Job summary
Contract: 12 Month Fixed term
2 Full Time Posts.
Salary: Up to£26,000 dependent on experience
A full current driving licence and use of a car is essential.
Candidates are strongly encouraged to apply early as applications will be considered upon submission.
The Learning Disability & Autism Care Co-ordinators will work within South (IW) - (The Bay Medical Practice, South Wight Medical Practice, Ventnor Medical Practice) and North & East (IW) - (Tower House, Esplanade, Argyll House, East Cowes, St Helens, Medina) Primary Care Network (PCN) tosupport people with a learning disability and autism to achieve better health outcomes andexperience of services. They will act as a central contact point for patientsand carers to ensure that services are co-ordinated and reflect what isimportant to the person.
The successfulcandidate will be based within practices in the PCN. The role is intended tobecome an integral part of the PCNs multidisciplinary team to further embed apersonalised care approach to the care of people with a learning disability and/or autism.
This is a new roleand the post holders will be instrumental to its future development.
Please note that the PCN Learning Disability & Autism Care Co-ordinatorrole is not a clinical role but will require to undertake relevant trainingsuch as safeguarding, confidentiality and data protection etc
Main duties of the job
It is well knownthat people with a Learning Disability (LD) and Autism (A) have poorer outcomesand die younger than people who do not, reducing these inequalities is a keypriority for the NHS.
Learning Disability Annual Health Checks that arefacilitated in Primary Care are an important mechanism for ensuring that theneeds of people with learning disabilities are regularly reviewed, and thatthey are offered the support they need to access health and care services. The PCN Learning Disability & Autism Care Co-ordinator will support people to prepare for their Annual Health Check,co-ordinating any communications and reasonable adjustments required. The PCN LearningDisability & Autism Care Co-ordinator will support patient and carers so thatany actions that result from the Annual Health Check are put into place, actingas link between patients, Primary Care and wider health and care services.
Further information about the annual health check can be found here :Learning disabilities - Annual health checks - NHS (
About us
We support our member GP practices to help them deliver the bestpossible care to patients on the Island. We host a team of Social Prescribers,Health and Wellbeing Coaches and Care Co-ordinators under a Primary CareContract that support our Island practices.
We aim to do that by providing centralised services that enableGPs to enhance their offer of support to patients.
We also provide directsupport to GPs and practice staff to enable them to develop, lead and managetheir practices more effectively and efficiently on aday-day basis. For example, providing training and education,mentoring, recruitment support, resources, access to specialist roles andsharing best practice.
We also help bid for and secure additional funding from NHSEngland, where it becomes available, to help support new initiatives that helppractices to meet their patients care needs and we work to support generalpractice/primary care, to make sure it has a voice within the wider healthcaresystem as it develops plans for the future care for our population.
Job description
Job responsibilities
Description of role/ coreresponsibilities
The post holder will:
Work closelywith GPs and other Primary Care professionals within the PCN to identify andmanage a caseload of patients with a learning disability and / or Autism.
Work with people and their carersand primary care staff to organise and prepare for Annual Health Checks,enabling them to be actively involved in managing their care and supported tomake choices that are right for them.
Help to connect patients and theircarers with relevant services, ensuring that reasonable adjustments are madethat facilitate improved access to services, and promote optimum outcomes forthe person.
Focus delivery of thiscomprehensive model to reflect local priorities, promote inclusion and reduce healthinequalities.
Identify andreport on key themes and issues to inform the strategic approach to servicedevelopment.
Develop engagement pathways for patients on theLD register.
Review forward plan for LD A HC.
Co-ordinate LD A HC elements with appropriateclinicians.
Review DNA and understanding any themes anddelivering quality improvement projects.
Develop and maintain key relationships withorganisations and people with lived experience.
Complete and follow up Health Action Plan.
Create a database of resources for clinicians touse.
Develop and deliver health promotion work forpeople with a learning disability and autistic people.
Develop and co-ordinate specific tests andcancer screening services for LD & A people to improve access and uptake.
Supportpractices in primary care networks to become LD friendly practices.
JobResponsibilities
Service Delivery
Provide support for patients with suspected Autism to access theservice, to facilitate the referral for ASD assessment and provide support and signpostingduring the lengthy wait for assessment.
Proactively identify and work witha cohort of people to support their personalised care requirements, using theavailable decision support aids.
Support the Practice to establishpreferred means of communication to comply with The Accessible InformationStandard 2016 and ask about Reasonable Adjustments to meet The Equality Act2010, to ensure that these are documented/coded and flagged correctly.
Establish who is the persons mainsupport and support the practice to ensure this is documented and codedcorrectly.
Identify barriers to accessinghealth care services, and plan actions and initiatives to overcome and assisteasier access to services.
Work with people, their families,and carers to improve their understanding of the Learning Disability AnnualHealth Check (LDAHC).
Work with Practices, people andtheir families and carers or other support services to prepare for the LDAHC.
Review attendance to AHCappointments and follow up those which have not attended or not been supportedto attend and support to reschedule as appropriate.
Bring together a personsidentified care and support needs and support them to explore their optionswith the clinicians to produce a single personalised care and support plan: TheHealth Action Plan (HAP).
Help patients and their carersprepare for conversations they have with Primary Care professionals, ensuringthat their changing needs are addressed.
Followup on AHC appointment to ensure patients and carers have the support to ensurequality health outcomes.
Support the interface betweenprimary care services, specialist community services and acute services,thereby ensuring that people with a learning disability can enjoy good healthand receive appropriate treatment when necessary.
Develop plans to meet theadditional health needs of people with a learning disability who come fromethnic communities that experience health inequalities.
Promote and encourage the use ofclient held information (communication/ hospital passports), for when patientsaccess healthcare services. Support development of communication/hospital whenneeded.
Help people to manage their needs,answering their queries and supporting them to make appointments.
Raise awareness of shared decision-makingand decision support tools and assist people to be more prepared to have ashared decision-making conversation.
Ensure that people have goodquality, accessible information to help them make choices about their care.
Assist people to accessself-management education courses, peer support or interventions that supportthem in their health and wellbeing.
Explore and assist people toaccess personal health budgets where appropriate.
Provide coordination andnavigation for people and their carers across health and care services,alongside working closely with social prescribing link workers, health andwellbeing coaches and other primary care roles.
Support the coordination anddelivery of best interest decision making meetings & Multi-disciplinary teammeetings within PCNs.
Promote and enable access toscreening and immunisation programmes.
Identify unpaid carers and helpthem access services to support them. If the carer is a patient at a practicewithin the PCN, ensure they are correctly coded.
Identify when action or additional support isneeded, alerting timely a named clinical contact in addition to relevant professionals,and highlighting any safety concerns.
Identify and raise any issues or concerns relatingto care provision.
Work independently on a day to day basis, makingdecisions within scope of role and actively seek supervision where required.
Clinical (dependant on experience andTraining)
Undertake part one of the LD annual health check
Phlebotomy
Record height, weight, blood pressure, pulse andbasic observations
Urinalysis
Person Specification
Skills and Knowledge
Essential
1. Knowledge of national priorities to improve outcomes for people with a learning disability
2. Knowledge of how the NHS works, including primary care and PCNs
3. Knowledge of Safeguarding Children and Vulnerable Adults policies and processes
4. Able to work without day to day supervision
5. Ability to identify risk and assess / manage risk when working with individuals,
6. Ability to recognise and work within limits of competence and seek advice when needed
7. Can communicate complex and sensitive information, both verbally and in writing, in an understandable form to a variety of audiences (patients/carers and professionals)
8. Excellent interpersonal, influencing and negotiating skills
9. Work effectively independently and as a team member
10. Able to build effective working relationship with people, families and professionals.
11. Ability to produce timely and informative reports
12. Ability to manage a case load
13. Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
14. Ability to respond to unexpected events
Qualifications
Essential
15. GCSE grade A-C in maths and English or skills level 2 in maths and English (or equivalent)
Experience
Essential
16. Experience of working with people with a learning disability or additional care needs due to cognitive impairment and their carers
17. Knowledge of national priorities to improve outcomes for people with a learning disability
18. Knowledge of how the NHS works, including primary care and PCNs
19. Experience of working in health, social care and other support roles in direct contact with people, families or carers (in a paid or voluntary capacity)
20. Experience of working within multi-professional team environments
21. Experience or training in personalised care and support planning
Desirable
22. Experience of providing motivational coaching to support peoples behaviour change
23. Experience of data collection and using tools to measure the impact of services