Primary Care Network Care Coordinator

6 months ago

Billingham, United Kingdom Hartlepool & Stockton Health [H&SH] Full time

**Job Purpose**: support the MDTs within the Primary Care Network (PCN) to deliver effective, co-ordinated care for specific patient groups support the PCN to deliver effective, coordinated care to the care homes in their locality, working with the Clinical lead and other partners liaise with other clinical and no-clinical professionals within the team and other partners involved in patient care locally utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care holistically bring together all of a persons identified care and support needs, and explore options to meet these help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care provide coordination 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 professionals assist people to access self-management education courses, peer support or interventions that support them to take more control of their health and wellbeing; support the coordination and delivery of MDTs within the PCN explore and assist people to access personal health budgets where appropriate; promote the role and MDT within the Network to ensure that action points identified within the MDT are recorded and followed up support the PCN with various projects such as the Care Home DES work closely with other members of the personalised care team such at Social Prescribing Link Workers and Health and Wellbeing Coaches work with the GPs and other primary care professionals within the PCN to identify and manage a caseload of patients, and as appropriate, refer people back to other health professionals within the PCN; raise awareness within the PCN of shared decision-making and decision support tools; raise awareness of how to identify patients who may benefit from shared decision making and support PCN staff and patients to be more prepared to have shared decision-making conversations Confidentiality: In the performance of the duties outlined in this Job Description, the post-holder may have access to confidential information relating to patients and clients, their carers, and staff from a number of organisations. They may also have access to business organisational information. All such information from any source is to be regarded as strictly confidential Equality and Diversity: The post-holder will support the equality, diversity and rights of patients, carers and colleagues Health and Safety To work in accordance with health and safety policies and procedures including reporting and recording

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