Care Coordinator

2 weeks ago

Blackpool, United Kingdom Blackpool Central West Primary Care Network Full time

Job summary

Care coordinators provide extra time, capacity and expertiseto support patients in preparing for or in following-up clinical conversationsthey have with primary care professionals.

They will work closely with the GPsand other primary care professionals within the PCN to identify and manage acaseload of patients, making sure that appropriate support is madeavailable to them and their carers, and ensuring that their changing needs areaddressed. They focus delivery of the comprehensive model of personalised care to reflect localpriorities, health inequalities or population health management riskstratification.

Main duties of the job

Proactively identify and work with a cohort of people (this may include; patients living with Cancer, patients residing in Care Home Settings, patients that frequently attend hospital or who have multiple appointments and patients with multiple long-term conditions) tosupport their personalised care requirements, using the available decisionsupport aids.

Navigate and coordinate all a person identified care and supportneeds and explore their options to meet these into a single personalised careand support plan, in line with PCSP best practice. Working with the person, their family/carer and other professionals (including social prescribing link workers, health and wellbeing coaches and other primary care roles) about their current circumstances and how they could be improved.

Work with End of Life patients to case-find and thencomplete EPaCCS (care plans) on the patients behalf. Ensure that patients wishes and preferences are recorded and shared with wider teams to enable smooth transition of care between services.

Raise awareness of shared decision making and decision supporttools and assist people to be more prepared to have a shared decision-makingconversation.

Improve patients health and wellbeing by supporting them to self-manage their own needs and providing consistent and timely support and advice when needed.

About us

The Blackpool Central West PCN has recently been formed dueto new NHS legislation and consists of the following practices:

Adelaide Street Family Practice (incorporating Harris Medical Centre & Elizabeth Street Surgery)

St Pauls Medical Centre

South King Street Medical Practice

The three practices have worked together for several years asa neighbourhood and have a dedicated team attached to them which contain healthand well-being workers; district nurses and a full nursing home team, plusothers.

We are in the exciting position of adding new roles tocompliment the current surgery teams- to work towards bringing the three surgeries together under the Central West PCN, to give the patients apatient-centred care approach.

Job description

Job responsibilities

Basic purpose of the role

Care coordinators provide extra time, capacity and expertiseto support patients in preparing for or in following-up clinical conversationsthey have with primary care professionals. They will work closely with the GPsand other primary care professionals within the PCN to identify and manage acaseload of identified patients, making sure that appropriate support is madeavailable to them and their carers, and ensuring that their changing needs areaddressed. They focus delivery of the comprehensive model to reflect localpriorities, health inequalities or population health management riskstratification.

Key role requirements

a. Proactively identify and work with a cohort of people tosupport their personalised care requirements, using the available decisionsupport aids.

b. Bring together all of a persons identified care andsupport needs, and explore their options to meet these into a singlepersonalised care and support plan, in line with PCSP best practice.

c. Help people to manage their needs, answering theirqueries and supporting them to make appointments.

d. Work with End of Life patients to case-find and thencomplete EPaCCS (care plans) on the patients behalf.

e. Raise awareness of shared decision making and decisionsupport tools, and assist people to be more prepared to have a shared decisionmaking conversation.

f. Ensure that people have good quality information to helpthem make choices about their care,

g. Support people to understand their level of knowledge,skills and confidence when engaging with their healthand wellbeing.

h. Provide coordination and navigation for people and theircarers across health and care services, alongside working closely with socialprescribing link workers, health and wellbeing coaches and other primary careroles.

i. Support the coordination and delivery of MDTs withinPCNs.

General

Ensure that all activities are monitored and evaluated.

Attend internal meetings as required.

Work in accordance with PCN policies, including the equalopportunities policy and practice.

Attend any training courses and supervision sessions asrequired.

Work with due regard to the PCN Health and Safety Policy,ensuring that all practices and procedures are undertaken in accordance withissued guidelines.

Undertake any other duties as may reasonably be requiredfrom time to time.

Special working conditions

To be prepared to work flexibly, including evenings andweekends if required.

Currently the position will be based at Unit 10, Faraday Way. Visits to each surgery and agile working may be required.

Person Specification

Experience

Desirable

Experience of working in General Practice/Primary Care/Social Care Experience of managing conflicting workloads Experience of managing challenging conversations Experience of working with vulnerable/patients with complex needs Experience of multi-disciplinary team working

Qualifications

Essential

GCSE grade A to C in English and Maths Be prepared to undertake all training as required The Personalised Care Institute (live from April 2020) will set out what training is available and expected for Care Coordinators.

Desirable

Qualified to NVQ level 3 in a relevant topic

Knowledge and skills

Essential

Ability to work as part of diverse team Good IT skills Excellent communication skills Ability/willingness to work flexibly if required

Desirable

Ability to drive/ have own car Experience of working with EMIS systems/General practice software Ability to coordinate meetings/agenda setting and minute taking

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