York Road PCN Care Coordinator

NHS; Leeds; On-site; GBP 20,000 - 30,000; Full time

Job summary

A healthcare provider in Leeds is seeking a Care Coordinator to support their Primary Care Network. The role includes coordinating care in registered Care Homes, assisting with dementia reviews, and engaging in multidisciplinary team meetings. Applicants should have experience in health or social care and possess strong communication skills. This position offers the chance to significantly impact patient care and well-being.

Qualifications

• Experience in health or social care roles.
• Administrative duties including preparing for meetings.
• Ability to adapt to a changing environment.

Responsibilities

• Lead and organise GP ward rounds in care homes.
• Coordinate and minute MDT meetings for care homes.
• Support vulnerable patients living in the community.

Skills

Effective verbal communication skills

Understanding of health inequalities

Ability to use own initiative

Analyzing patient data

Education

GCSEs/Diploma/HNC level

Tools

Microsoft Word

Microsoft Excel

Microsoft Teams

Job description

Job summary

LOCATION: York Road PCN – You will be based at one of the 5 surgeries in the PCN but will be expected to travel between the practices in the PCN when required.

An exciting opportunity has arisen for a Care Coordinator to support York Road Primary Care Network (PCN), with the primary focus on coordinating care within the PCNs two registered Care Homes. The post holder will work closely with GPs, nurses, pharmacists, care-home staff and the wider multidisciplinary team to deliver high-quality, person-centred care to residents, many of whom are living with frailty, dementia or long-term conditions.

A significant part of the role includes supporting weekly GP ward rounds, completing or assisting with dementia reviews, and coordinating and minuting weekly MDT meetings for each care home, ensuring all residents receive timely, proactive and well‑organised care.

The post holder will act as a consistent point of contact for residents, patients, families and carers, care home staff and ensuring continuity, holistic support and improved outcomes.

Posted: 25 November 2025

Job responsibilities

Primary Care-Home Responsibilities

• Lead and organise weekly GP ward rounds in each care home, ensuring residents due for review are prepared and all follow‑up actions are recorded and communicated.
• Support and/or complete dementia reviews, gathering information, engaging with families and care‑home staff, and updating clinical records.
• Coordinate, prepare for and minute weekly MDT meetings for each care home, ensuring high‑quality communication across the multidisciplinary team.
• Develop and maintain Personalised Care and Support Plans (PCSPs) for care‑home residents, ensuring a holistic, person‑centred approach.
• Proactively identify residents at risk of deterioration, escalating appropriately to prevent unplanned hospital admissions.

Wider PCN & Community Care Responsibilities

• Support the PCN team in coordinating personalised care for vulnerable patients living in the community, including frail/elderly individuals and those with multiple long‑term conditions.
• Meet with people, families and carers in practices, in their homes, in community locations or in care homes to review needs, co‑ordinate care and help them access appropriate services.
• Assist patients and families in understanding their health conditions, navigating support options and managing their own wellbeing.
• Refer patients to primary care, social care, community and voluntary‑sector services where appropriate.
• Work jointly with PCN staff including social prescribers, pharmacists, mental health teams and community services to ensure high‑quality joined‑up care.

Clinical & Monitoring Tasks (if trained/competent)

• Undertake delegated tasks such as phlebotomy, blood pressure checks, observations and health checks within care homes and the wider community.
• Support clinicians by preparing information for reviews and completing agreed follow‑up actions.

Communication & Coordination

• Act as a central point of contact for residents, patients, families, care‑home staff and PCN colleagues.
• Communicate sensitively using language appropriate to the patient or carers level of understanding.
• Promote shared decision‑making and help individuals prepare for clinical conversations.

Administration, Record Keeping & Data

• Prepare documentation for ward‑rounds, dementia reviews and MDT meetings.
• Update care plans and patient records accurately, using appropriate coding.
• Analyse data to identify priority residents or patient groups requiring targeted intervention.
• Maintain strict confidentiality in line with GDPR and organisational policies.

Safeguarding

• Identify safeguarding concerns and elevate in line with local policy.
• Support safeguarding processes and investigations when required.

Partnership Working

• Build strong working relationships with care‑home teams, community health professionals, social care and voluntary‑sector organisations.
• Improve access to support services for both care‑home residents and vulnerable community patients.
• Contribute to PCN initiatives and public health campaigns, including vaccinations and screening.

Person Specification

Other requirements – Essential

• Right to work in the UK
• Car owner and has valid UK driving licence to travel across the PCN area and attend city wide meetings
• Professional attitude and appearance
• Reliability and ability to adapt to a changing environment including remote working when required
• Flexibility to develop the role as care coordinator to meet the needs of the PCN Service Specifications

Experience – Essential

• Experience of working in health, social care and other support roles in direct contact with people, families or carers (in a paid or voluntary capacity)
• Signposting to patient services
• Administrative duties including preparing for meetings and writing minutes
• Working in partnership with other organisations to improve outcomes
• Working in changing environments with high demand
• Completing audits and writing reports
• Microsoft Word/ Excel/ PowerPoint/ Teams applications
• Multidisciplinary team working including health, social and 3rd sector organisations

Desirable

• Experience in phlebotomy, general observations, wound care, health checks
• Understands about primary care and community services
• Using clinical systems and other digital software
• Working with patients/service users in a face‑to‑face role in the delivery of personal services

Skills and knowledge – Essential

• General Data Protection Regulations and Confidentiality
• Effective verbal, written and digital communication skills
• Health inequalities and wider determinants of health
• Understanding of the needs of older people / adults with disabilities / long term conditions particularly in relation to promoting their independence
• Understanding of medical terminology around frailty, population health management and long term conditions
• Ability to use own initiative and prioritises own workload without direct supervision
• Collecting and analysing patient data sets / reports to identify patient cohorts to prioritise
• Willing to develop and undertake training as required

Desirable

• Understanding of the current issues facing the NHS including Primary Care Networks

Qualifications – Essential

• Education and Qualification
• GCSEs/Diploma/HNC level (or relevant experience)

Desirable

• NVQ Level 3 in a health or social care related discipline (or relevant experience)
• Care Certificate
• ECDL or other equivalent IT qualification

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.

Employer details

South and East Leeds GP Group

Hosted employer's address

1st Floor Park Edge Practice

Leeds

West Yorkshire

LS14 1HX