Care Coordinator

3 days ago

Nottingham, United Kingdom Primary Integrated Community Services Ltd Full time

**ABOUT THE ROLE**

We have an exciting opportunity for a PCN Care Co-ordinator to join our new Anticipatory Care Team. PICS are looking for an enthusiastic and highly organised person to work within the team providing coordination, administrative and support to the Clinical teams and other members of the PCN. The role will further enhance the integrated care provided for the patients and develop new proactive support to the local population. This exciting new role will operate across Nottingham West PCN, covering Eastwood, Stapleford and Beeston.

**MAIN DUTIES OF THE JOB**
- Work within the established and developing NW services to support the local population with multiple long-term conditions who could be considered “at risk”.
- Be responsible for daily proactive case finding of patients on e-HealthScope to identify ‘at risk’ patients to support the PCN team with identifying community pathways that might prevent hospital admission and for identifying potential gaps in care

**KEY REQUIREMENTS**
- Good standard of education - GCSE or equivalent in English and Mathematics
- Proven administrative experience in a complex and demanding environment.

Nottingham West Primary Care Network

Nottingham West PCN is a group of GP practices (12) that are committed to work together to add additional services and roles to support the workload in GP practices. We cover 108,865 patients within our locality. Our network works closely with all practices and other key members of the network including Pharmacies, Citizens Advice, Voluntary Sector and Local District and Borough Councils. Our aim is to continually improve services to patients utilising all available resources.

Our PCN work in partnership with PICS to provide a host organisation for employment contracts, HR and corporate support. The day-to-day work is situated in the GP practices and the everyday line management is undertaken by staff within the Primary Care Network.

ABOUT PICS

JOB PURPOSE

The post holder will work within the Anticipatory Care (AC) PCN Team, providing coordination and administrative support to the team and other members of the PCN.

Anticipatory Care is an NHS Long Term Plan that aims to provide proactive and personalised support for a targeted subset of individuals living with multiple long-term conditions. This service supports adult patients and carers with complex needs who could benefit from proactive Multi-Disciplinary Teams (MDTs) in local communities to be able to live independently for longer and to reduce avoidable hospital admissions and GP visits.

The Anticipatory Care (AC) Care Coordinator role will work within the established and developing NW services to support the local population with multiple long-term conditions who could be considered “at risk”. The role will further enhance the integrated care provided for the patients and develop new proactive support to the local population.

The service will utilise the established health and care system for individuals with multiple long-term conditions to identify the “at risk” patient group and intervene proactively and holistically while the patient is at home.

The Care Coordinator will proactively case find and identify patients who are most vulnerable from admission and/or health deterioration and work closely with the clinical team to support patients to manage their health conditions and to achieve the best quality of life and independence possible through robust health assessments and care planning

This service and role will further enhance the patient-centred integrated care in the local area improving the experience of health and social care for our patients.

The Care Coordinator will work closely with teams to assist in co-ordinating care utilising population health intelligence. The role will promote integrated working across Nottingham West Primary care network (PCN), General Practice and existing statutory and voluntary health and social care services.

The role will work with a variety of services including, but not exclusive to; dementia, mental health, social prescribing, pharmacy, respiratory, vaccination, care homes and other services identified as a priority within the Primary care network (PCN).

The post holder will work closely with General Practices and existing services to support the coordination and delivery of multidisciplinary team meetings and support the PCN to proactively identify patients who require a personalised care and support plan

**KEY RESPONSIBILITIES**

**ROLE OBJECTIVES**:
The post holder, working closely with the PCN Anticipatory Care Team, GP’s and existing community services will:

- Work within the established and developing NW services to support the local population with multiple long-term conditions who could be considered “at risk”. The role will further enhance the integrated care provided for the patients and develop new proactive support to the local population.
- Utilise Population Health Intelligen

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