Pcn Care Coordinator

The post holder will contribute to tackling inequalities in health and social care particularly regarding individuals with long-term conditions. An ethos of promotion of independence and partnership-working is integral to this post. Key aspects of this role will include supporting the following PCN activities: - The care coordinator will work as a key part of the Primary Care Network (PCN) Team and Enhanced Access Service Work Closely with the GP's and other primary care professionals within PCN to support the delivery of quality patient services for all our patients Plays an integral role in facilitating MDT's, to improve the continuity of care by acting as a point of contact for residents, families and professionals. Work with members of the primary care teams to develop and implement data collection systems that will provide accurate and timely data to monitor and evaluate services Key Responsibilities - Provide a first point of contact for patients and clinicians in coordinating patients care Provide administrative support for the Enhanced Access service, including organising staffing rotas, completing patient referrals and to support with the day to day provision of the service.

Deal with incoming queries from patients and/or their carers and other healthcare providers. Work with PCN manager to utilise GP Practice clinical systems (EMIS) and population health data to proactively identify relevant cohorts of patients to support practices to deliver personalised care and meet the outcomes of the PCN DES Service Specifications e.g., Early Cancer Diagnosis, Cardiovascular Disease Prevention and Diagnosis Encourage people, their families and carers to provide feedback and engage fully in the care coordination process. Work proactively with our Care Homes, for example supporting flu and COVID vaccinations or other healthcare services. Work proactively with other PCN Additional Roles staff to identify any patient service needs or inequalities and work closely with the Federation team and PCN CDs to work up any projects or initiatives to support patient care.

Support the coordination and delivery of MDTs within the PCN. To support the PCN Transformation and Development Manager in administrative duties relating to other PCN activities and workstreams, including planning and organising meetings, taking minutes and / or action notes and ensuring they are shared / uploaded where appropriate. To support the PCN Clinical Director to collect information from member practices, identify anomalies and summarise. Gather information and undertake enquires for the PCN and the wider group as and when necessary.

Work with the Integrated Neighbourhood Teams group on identified projects as they occur Monitor tasks to ensure they are completed and care delivered through regular audit of the clinical system. Provide coordination and navigation for people and their carers across health and care services, working closely with social prescribing link workers and other primary care professionals. Signpost and organise appointments, follow ups or other actions to help the PCN provide high quality, compassionate care to our patient population. The list of duties in the job description should not be regarded as exclusive or exhaustive.

There will be other duties and requirements associated with the job and the right to update the job description from time to time to reflect changes in or to the job.