Locality Co-ordinator

6 months ago

Surbiton, United Kingdom Your Healthcare CIC Full time

1. Job Purpose The post holder/s will support the ongoing implementation of Integrated Neighbourhood Teams & MDT working across the Royal Borough of Kingston & the borough of Richmond. The postholder will be fundamental in supporting Primary Care Networks (PCNs) to function effectively, implement changes to ways of working and evaluate the success of this new way of working. The postholder will support the implementation, management, and delivery of fortnightly Proactive Anticipatory Care (PAC) MDT meetings across two PCNs.

They may also be asked to work with other PCNs in Kingston or Richmond to provide cover where required. The teams who deliver PAC are made up of professionals from many different services, such as GP Practices, Social Care and community nursing. PAC aims to improve the use of the health and care system by intervening earlier, proactively and more holistically while the patient is at home. The post holder will be responsible for liaising with all members of the MDT, in addition to wider specialists, to ensure the fortnightly meetings run smoothly, and referrals are managed effectively.

The post holder will have a key responsibility to shape the requirements of this role in the future. Whilst the job description and person specification outlines key attributes, the post holder will need to be flexible and open to changing and developing the role as required. 4. Key Result Areas Supporting the functioning of MDTs and locality teams Set-up MDT meetings for each practice and ensure the right professionals are involved, notified and prepare for the meetings in the correct way Produce summary notes of MDT meetings including agreed actions Information gathering through coordinating professional input and using the local case-management system to access key information Participate in the review of patient outcomes and goals as required Alongside the PAC Managers, act as a contact point for all PCN MDTs that you will be supporting.

In conjunction with the PAC Managers, continually work to review and improve processes to ensure MDTs function in the most effective way Run the Health Insights risk stratification tool on behalf of each Practice in the PCN, providing them with a cleansed list suitable for clinical review. Monitor key actions and highlight review periods set by MDTs Support the development of Integrated Neighbourhood Teams (INTs) within Kingston and Richmond. This will involve working closely with PCNs to support their growth as an INT Information management, analysis and evaluation Establish agreed performance and reporting systems and undertake case tracking of individuals discussed to support PAC evaluation Coordinate distribution, processing and analysis of wellbeing surveys to patients and users to support PAC evaluation Report on implementation measures for the PCNs to the PAC Manager Access required organisational information systems for information gathering and inputting as required to support MDTs Develop and champion the use of the locally agreed case-management system as a core aspect of MDT and locality working Communication and working with others Establish good working relationships across a range of professionals within multi-disciplinary teams including health, social care and voluntary sector staff Liaise with the HIU team and LAS, alongside other service providers, to identify patients suitable for referral to PAC Provide admin support to the MDT to set up huddles as required. Engage with all Quality Improvement (QI) meetings to share good practice/learning.

In particular, Locality Coordinators will be asked to present monthly highlight reports to the group. Influence wider team members to adopt new processes and ways of working to support the aims of the programme Present and communicate information in a range of formats to support engagement Report any issues or updates to the PAC Managers in a timely manner Role development Work with the PAC Managers, other Locality Coordinators, wider team and programme manager to develop the role, required responsibilities, functions and requirements going forward Work flexibly to meet the needs of the MDTs and highlighting any gaps in provision / service.

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