Care Coordinator

Primary Duties and Areas of Responsibility

Take overall responsibility for coordination and delivery of the weekly PCN led MDT meetings. A key role of the Care Coordinator will be to schedule the weekly MDT meetings, manage the meeting agenda items; ensuring that all new referrals are identified, and information circulated to team members in advance of the meeting. Utilise population health intelligence and PCN / Partner data to proactively identify and work with a cohort of patients to deliver personalised care.Support patients to utilise decision aids in preparation for a shared decision-making conversation.

Holistically bring together all of a persons identified care and support needs, and explore options to meet these within a single personalised care and support plan (PCSP), in line with PCSP best practice, based on what matters to the person.

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.

Support people to take up training and employment, and to access appropriate benefits where eligible.

Support people to understand their level of knowledge, skills and confidence (their Activation level) when engaging with their health and wellbeing, including through the use of the Patient Activation Measure.

**Overview of your organisation**

Newly formed Primary Care Network (PCN) linked to 4 GP Surgery sites, team is growing and evolving and now seeking more staff to deliver the care services to our patients.

Developing new and exciting additional roles to support GP's and clinical teams at enhancing patient services in the local community.

Vibrant, friendly working atmosphere with great career progression opportunities.

**Job description**

Take overall responsibility for coordination and delivery of the weekly PCN led MDT meetings. A key role of the Care Coordinator will be to schedule the weekly MDT meetings, manage the meeting agenda items; ensuring that all new referrals are identified, and information circulated to team members in advance of the meeting. Utilise population health intelligence and PCN / Partner data to proactively identify and work with a cohort of patients to deliver personalised care.

Support patients to utilise decision aids in preparation for a shared decision-making conversation.

Holistically bring together all of a persons identified care and support needs, and explore options to meet these within a single personalised care and support plan (PCSP), in line with PCSP best practice, based on what matters to the person.

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.

Support people to take up training and employment, and to access appropriate benefits where eligible.

Support people to understand their level of knowledge, skills and confidence (their Activation level) when engaging with their health and wellbeing, including through the use of the Patient Activation Measure.

Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing and increase their activation level.

Explore and assist people to access personal health budgets where appropriate.

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 primary care professionals.

Work with the GPs and other primary care professionals within the PCN to identify and manage a caseload of patients, and where required 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.

**Qualifications**

**Essential criteria**

GCSE or equivalent grade C level qualification in Maths and English. Experience Minimum of 1 years experience of working with healthcare professionals and or previous experience in the NHS or social care or relevant field. Experience of coordinating and liaising with multiple stakeholders or individuals to meet specified outcomes. Experience providing advice/signposting to patients. Experience of undertaking quality improvement activity. Excellent organisational and administration skills. Ability to analyse and interpret information and present results in a clear and concise manner. Able to prioritise and manage own workload.

**Desirable criteria**

Experience of working in a multi-disciplinary setting where influence and negotiation is required. Experience of using technology and digi