Care Co-ordinator in Northampton

We are looking to recruit to the post of care coordinator, to work within our Primary Care Network multidisciplinary healthcare team.

The successful candidate will play a key role in proactively identifying and working with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services.

They will work closely with GPs and practice teams, making sure that appropriate support is made available to people; supporting them to understand and manage their condition and ensuring their changing needs are addressed.

They will enable people to access the services and support they require to meet their health and wellbeing needs, helping to improve peoples quality of life.

They will work alongside social prescribing link workers and health and wellbeing coaches to provide an all-encompassing approach to personalised care and enable people navigate through the health and care system.

The postholder will work with a diverse range of people from different cultural and social backgrounds.

The ability to work confidently and effectively in a varied, and sometimes challenging environment is essential.

The successful candidate will have excellent interpersonal and communication skills, and be organised, patient and empathetic.

They will have experience of working in health, social care or other support roles including direct contact with people, families or carers.

Main duties of the job

Care coordinators play an important role within a PCN to proactively identify and work with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services.

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; supporting them to understand and manage their condition and ensuring their changing needs are addressed.

This is achieved by bringing together all the information about a person’s identified care and support needs and exploring options to meet these within a single personalised care and support plan, based on what matters to the person.

Care coordinators review patients needs and help them access the services and support they require to understand and manage their own health and wellbeing, referring to social prescribing link workers, health and wellbeing coaches, and other professionals where appropriate.

Care coordinators could potentially provide time, capacity and expertise to support people in preparing for or following-up clinical conversations they have with primary care professionals to enable them to be actively involved in managing their care and supported to make choices that are right for them.

Their aim is to help people improve their quality of life.

About us

The successful candidate will be based in a local cluster of General Practices as part of Parkwood Primary Care Network (PCN).

They will be caring, dedicated, reliable and person-focused and enjoy working with a wide range of people.

They will have good written and verbal 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.

This role is intended to become an integral part of the PCN’s multidisciplinary team, working alongside social prescribing link workers and health and wellbeing coaches to provide an all-encompassing approach to personalised care and promoting and embedding the personalised care approach across the PCN.

There may be a need to work remotely depending on the requirements of the role.

Please note that the role of a care coordinator is not a clinical role.

Job responsibilities

Key responsibilities

• 1. Enable access to personalised care and support
• Take referrals for individuals or proactively identify people who could benefit from support through care coordination;
• Have a positive, empathetic and responsive conversation with the person and their family and carer(s) about their needs;
• Work towards increasing patients understanding of how to manage and develop health and wellbeing through offering advice and guidance;
• Develop an in-depth knowledge of the local health and care infrastructure and know how and when to enable people to access support and services that are right for them;
• Use tools to measure people’s levels of knowledge, skills and confidence in managing their health and to tailor support to them accordingly;
• Support people to develop and implement personalised care and support plans;
• Review and update personalised care and support plans at regular intervals;
• Ensure personalised care and support plans are communicated to the GP and any other professionals involved in the person’s care and uploaded to the relevant online care records, with activity recorded using the relevant SNOMED codes.
• 2. Coordinate and integrate care
• Making and managing appointments for patients, related to primary, secondary, community, local authority, statutory, and voluntary organisations;
• Help people transition seamlessly between secondary and community care services, conducting follow-up appointments, and supporting people to navigate through wider the health and care system;
• Refer onwards to social prescribing link workers and health and wellbeing coaches where required;
• Regularly liaise with the range of multidisciplinary professionals and colleagues involved in the persons care, facilitating a coordinated approach and ensuring everyone is kept up to date so that any issues or concerns can be appropriately addressed and supported;
• Actively participate in multidisciplinary team meetings in the PCN as and when appropriate;
• Identify when action or additional support is needed, alerting a named clinical contact in addition to relevant professionals, and highlighting any safety concerns.
• Record what interventions are used to support people, and how people are developing on their health and care journey;
• Keep accurate and up-to-date records of contacts, appropriately using GP and other records systems relevant to the role, adhering to information governance and data protection legislation;
• Work sensitively with people, their families and carers to capture key information, while tracking the impact of care coordination on their health and wellbeing;
• Encourage people, their families and carers to provide feedback and to share their stories about the impact of care coordination on their lives;
• Record and collate information according to agreed protocols and contribute to evaluation reports required for the monitoring and quality improvement of the service.
• 3. Professional development and governance
• Work with a named clinical point of contact for advice and support;
• Undertake continual personal and professional development, taking an active part in reviewing and developing the role and responsibilities, and provide evidence of learning activity as required;
• Adhere to organisational policies and procedures, including confidentiality, safeguarding, lone working, information governance, equality, diversity and inclusion training and health and safety.
• 4. Team and service improvement
• Establish strong working relationships with GPs and practice teams and work collaboratively with other care coordinators, social prescribing link workers and health and wellbeing coaches, supporting each other, respecting each others views and meeting regularly as a team;
• Act as a champion for personalised care and shared decision making within the PCN;
• Demonstrate a flexible attitude and be prepared to carry out other duties as may be reasonably required from time to time within the general character of the post or the level of responsibility of the role, ensuring that work is delivered in a timely and effective manner;
• Identify opportunities and gaps in the service and provide feedback to continually improve the service and contribute to business planning;
• Contribute to the development of policies and plans relating to equality, diversity and reduction of health inequalities;
• Work in accordance with the practices and PCNs policies and procedures;
• Contribute to the wider aims and objectives of the PCN to improve and support primary care.

Person Specification

Qualifications

• NHS & Primary Care Networks (PCNs) Qualifications

• Level 2 or 3 in Health and Social Care, or the Care Certificate.
• Training: Personalised Care Institute accredited training in personalised care and support planning.
• If a candidate deems suitable for this role without completing the above qualification we would look to enrol them (2 day course) to meet the requirement, with a contractual agreement in place to stay with the Business for 2 years or repay the fee of the course if they were to leave earlier than the 2 year fixed term contract.
• Experience: Experience using clinical IT systems (like EMIS Web or Systm One), handling patient triage, and working in a GP or NHS environment
• Communication & Interpersonal Skills
• Active listening: Understanding patient needs and anxieties without interrupting.
• Empathy: Showing genuine care and compassion to vulnerable individuals.
• Clear speaking: Explaining complex care plans simply to patients and families.
• Written clarity: Writing accurate, concise case notes and emails for medical teams.
• Technical & Organizational Skills
• Time management: Balancing rotating schedules, sudden emergencies, and routine check-ins.
• Digital literacy: Navigating scheduling software and electronic patient records effortlessly.
• Emotional & Professional Resilience
• Stress tolerance: Staying calm and focused during high-pressure situations or medical crises.
• Conflict resolution: Diffusing tension between frustrated family members or stressed staff.
• Cultural sensitivity: Respecting diverse backgrounds, beliefs, and lifestyle choices.
• Team collaboration: Working seamlessly with doctors, social workers, and families

Experience

• Experience working in the NHS
• Personal or professional experience working with complex needs of patient care and co-ordination.
• Experience working with mental health, with a mental health first aid qualification
• Experience with coordinating well-being - coaching
• Experience working in Primary Care
• Experience working in a GP Practice
• Experience in Corporate Healthcare
• 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.

• Part-time, Flexible working, Home or remote working
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