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Care Co-ordinator
2 weeks ago
**Job Summary**
As one of our Care Co-ordinators, you will be responsible for supporting the practice in delivering excellent patient care by effectively co-ordinating different elements of care from multi-disciplinary teams within and outside the practice.
We are currently seeking to recruit an additional Care Co-ordinator to join our expanding care team. Working alongside our existing Care Coordinator team, Social Prescribing Link Workers and Health & Wellbeing Coaches as well as our GPs and clinical teams, you will coordinate care suited to the needs of individual patients.
If you share our values of collaboration, integrity, quality, respect and wellbeing and are looking for a new challenge, we would love to hear from you.
**Main duties of the job**
Acting as a key point of contact for patients, carers and healthcare professionals, you will ensure that an individual’s healthcare needs are addressed in a joined-up way, ensuring that they receive the right care from the right professional at the right time.
**About Us**:
Our practice has been serving the people of Fishponds and the surrounding areas for over 100 years. The surgery was founded by Dr Claude Bernard who at the time was working from a Victorian house at 564 Fishponds Road. His son Cyril then took over through the war years and the foundation of the NHS in 1948.
We are a stable practice with a fully established team. Our team consists of 5 partners and 5 salaried doctors, practice nurses and health care assistants a dietician, nurse practitioner and an advanced paramedic. Supported by a large team of care coordinators. The surgery is managed by our practice manager, deputy and management administrator.
We embrace change and technology to support process and service improvement through efficiency to help manage the workload. We hold weekly clinical meetings with the support of a friendly and approachable team. We are proud to be a training practice teaching medical students from year 1 to 5 creating a real positive vibe in the surgery. We are also part of a successful PCN enjoying the benefits of collaborative working and the exchange of ideas. We are a high QOF achiever with strong administrative process.
- Primary Key Responsibilities_
a. Deliver reception services including call handling and appropriately triage and signpost patients to the most appropriate clinician and appointment. Expanding the care navigator role to incorporate new ways of working and support patients to Holistically bring together all of a person’s 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 following the NHS Comprehensive Care Model. See also YouTube NHS Comprehensive Personalised Care Model - Explainer Animation
b. Contact hospitals to follow up referrals, liaise with hospitals for updates on patients or advice.
c. Organise and attend MDT meetings and patient group consultations.
d. Utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care.
e. Support patients to utilise decision aids in preparation for a shared decision-making conversation.
f. 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, using tools to understand people’s level of knowledge, confidence in skills in managing their own health.
g. Support and coordinate covid, flu and immunisation clinics.
h. 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 (PAM)
i. 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.
j. Explore and assist people to access personal health budgets where appropriate.
k. 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.
l. 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.
m. Raise awareness within the PCN of shared decision making and decision support tools.
n. 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.
o. Acting as a non-clinical champion coordinating referral practices safety netting, and screening activity in conjunction
