PCN Care Coordinator

Hurley Group; Greater London; On-site; GBP 30,000 - 40,000; Full time

Job summary

A healthcare organization is seeking a PCN Care Coordinator to support patients in managing their care. This role involves communication with GPs and clinicians to ensure comprehensive care for patients. Applicants should possess excellent organizational skills, be knowledgeable in personal care approaches, and be adept at using clinical systems. The position is permanent with 37.5 hours per week and offers the opportunity to make a positive impact in patient care.

Qualifications

• Ability to organize, plan, and prioritize on own initiative, especially under pressure.
• Experience of working with healthcare professionals or previous experience in the NHS or social care.
• Knowledge of personalised care approach and medical terminology.

Responsibilities

• Support patients in managing their care and coordinate their needs.
• Identify and manage a caseload of patients while ensuring appropriate support.
• Document and monitor patient coordination and service delivery.

Skills

Excellent communication

Administrative skills

Time management

Teamwork

Problem-solving

Education

ECDL or equivalent

Training in motivational coaching

Tools

EMIS ERS

Microsoft Office (Word, Excel, PowerPoint)

Job description

We are looking for 1 WTE PCN Care Coordinators with excellent communication and administrative skills to work with the GPs and other clinicians within the Waterloo Health Centre.

You will be working with GPs and other clinicians, to assist patients in the management of their care.

One of successful care coordinators will concentrate on providing Administration support across practices as well as Care Coordination.

You will be none judgmental, empathetic as the first point of contact for patients, clinicians and community carers. Identifying personalised care plans, engaging them in training and employment to improve their wellbeing.

Having excellent time management skills will be important to manage your workloads and deliver role objectives within the timescales

*Previous applicants need not apply*

Main duties of the job

North Lambeth Primary Care Network are excited to advertise a new rolein our network

As a Care coordinator you will play a crucial role in supportingpatients in preparing for or in following-up clinical conversations they havewith primary care professionals.

You will work closely with the GPs and other primary care professionalswithin the PCN to identify and manage a caseload of identified patients, makingsure that appropriate support is made available to them and their carers, andensuring that their changing needs are addressed.

You will focus delivery of the comprehensive model to reflect localpriorities, health inequalities or population health management riskstratification.

About us

North Lambeth PCN:

North Lambeth Primary Care Network consists of 6 practices (Hurley andRiverside Practices, Lambeth Walk Group Practice, Mawbey Group Practice,South Lambeth Road Group Practice, Waterloo Health Centre and the VauxhallSurgery) working together to provide excellent patient care to a population ofover 69,000 patients. As a Network we are striving to be at the forefront ofPCN development and are involved in several exciting pilot projects.

Job responsibilities

1x PCN Care Coordinators wanted at North Lambeth Primary Care Network

Role Title

Hours

37.5hours per week.

Duration

Permanent

Reporting to

PCN Network Manager

Location

NorthLambeth member practices for the Primary Care Network

Key responsibilities

• 1.Undertakework in line with PCN directed priorities.
• 2.Proactively identify and work with a cohort of people to supporttheir personalised care requirements, using the available decision support aids
• 3.Ensure regular and consistent communication with the referrer regarding patientprogress and any complications or guidance
• 4.Raise awareness of health promotion and NHS health checks inpractices
• 5.Work with Member Practices to facilitate the .
• 6.Evaluate treatment programmes that promote health andwell-being
• 7.Co-ordinate clinics, liaising with the schedulers and contacting the identified patients with appointments.
• 8.Manage patient initiated calls for help/signposting etc,booking into named GP urgent care slots/tel slots if necessary.
• 9.Document and monitor aspects of patient co-ordination andservice delivery, supporting data collection and audit using the patientadministration system
• 10.Demonstrate the ability to recognise and respondappropriately when faced with a sudden deterioration or emergency situation,alerting the team or enabling a rapid response.
• 11.Dependant on work plans, there may be a requirement to workacross different tumour groups and teams.
• 12.Organise and prioritise own workload the postholder shouldbe comfortable working independently and as a committed member of the multi-disciplinary team.
• 13.Support national screening programmes
• 15.Monitor referrals to ensure tasks are completed and care delivered by keeping in regulartelephone contact
• 16.Direct liaisonwith multi agencies to coordinate care for patients
• 17.Refer to PCN social prescribing link workers were a patient is identified as potentially benefitting from this service
• 18.To support patient/carer contact roles, and collate patient and carer feedback on theirexperiences
• 19.Support Qualityand Outcome Frameworks and other DES/LES specifications
• 20.Maintain and develop engagement with all practice staff and encourage best practice
• 21.Act as the first port of call for patients, in their caseloadin relation to their care.
• 22.Bring together all of a persons identified careand support needs, and explore their options to meet these into a single personalised care and support plan (PCSP), in line with PCSP best practice
• 23.Help people to manage their needs, answeringtheir queries and supporting them to make appointments
• 24.Support people to take up training, employmentand access appropriate benefits where eligible
• 25.Raise awareness of shared decision-making and decisionsupport tools, and assist people to be more prepared to have a shareddecision-making conversation
• 26.Ensure that people have good quality informationto help them make choices about their care
• 27.Support people to understand their level of knowledge,skills and confidence their Activation level when engaging with theirhealth and wellbeing, including using the Patient Activation Measure
• 28.Assist people to access self-management educationcourses, peer support or interventions that support them in their health andwellbeing
• 29.Explore and assist people to access personalhealth budgets where appropriate
• 30.Provide coordination and navigation for people andtheir carers across health and care services, alongside working closely withsocial prescribing link workers and other primary care roles
• 31.Support the coordination and delivery of MDTswithin PCNs. - ManageMDT meetings for this patients and identifying issues to be addressed, liaisingwith other agencies if necessary as well as GPs, Pharmacists and Nursing team.
• 32.Liaise directly withCare Homes and other key providers, to identify patients for discussion at MDT,and compile and circulate relevant information to attendees
• 33.Other duties asdefined by the PCN as necessary

Confidentiality

In the course of seeking treatment,patients entrust us with, or allow us to gather, sensitive information inrelation to their health and other matters. They do so in confidence and havethe right to expect that staff will respect their privacy and actappropriately.

In the performance of the dutiesoutlined in this job description, the post-holder may have access toconfidential information relating to patients, their carers, practice or staffinformation. All such information from any source is to be regarded as strictlyconfidential.

Information relating to patients,carers, colleagues, or the members practices may only be divulged to authorisedpersons in accordance with PGPA policies and procedures relating toconfidentiality and the protection of personal and sensitive data, or under theguidance of your manager.

This role profile is not exhaustive, and you may be directed tocomplete other tasks according to the skills and requirements for individualroles. These duties will always be reasonable and deemed within theexpectations of your position.

Person Specification

Personal Qualities & Attributes

• Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines.
• Able to work as part of a team
• Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
• Ability to communicate effectively, both verbally and in writing, with people, their families, carers, partner agencies and stakeholders.
• Ability to maintain effective working relationships and to promote collaborative practice with all colleagues in PCN and the various Practice teams
• Demonstrates personal accountability, emotional resilience and works well under pressure

Skills and knowledge

• Knowledge of the personalised care approach
• Advanced experience of using word, excel and PowerPoint including ability to use word processing skills, emails and the internet to create simple plans and reports
• Creative problem solver and willing to search for hard-to-find information
• Knowledge of general practice clinical systems, such as, EMIS ERS, Footfall
• Ability to read large amounts of information and extract the salient points, to analyse data and report on findings

Other

• Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
• Access to own transport and ability to travel across the locality on a regular basis
• Continued commitment to improve skills and ability in new areas of work

Experience

• Experience of working with healthcare professionals and or previous experience in the NHS or social care or relevant field (including unpaid work)
• Experience of data collection and providing monitoring information to assess the impact of services
• Experience of partnership/collaborative working and of building relationships across a variety of organisations
• Experience of working with or in general practice
• Working in a multi-disciplinary setting where influence and negotiation is required
• Knowledge/familiarity with medical terminology
• Experience of supporting people, their families and carers in a related role (including unpaid work)
• Experience in use of databases
• Vulnerable adults awareness
• Experience of care of the elderly

Qualifications

• ECDL or equivalent
• Demonstrable commitment to professional and personal
• development
• Training in motivational coaching and interviewing or equivalent

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.