Care Coordinator - EHCH Team

NHS; Lincoln; On-site; GBP 24,000 - 30,000; Full time

Job summary

A regional healthcare provider is seeking a Care Coordinator to enhance patient support within the PCN. The role involves working closely with GPs to manage patient care, develop personalised support plans, and ensure seamless navigation through healthcare services. The ideal candidate will have strong communication skills, administrative experience, and a background in healthcare. This position offers opportunities for personal development and participation in multidisciplinary team meetings.

Qualifications

• Experience of working in a healthcare setting or in a public facing role.
• Primary Care / General Practice Experience.

Responsibilities

• Work with people, their families and carers to improve their understanding of their condition.
• Develop and review personalised care and support plans to manage their needs.
• Coordinate navigation for people across health and care services.

Skills

Excellent communication skills

Administrative skills

Customer service skills

Good IT and computer skills

Education

Good standard of secondary education, including English and Maths

Job description

We are looking for a new Care Coordinator to join our successful EHCH team. The candidate will have excellent communication and administrative skills, to join our Ageing well teamworking on the Enhanced Health in Care Homes and Housebound service.

You will work alongside GPs and other professionalssupporting patients living in Care Homes.

Main duties of the job

You will work closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that their changing needs are addressed.

About us

We are a Primary Care Network (PCN) with 9 member GPpractices in the Lincolnshire areas. A PCN are a group of GP practices workingtogether to provide NHS services to our patients. IMP Healthcare currentlyprovide the following services to over 70,000 patients: Mental Health, SocialPrescribing, Enhanced Health in Care Homes, House Bound patients services,clinical pharmacy, first contact physiotherapy. We also provide an ExtendedAccess service. Patients can access appointments outside of core GP hours.

Job responsibilities

Working with people, their families and carers, to improvetheir understanding of their condition.

Support people to develop and review personalised care andsupport plans to manage their needs and achieve better healthcare outcomes.

Provide coordination and navigation for people and theircarers across health and care services. Helping to ensure patients receive ajoined-up service and the appropriate support from the right person at theright time.

Work collaboratively with GPs and other primary careprofessionals within the PCN to proactively identify and manage a caseload,which may include patients with long-term health conditions, and whereappropriate, refer back to other health professionals within the PCN.

Support the coordination and delivery of multidisciplinaryteams with the PCN.

Raise awareness of how to identify patients who may benefitfrom shared decision making and support PCN staff and people to be moreprepared to have shared decision-making conversations.

Take referrals or proactively identify people who couldbenefit from support through care coordination.

Have positive, empathetic and responsive conversations withpeople and their families and carer(s), about their needs.

Develop an in-depth knowledge of the local health and careinfrastructure and know how and when to enable people to access support andservices that are right for them.

Support people to develop and implement personalised careand support plans.

Review and update personalised care and support plans atregular intervals.

Ensure personalised care and support plans are communicatedto the GP and any other professionals involved in the persons care and uploadedto the relevant online care records, with activity recorded using the relevantSNOMED codes.

Make and manage appointments for patients, related toprimary care.

Help people transition seamlessly between secondary andcommunity care services, conducting follow-up appointments, and supportingpeople to navigate through the wider health and care system.

Refer onwards to social prescribing link workers and otherservices where required and to clinical colleagues where there is anunaddressed clinical need.

Regularly liaise with the range of multidisciplinaryprofessionals and colleagues involved in the persons care, facilitating acoordinated approach and ensuring everyone is kept up to date so that anyissues or concerns can be appropriately addressed and supported.

Actively participate in multidisciplinary team meetings inthe PCN.

Identify when action or additional support is needed,alerting a named contact in addition to relevant professionals, andhighlighting any safety concerns.

Record what interventions are used to support people, andhow people are developing on their health and care journey.

Work with your supervising GP / ANP to undertake continualpersonal and professional development, taking an active part in reviewingyearly progress, and developing the roles and responsibilities and developingclear plans to achieve results within priorities set by others.

Work with your supervising GP / ANP to access regularclinical supervision, to enable you to deal effectively with the difficultissues that people present.

Involved in one-to-one meetings with line manager regularlyto discuss targets and outcomes achieved.

Establish strong working relationships with GPs and practiceteams and work collaboratively with other care coordinators, social prescribinglink workers, and the wider PCN team, supporting each other, respecting eachothers views and meeting regularly as a team.

Act as a champion for personalised care and shared decisionmaking within the PCN.

Demonstrate a flexible attitude and be prepared to carry outother duties as may be reasonably required from time to time within the generalcharacter of the post or the level of responsibility of the role, ensuring thatwork is delivered in a timely and effective manner.

Identify opportunities and gaps in the service and providefeedback to continually improve the service and contribute to businessplanning.

Contribute to the development of policies and plans relatingto equality, diversity and reduction of health inequalities.

Adhere to organisational, practices and PCN policies andprocedures, including confidentiality, safeguarding, lone working, informationgovernance, equality, diversity and inclusion training and health and safety.

Contribute to the wider aims and objectives of the PCN toimprove and support primary care.

Person Specification

Qualifications

• Good standard of secondary education, including English and Maths

Experience

• Experience of working in a healthcare setting or in a public facing role. Excellent customer service skills
• Primary Care / General Practice Experience Good IT and computer skills

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.