Pcn Care Co-ordinator
5 months ago
The South Hams is a region of rural and coastal Devon, much of which is designated as an Area of Outstanding Natural Beauty with some of the most beautiful beaches and coastal walks, a great place for family and friends to enjoy. It has a mild climate and is a wonderful place to live and work. It has been long recognised as a 'foodies' paradise with many niche and high-end producers servicing fantastic local restaurants, farmers markets and celebrated food festivals. Working for the South Hams Primary Care Network you will have the opportunity of flexible working patterns with support and encouragement to learn by offering training programs, mentoring and tuition assistance for work-related courses.
You will be part of a team network and where you will feel you are making a difference. We offer an NHS pension scheme and excellent annual leave allowances. You will work as part of a multidisciplinary team to: Work with the PCN to support the personal care requirements for an identified cohort of patients, using available decision support aids. Support the PCN in bringing together all of a patients identified care and support needs, and explore options to meet these within a single personalised care and support plan (PCSP), in line with PCSP best practice, based on what matters to the patient.
Support the PCN in improving overall patient care through promotion of services available to them locally within the PCN and the wider health system Support the practices in identifying appropriate patient cohorts for targeted intervention Coordinate multidisciplinary meetings across local care organisations identifying patients in need of review and collating any information required to facilitate their review prior to the meeting. Provide admin support to multidisciplinary meetings including taking minutes. Liaise with other key stakeholders as needed for the collective benefit of the patient including but not limited to GPs, nurses, pharmacists and other support staff from within the PCN practices or from other provider organisations. Assist patients and carers in managing their own needs, answering their queries and supporting them to address their needs.
Communicate effectively and sensitively using language appropriate to the patient and their carer and their level of understanding. Provide accurate, impartial information, support and guidance to patients and their carers to enable them to make choices about their care. Raise awareness of shared decision making and decision support tools and assist patients to be more prepared for shared decision-making conversations. Provide coordination and navigation for patients and their carers across health and social care services, where appropriate linking with social prescribers and other patient link workers in the PCN.
Work in partnership with key providers in the local community to enable improved access to services for patients support patients to take up training and employment, and to access appropriate benefits where eligible Explore and assist patients to access personal health budgets where appropriate Support patients to understand their level of knowledge, skills and confidence (their activation level) when engaging with their health and wellbeing, including through the use of the Patient Activation Measure Actively engage with, assist and provide advice to carers, to enable them to sustain their caring role escalating any concerns to the practice when required Work with practices to support delivery of any national and local targets with regard to the GP contract e.g. PCN DES
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