Care Co-ordinator

2 months ago


Bromley, United Kingdom MDC Primary Care network Full time

JOB TITLE: Care Co-Ordinator
Rate of pay: Depending on experience

**Hours: Part Time**

**Reporting to**: PCN Clinical Director/PCN Manager

**PCN Structure**
MDC PCN is a forward thinking group of 3 Bromley Practices which has been formed to benefit patients by offering improved access and extending the range of services available to them, and by helping to integrate primary care with wider health and community services. This PCN consists of The Woodlands Practice, The Chislehurst Medical Practice and The Links Medical Practice (Mottingham and Downham) covering over 37,000 patients.

**Organisational Values / Objectives**
MDC PCN aims to work strategically with all its practices, to help secure the best services for patients whilst working together, to support the member practices in the challenges of a changing NHS. The network aims to improve the morale of general practice in Bromley, by sharing expertise, services and supporting its workforce. The network will make a positive impact on medical services in Bromley, by working closely with the CCG, local NHS trusts, local providers and patient groups, to improve the delivery of healthcare to the local population.

**Job Summary**
Care Coordinators could potentially provide extra time, capacity, and expertise to support patients in preparing for or in following-up clinical conversations they have with primary care professionals. They will work closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that 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 should be familiar with the six components of the universal model for personalised care with a specific focus on:

- Supported self-management, especially for people with long-term conditions
- Shared decision-making between professionals and the people they support
- Social prescribing and community-based support
- Personalised care and support plans
- Choice - over where and how people receive care
- Personal health budgets for people with complex physical needs

**Responsibilities of the post -**
1. Provide administrative support for the Network Manager.

2. Carry out administrative work to support patient clinics such as vaccination clinics, and nurse clinics including setting up clinics, booking staff, arranging appointments, liaising with other staff and patients when necessary;
3. Liaise with ARRS staff with regards to PCN and practice indicators and targets;
4. Monitor Practices’ performance against contract targets and support work towards achieving those targets and feed back to Clinical Directors;
5. Carry out administrative work for meetings including taking minutes and actioning action points as required;
6. Carry out searches on the clinical computer system and report activity data to the Clinical Directors and Network Manager;
7. Utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care;
8. Provide co-ordination and navigation for people and their carers across health and care services working closely with social prescribing link workers, health and wellbeing coaches and other primary care professionals;
9. Assist the PCN Clinical Directors and Network Manager with regard to the Network Contract Directed Enhanced Service;
10. Support the other care co-ordinators within the PCN, and help develop their role;
11. Organise PCN publicity and events when required;
12. Maintain good communication with PCN practices;
13. Participate in training, as appropriate;
14. Work within organisation policies, procedures and guidelines.

Any other duties considered appropriate to the post.

**Duties include, but not limited to;**
- Work with people, their families and carers, to improve their understanding of their condition.
- Support people to develop and review personalised care and support plans to manage their needs and achieve better healthcare outcomes.
- Help people to manage their needs by providing a contact to answer queries, make and manage appointments, and ensure that people have good quality written or verbal information to help them make choices about their care.
- Assist people to access self-management education courses, peer support, health coaching and other interventions that support them in their health and wellbeing, and increase their levels of knowledge, skills and confidence in managing their health.
- Provide co-ordination and navigation for people and their carers across health and care services. Helping to ensure patients receive a joined-up service and the appropriate support from the right person at the right


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