Clinical Care-coordinator

6 months ago


Marlborough, United Kingdom Burbage Surgery Full time

Develop and review personalised care and support plans with patients, their families, and carers to better manage their needs and achieve improved healthcare outcomes. Collaborate with patients, their families, and carers to increase everyone's understanding of the patient's condition. Help people manage their health conditions through undertaking routine screening and annual clinical reviews 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 Key tasks You will be trained to carry out tasks such as phlebotomy, blood pressure monitoring, NHS Healthchecks, Urinalysis, and chaperoning to help support the GPs and Nurses, and prepare patients for their annual long term condition reviews Working towards increasing patients understanding of how to manage and develop health and wellbeing through offering advice and guidance Work with the wider PCN, surgery staff, and the social prescribing service to look at how carers can support people - this could include the initial identification of carers onto the carer register, Maintain a professional attitude to patients and display a caring, positive attitude at all times Work strictly within guidelines and policies which are set Coordinate and Integrate Care 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, by participating in multidisciplinary team meetings at the Surgery and in the PCN as and when appropriate Monitor and review Practice performance of the IIF indicators and target cohorts Identify when action or additional support is needed, alerting a named clinical contact in addition to relevant professionals, and highlighting any safety concerns Information accuracy, storage and transmitting 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 Record and collate information according to agreed protocols and contribute to evaluation reports required for the monitoring and quality improvement of the service. Professional Development You will be working alongside the wider team, to gain advice and support.



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