Job summary Working as part of a Multi-Disciplinary Team (MDT), the job holder will play a key role in progressing the Primary Care Network ( PCN ) vision of creating a new wider Community Service, enhancing existing care models in a collaborative way across the PCNs within Bexley. This role plays a pivotal part in improving the quality of seamless coordinated care across the PCN, that enables MDTs to advance in their ways of working and ultimately contributes to the effectiveness of patient care provided. As a Care Coordinator the job holder will work closely with the practices and the MDT, as a pivotal role for ensuring all patients across the locality receive the best possible care and service. This role will support the Clinical Directors and other key stakeholders in coordinating all activity including access to services, advice and information, and ensuring health and care planning is timely, efficient and patient-centred. The job holder will assist in the advancing of digitalisation of systems and networks to enhance the flow and accessibility of data and information to ensure the seamless coordination of the patients journey through primary care Main duties of the job To work with GPs and other primary care professionals within the PCN to identify and manage a caseload of patients. To support Clinical Directors and other key stakeholders in the successful delivery and implementation of the Directed Enhanced Service (DES). To work closely and in partnership with the Social Prescribing Link Workers and Health and Wellbeing Coaches, supporting patients to utilise decision aids, help create single personalised care and support plans, in line with best practice. To help patients manage their needs through proactively responding to queries, making and managing appointments, other interventions that progress the patients care journey, holistically bringing 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. Modify and adapt working practices to meet the needs of the patient, where appropriate, providing coordination and navigation through the aid of digital tools for patients and their carers across the health and care services. Complete documentation (including electronic patient records where used) as per PCN guidelines and Information Governance (IG) requirements, e.g. Data Protection. To support the overall effectiveness of exemplary coordination and delivery of the MDTs within the PCN. About us Bexley Health Neighbourhood Care (BHNC) is a GP Federation supporting the 21 Bexley Practices / 4 PCNs who are working collaboratively to enhance the health and wellbeing of Bexley residents, covering over 246,000 patients. Organisational Values / Objectives The goals of BHNC are to work strategically with all Bexley Primary Care Networks (PCNs), to help secure the best services for patients whilst working together, to support the member practices in the challenges of a changing NHS. Bexley Health Neighbourhood Care (BHNC) aims to improve the morale of PCNs / general practice in Bexley, by sharing expertise, services and supporting its workforce. BHNC will make a positive impact on medical services in Bexley, by working closely with the CCG, local NHS trusts, local providers and patient groups, to improve the delivery of healthcare to the local population. Date posted 09 January 2025 Pay scheme Other Salary £14 an hour depending on experience (25hrs per week) Contract Permanent Working pattern Part-time Reference number B0027-25-0000 Job locations Sidcup Medical Centre 2 Church Avenue Sidcup Kent DA14 6BU Job description Job responsibilities To work with GPs and other primary care professionals within the PCN to identify and manage a caseload of patients. To support Clinical Directors and other key stakeholders in the successful delivery and implementation of the Directed Enhanced Service (DES). To work closely and in partnership with the Social Prescribing Link Workers and Health and Wellbeing Coaches, supporting patients to utilise decision aids, help create single personalised care and support plans, in line with best practice. To help patients manage their needs through proactively responding to queries, making and managing appointments, other interventions that progress the patients care journey, holistically bringing 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. Modify and adapt working practices to meet the needs of the patient, where appropriate, providing coordination and navigation through the aid of digital tools for patients and their carers across the health and care services. Work as an effective member of a multi-professional team, giving support to non-registered staff as required, without assuming supervision, education or line management role. Complete documentation (including electronic patient records where used) as per PCN guidelines and Information Governance (IG) requirements, e.g. Data Protection. Support the production and implementation of new working processes within the practice to optimise the quality of prescribing and patient care. To support the overall effectiveness of exemplary coordination and delivery of the MDTs within the PCN. Job description Job responsibilities To work with GPs and other primary care professionals within the PCN to identify and manage a caseload of patients. To support Clinical Directors and other key stakeholders in the successful delivery and implementation of the Directed Enhanced Service (DES). To work closely and in partnership with the Social Prescribing Link Workers and Health and Wellbeing Coaches, supporting patients to utilise decision aids, help create single personalised care and support plans, in line with best practice. To help patients manage their needs through proactively responding to queries, making and managing appointments, other interventions that progress the patients care journey, holistically bringing 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. Modify and adapt working practices to meet the needs of the patient, where appropriate, providing coordination and navigation through the aid of digital tools for patients and their carers across the health and care services. Work as an effective member of a multi-professional team, giving support to non-registered staff as required, without assuming supervision, education or line management role. Complete documentation (including electronic patient records where used) as per PCN guidelines and Information Governance (IG) requirements, e.g. Data Protection. Support the production and implementation of new working processes within the practice to optimise the quality of prescribing and patient care. To support the overall effectiveness of exemplary coordination and delivery of the MDTs within the PCN. Person Specification Communication & Relationships Essential Excellent communication skills, with the ability to select, adjust and use appropriate forms of verbal and non-verbal communication with patients and professional colleagues, Excellent interpersonal skills, with the ability to establish and maintain effective relationships with others, Able to appropriately build relationships to gain the cooperation of relevant stakeholders (including patients, senior and peer colleagues, and other professionals), Able to communicate with patients, relatives, colleagues and other health professionals and stakeholders in a calm, caring and professional manner, treating them with dignity and respect at all times. Desirable Able to identify anxiety and stress in patients, carers, relatives and others, recognising the potential impact upon communication, Can demonstrate good influencing and negotiation skills, empathy and reassurance Qualifications Essential Evidence of continuing professional development, Demonstrates a continued commitment to improve skills and the ability to work in new areas Desirable Educated to diploma level, or equivalent experience, Safeguarding and other mandatory training. Experience Essential Experience in dealing with a diverse range of people in a public/patient environment, Experience in demonstrating a good level of professionalism, responsibility and accountability, Demonstratable experience of being able to remain calm under pressure and showing empathy in stressful situations Experience of partnership/collaborative working and of building relationships across a variety of organisations, An appreciation of the NHS agenda and government targets. Desirable Minimum of 1 years care coordination experience, Experience of coordination and development of a range of systems and processes in relevant organisational settings, Able to analyse and interpret care plans and needs assessments, Experience of working effectively within a multidisciplinary team, Awareness of systems to support the management of patients in a primary care setting Analytical & Judgmental Skills Essential Ability to assess a professional situation, determine the nature and severity of the problem and utilise knowledge and experience to deal with the problem, Excellent attention to accuracy and detail within administrative tasks Desirable Able to identify and raise risk management issues according to policy/protocol, Recognise that they are responsible for decisions made and recognises when to refer patient care to more suitable care providers, Recognises priorities when problem solving, identifying deviations from normal patterns, and is able to refer these where required for resolution Planning & Organisation Skills Essential Can demonstrate a flexible approach to meet service needs and can adapt to cope with uncertainty and change, Excellent time keeping skills, Exceptional ability to effectively manage, plan and coordinate multiple activities, overcoming barriers and issues that would prevent seamless coordination of activities Desirable Can demonstrate the ability to work in a busy environment dealing with both urgent and important tasks whilst also supporting others. Qualities and Standards Essential oCommitment to reducing health inequalities and proactively working to reach people from all communities, oEmbraces equality, diversity and inclusivity at every opportunity and the NHS core principles; dignity and respect, compassion, be included, responsive care and support and wellbeing, oKnowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety, oAble to operate competently with regard to managing data and information in accordance with the Data Protection Act (DPA) (2018) and the General Data Protection Regulation (GDPR) (2018), Access to Health Records Act (AHRA) (1990) and the Public Interest Disclosure Act (1998). Personal Ability Essential Knowledge of IT systems, including ability to use word processing systems and software, emails, and the internet to create simple plans and reports, Adaptable, self-motivated and able to work flexibly and enthusiastically as part of an integrated multi-skilled team, or on own initiative, Able to work effectively under pressure, able to recognise personal limitations and refer to more appropriate colleague(s) when necessary, and take accountability for own development needs, flexible in relation to work patterns Person Specification Communication & Relationships Essential Excellent communication skills, with the ability to select, adjust and use appropriate forms of verbal and non-verbal communication with patients and professional colleagues, Excellent interpersonal skills, with the ability to establish and maintain effective relationships with others, Able to appropriately build relationships to gain the cooperation of relevant stakeholders (including patients, senior and peer colleagues, and other professionals), Able to communicate with patients, relatives, colleagues and other health professionals and stakeholders in a calm, caring and professional manner, treating them with dignity and respect at all times. Desirable Able to identify anxiety and stress in patients, carers, relatives and others, recognising the potential impact upon communication, Can demonstrate good influencing and negotiation skills, empathy and reassurance Qualifications Essential Evidence of continuing professional development, Demonstrates a continued commitment to improve skills and the ability to work in new areas Desirable Educated to diploma level, or equivalent experience, Safeguarding and other mandatory training. Experience Essential Experience in dealing with a diverse range of people in a public/patient environment, Experience in demonstrating a good level of professionalism, responsibility and accountability, Demonstratable experience of being able to remain calm under pressure and showing empathy in stressful situations Experience of partnership/collaborative working and of building relationships across a variety of organisations, An appreciation of the NHS agenda and government targets. Desirable Minimum of 1 years care coordination experience, Experience of coordination and development of a range of systems and processes in relevant organisational settings, Able to analyse and interpret care plans and needs assessments, Experience of working effectively within a multidisciplinary team, Awareness of systems to support the management of patients in a primary care setting Analytical & Judgmental Skills Essential Ability to assess a professional situation, determine the nature and severity of the problem and utilise knowledge and experience to deal with the problem, Excellent attention to accuracy and detail within administrative tasks Desirable Able to identify and raise risk management issues according to policy/protocol, Recognise that they are responsible for decisions made and recognises when to refer patient care to more suitable care providers, Recognises priorities when problem solving, identifying deviations from normal patterns, and is able to refer these where required for resolution Planning & Organisation Skills Essential Can demonstrate a flexible approach to meet service needs and can adapt to cope with uncertainty and change, Excellent time keeping skills, Exceptional ability to effectively manage, plan and coordinate multiple activities, overcoming barriers and issues that would prevent seamless coordination of activities Desirable Can demonstrate the ability to work in a busy environment dealing with both urgent and important tasks whilst also supporting others. Qualities and Standards Essential oCommitment to reducing health inequalities and proactively working to reach people from all communities, oEmbraces equality, diversity and inclusivity at every opportunity and the NHS core principles; dignity and respect, compassion, be included, responsive care and support and wellbeing, oKnowledge of and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety, oAble to operate competently with regard to managing data and information in accordance with the Data Protection Act (DPA) (2018) and the General Data Protection Regulation (GDPR) (2018), Access to Health Records Act (AHRA) (1990) and the Public Interest Disclosure Act (1998). Personal Ability Essential Knowledge of IT systems, including ability to use word processing systems and software, emails, and the internet to create simple plans and reports, Adaptable, self-motivated and able to work flexibly and enthusiastically as part of an integrated multi-skilled team, or on own initiative, Able to work effectively under pressure, able to recognise personal limitations and refer to more appropriate colleague(s) when necessary, and take accountability for own development needs, flexible in relation to work patterns 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. Employer details Employer name Bexley Health Neighbourhood Care CIC Address Sidcup Medical Centre 2 Church Avenue Sidcup Kent DA14 6BU Employer's website https://www.bhnc.org.uk/ (Opens in a new tab)