Care Coordinators support patients in preparing for or in following-up clinical conversations they have with primary care professionals. Care Coordinators also support existing community groups to be accessible and sustainable and help the Social Prescribing team to assist people to start new community groups, where appropriate, working collaboratively with all local partners.
The Care Coordinator will work as a key part of the Primary Care Network (PCN) multi-disciplinary team, helping PCNs to strengthen community and personal resilience and reduce health and wellbeing inequalities by addressing the wider determinants of health, such as debt, poor housing and physical inactivity, by increasing people's active involvement with their local diverse communities.
This role has been funded for 12 months to support Red House practice. The Care Coordinator will lead a pilot working with families who are disengaged in healthcare, and have low activation which may impact the whole family.
Main duties of the job
1. Proactively identify people to support their personalised care requirements, using the available decision support aids.
2. Telephone triage all incoming referrals to bring together all of a person's identified care and support needs, and explore their options to meet these via a single personalised care and support plan, or seamlessly refer cases, if necessary, to appropriate professionals.
3. Help people to manage their needs, answering their queries and supporting them to make appointments or to take up training and employment, and to access appropriate benefits where eligible.
4. Support people to understand their level of knowledge, skills and confidence when engaging with their health and wellbeing, including through use of the Patient Activation Measure.
5. Raise awareness of shared decision making and decision support tools, and assist people to be more prepared to have a shared decision making conversation.
6. Ensure that people have good quality information to help them make choices about their care.
7. Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing.
8. Provide coordination and navigation for people and their carers across health and care services, alongside working closely with social prescribing link workers, health and wellbeing coaches and other primary care roles.
About us
Sunderland GP Alliance is a not-for-profit collaboration of GP practices in Sunderland, covering approximately 285,000 patients. Formed in 2015, Sunderland GP Alliance exists to help GPs work collaboratively for the benefit of patients and staff.
Person Specification
Qualifications
* Demonstrable commitment to personal and professional development.
* Proficient in the use of Microsoft Office applications.
* Able to provide a culturally sensitive service supporting people from all backgrounds and communities respecting lifestyle and diversity.
* Must be a car driver.
* Experience of working in general practice.
* Knowledge of how the NHS works, primary care and PCNs.
Experience
* Excellent communication skills and an ability to engage successfully with a wide range of people at all levels.
* Experience of collecting and recording confidential information and data.
* Ability to identify risk to self and others, identifying and reporting safeguarding incidents.
* Ability to actively listen and empathise with people and provide personalised support in a non-judgmental way.
* Basic knowledge of long-term conditions and the complexities involved; medical, physical, emotional, and social.
* The ability to work calmly under pressure.
* The ability to adapt your leadership and management style to different situations.
* Experience of championing diversity and inclusion and promoting actions to make improvements to the experience of diverse groups.
* Experience of working in a multi-setting complex programme environment.
* Experience of working in a community setting.
* Extensive knowledge of local services within Sunderland through either living or working within one of the wider Sunderland settings.
* Experience of working with GPs and/or other Health or Social Care providers or knowledge of how systems work.
* Ability to provide motivational coaching to support people's behaviour change.
* NVQ Level 3 in adult care, advanced level or equivalent qualifications or working towards.
Motivation and Skills
* Outstanding organisational skills, able to prioritise and work to deadlines.
* Work effectively and collaboratively as part of a team but also autonomously.
* Promote and maintain good working relationships with a variety of external partners.
* Keep accurate records of discussions and clearly replicate discussions in writing.
* Work on own initiative but within constraints of the role.
* Understanding of and commitment to equality, diversity, and inclusion.
* Ability to competently use technology and IT systems including word processing, email, and the internet to create simple personalised plans with individuals.
* Ability to work across multiple sites in the Sunderland area.
* Confident and comfortable with difficult situations.
* Patient, friendly and approachable.
* Able to work under pressure and emotionally resilient.
* Ability to work flexible hours which may include occasional evenings or weekends with notice.
* Understanding the impact of economic and environmental factors on people's health and wellbeing.
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.
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