge, skills and confidence in managing their health.
• Support patients to develop and implement personalised care and support plans.
• Review and update personalised care plans regularly.
• Record interventions and track patient progress.
• Maintain accurate, up-to-date records and adhere to data protection legislation.
• Actively participate in multidisciplinary team meetings.
• Identify opportunities and gaps in service delivery.

Qualifications

• Educated to GCSE Level.

Essential Experience

• Knowledge of personalised care approach.
• Understanding of wider determinants of health and commitment to equality, diversity and inclusion.
• Strong organisational skills, including planning, prioritising, time management and record keeping.
• Knowledge of NHS workings, including primary care and PCNs.

Desirable Experience

• Knowledge of safeguarding children and vulnerable adults policies and processes.
• Basic knowledge of long-term conditions.

Essential Personal Qualities

• Ability to actively listen, empathise and provide personalised support.
• Ability to provide culturally sensitive service for all backgrounds.
• Commitment to reducing health inequalities.
• Strong communication skills, both verbal and written.
• Risk identification and management skills.
• Maintain effective working relationships and promote collaborative practice.
• Demonstrate personal accountability, emotional resilience and work well under pressure.
• Organise, plan and prioritise on own initiative.
• High level of written and verbal communication skills.
• Flexible and enthusiastic within a team or on own initiative.
• Knowledge of policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety.

Desirable Personal Qualities

• Ability to provide motivational coaching to support peoples behaviour change.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and a submission for Disclosure to the Disclosure and Barring Service (formerly CRB) is required.

Employer Details

Eden Medical Group
Warwick Square Group Practice
Warwick Square
Carlisle
CA1 1LB
https://www.edenmedicalgroup.co.uk/