PCN Care Coordinator

Rosedale Surgery; Lowestoft; Sur place; GBP 23 000 - 32 000; Plein temps

Résumé du poste

Rosedale & Kirkley Mill Surgeries in Lowestoft are seeking a PCN Care Coordinator to help patients and carers access services, coordinate care and stay connected with health and wellbeing supports.

You will support carers assessments, coordinate dementia and learning disability reviews, arrange health checks and liaise with social services and occupational therapy to deliver joined-up care across our two sites.

Qualifications

• GCSE or above in Maths and English.
• Qualification relevant to health or social care.
• Experience of developing relationships with a wide variety of people.
• Experience of working in primary care or GP practice.
• Coordination of services from a range of organisations.
• Proficient in use of SystmOne.

Responsabilités

• Coordinate care plans by collaborating with GPs, nurses, pharmacists, social prescribing link worker and health coach.
• Coordinate care between health and social care services for each patient.
• Carry out home visits for housebound patients where needed.
• Use practice reports to identify patient cohorts for personalised care.
• Provide data for audit and monitoring and data returns to the ICB.
• Keep accurate records in the GP system and the care plan.

Connaissances

Relationship building

Care coordination

Communication

Team collaboration

Formation

GCSEs in Maths & English

Outils

SystmOne

Description du poste

Join Rosedale & Kirkley Mill Surgeries as a PCN Care Coordinator and make a real difference to patients and carers in our community. Working alongside our supportive multidisciplinary team, you will help people access services, coordinate care and feel supported in managing their health and wellbeing.

Your varied role will include supporting carers, coordinating dementia and learning disability reviews, arranging health checks, liaising with social services and occupational therapy, and contributing to Lowestoft Primary Care Projects.

If you are compassionate, organised and enjoy building relationships, this is an opportunity to bring your skills to a team committed to personalised, accessible care.

Main duties of the job

You will work with patients, carers and our wider practice team to coordinate care, arrange reviews and connect people with appropriate health, social care and community support.

Your main duties will include:

Supporting carers assessments and acting as a Carers Champion.

Coordinating dementia reviews and annual health reviews for people with learning disabilities.

Arranging and supporting health checks and follow‑up care.

Liaising with social services and coordinating occupational therapy referrals.

Supporting delivery of the PCN CCCP project.

Maintaining accurate patient records and following up outstanding actions.

You will build trusting relationships with patients and carers, helping ensure their needs are understood and that care is joined up across services.

About us

At Rosedale & Kirkley Mill Surgeries, we care for over 23,000 patients across Lowestoft, with a team of more than 70 staff working across our two sites.

As a PCN Care Coordinator, you will work alongside our Health & Wellbeing Coaches, Data & Quality team and care coordinators across the wider network to deliver joined‑up care and improve patient outcomes.

We are a supportive, loyal team who value different perspectives and welcome open discussion. We challenge ideas respectfully, celebrate successes and maintain a healthy sense of humour. General practice is demanding, and we believe enjoying coming to work matters.

Job responsibilities

• Work with individual patients, using a holistic approach, to identify their goals for care, and agree a personalised care and support plan for their care
• Support delivery of these care plans by co‑coordinating input from a range of different professionals and services, and helping patients and their carers/family to navigate across health and social care services
• Work as part of the primary care team, coordinating care between GPs, practice nurses, clinical pharmacists, social prescribing link worker and health coach
• Work with patients over the phone, in person in the practice or for those who are housebound where necessary carry out home visits.
• Use practice level reports to identify suitable cohorts of patients to deliver personalised care
• Provide accurate and timely data to support audit and monitoring of the service, and any data returns as required by the ICB
• Keep accurate and up to date records of contacts with patients and their carers/ families in the patients GP record and in their care plan

Full job description is attached.

Person Specification

Qualifications

• GSCE or above in Maths and English
• Qualification relevant to health or social care

Experience

• Experience of developing relationships with a wide variety of people
• Experience of working in primary care or GP practice
• Coordination of services from a range of organisations
• Proficient in use of 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.