Care Coordinator

The Care Coordinator plays a key role within the Primary Care Network, proactively identifying and working with individuals particularly those who are frail, elderly, or living with long-term conditions to coordinate and navigate access to appropriate health and care services, ensuring they receive the right care, at the right time, from the right service. They work closely with GPs and practice teams to manage a caseload of patients, acting as a central point of contact to ensure appropriate support is made available to them and their carers. Care coordinators review patients' needs and navigate patients to help them access the services and support they require to understand and manage their own health and wellbeing, referring to social prescribing link workers and other professionals where appropriate. This non-clinical role focuses on improving the quality of life for patients by supporting them to manage their own health and ensuring they can access the right care and support when they need it. Care Coordinators help patients navigate the healthcare system and connect with appropriate services to enable better health outcomes. They will be caring, dedicated, reliable and enjoy working with a wide range of people. They will have good communication skills and strong organisational and time management skills. They will be highly motivated and proactive with a flexible attitude, keen to work and learn as part of a team and committed to providing people, their families and carers with high quality support.

Main duties of the job:

• Help individuals manage their health needs by responding to queries, arranging and managing appointments, and providing high quality written and verbal information to support informed decision making.
• Making and navigating appointment requests for patients, related to primary, secondary, community, local authority, statutory, and voluntary organisations.
• Work collaboratively with patients, their families, and carers to improve understanding of the individual's condition and support the development and regular review of personalised care and support plans to help manage their needs and achieve better health outcomes.
• Support and guide individuals in accessing self-referrals, peer support, health coaching, and other interventions that promote health and wellbeing.
• Identify unmet needs and refer patients to relevant services, including social prescribing link workers, community groups, mental health services.
• Work in partnership with GPs and other health care professionals within the PCN to proactively identify patients particularly those with long-term conditions who may benefit from care coordination or referral to additional support.
• Maintain accurate, up-to-date records of patient interactions and interventions using relevant clinical systems.
• Support the development of effective communication pathways between general practice teams, patients, carers, and other agencies involved in care delivery.

About us:

We are a PCN in our own right, which enables us to develop and shape the services we offer. The PCN is forward thinking and innovative, prioritising excellent patient care. The PCN has a friendly multidisciplinary team which includes: GPs, Nurses, Paramedics, Pharmacists, Physiotherapists, Frailty Team, Care Home Co-ordinator & Social Prescribers. We endeavour to recognise the value of our team members individually and collectively and to encourage their personal and professional development. We are committed to providing an open and supportive environment where all staff are comfortable sharing ideas and can expect to be provided with all the tools and support they need to enjoy working and succeeding.

If you share our passion for the NHS, believe in the value of quality patient care and would like to join our friendly and hardworking team within a practice that cares about staff health and wellbeing, we would be delighted to hear from you.

Key Responsibilities:

• Work collaboratively with patients, their families, and carers to improve understanding of the individual's condition and support the development and regular review of personalised care and support plans to help manage their needs and achieve better health outcomes.
• Help individuals manage their health needs by responding to queries, arranging and managing appointments, and providing high quality written and verbal information to support informed decision making.
• Support and guide individuals in accessing self-referrals, peer support, health coaching, and other interventions that promote health and wellbeing, empowering them to build the knowledge, skills, and confidence to manage their own care effectively.
• Assist individuals in accessing training, employment opportunities, and appropriate benefits, where eligible, such as through referral to social prescribing link workers.
• Identify unmet needs and refer patients to relevant services, including social prescribing link workers, community groups, mental health services, and voluntary sector organisations.
• Work in partnership with GPs and other primary care professionals within the PCN to proactively identify patients particularly those with long-term conditions who may benefit from care coordination or referral to additional support.
• Maintain accurate, up-to-date records of patient interactions and interventions using relevant clinical systems.
• Support the development of effective communication pathways between general practice teams, patients, carers, and other agencies involved in care delivery.
• Identify and support unpaid carers, helping them access appropriate services and resources to meet their own needs.
• Assist practices in keeping care records accurate and current by identifying and updating missing or outdated information about a patient's circumstances.

Person Specification:

Experience:

• Knowledge/experience of clinical medical systems.
• Experience of working in the NHS and preferably General Practice.
• Experience of communication with patients and vulnerable individuals.

Other essential criteria:

• Commitment to continuing professional development.
• Satisfactory completion of an enhanced check through the Vetting and Barring Service (this will be taken up if offered the post).
• Legal Right to work in the UK.
• Vaccinated or willing to be vaccinated for Hep B and other relevant employment vaccinations programmes.
• A commitment to anti-discriminatory practices in employment, training and service delivery.
• A flexible and adaptable approach to maintain the consistent delivery of high quality services.
• An understanding of Health and Safety.

Knowledge:

• Good organisational skills and methodical approach to managing a workload.
• Experience in patient navigation or care coordination.
• Calm and supportive approach to assisting patients or their carers navigate health and social care as needed.
• Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders.
• Ability to identify risk and assess/manage risk.
• Have a strong awareness and understanding of when it is appropriate or necessary to refer people to other health professionals/agencies.
• Ability to maintain effective working relationships and to promote collaborative practice with all colleagues.
• Ability to demonstrate personal accountability, emotional resilience and work well under pressure.
• Ability to actively listen, empathise with people and provide personalised support in a non-judgmental way.
• Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity.

Qualifications:

• Good standard of education with 5 C/GCSEs or equivalent.
• Evidence of continuing professional development.

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.