Job summary
Wideway Medical Practice is a CQC rated Outstanding practice which is a well-established and community-focused general practice located in Mitcham. We are committed to providing high-quality healthcare services to our patients. To support our ongoing growth and engagement with our community, we are seeking a dynamic and creative Digital Care Co-ordinator to join our team.
The successful candidate will play a key role in proactively identifying and working with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services
Main duties of the job
The successfulcandidate will play a key role in proactively identifying and working withpeople including the frail elderly and those with long term conditions toprovide coordination and navigation of care and support across health and careservices. They will help with content creation and management of the practicewebsite social media channels newsletters and other communications platforms.They will lead on managing and updating practice social media accounts andcreate and schedule posts. The candidate will assist in development andexecution of digital marketing campaigns to promote practice services healthawareness and community events. Linking in with our diverse and innovative personalisedcare team to coordinate and promote community outreach programs. They will workclosely with GPs and practice teams making sure that appropriate support ismade available to people supporting them to understand and manage theircondition and ensuring their changing needs are addressed. They will enablepeople to access the services and support they require to meet their health andwellbeing needs helping to improve peoples quality of life.
About us
Wide Way Medical Centre is a 16000 patient GP Practice situated in East Merton. We are a teaching practice and strive to provide high quality care to our patients. We are a dynamic and innovative team.
Job description
Job responsibilities
Carecoordinators play an important role to proactively identify and workwith people including the frail elderly and those with long-term conditions to providecoordination and navigation of care and support across health and care services.
According to independent research sixty six per cent of the UKpopulation are connected to a social account of some type. The benefit of sucha large audience can be cashed in in the form of efficient communication. Inthis age of socially connected societies healthcare information is easy todisperse to the masses.
Theywork closely with GPs and practice teams to manage a caseload of patients actingas a central point of contact to ensure appropriate support is made available tothem and their carers supporting them to understand and manage their conditionand ensuring their changing needs are addressed. Thisis achieved by bringing together all the information about a persons identified careand support needs and exploring options to meet these within a single personalisedcare and support plan based on what matters to the person.
Carecoordinators review patients needsand help them access the services and supportthey require to understand and manage their own health and wellbeing referringto social prescribing link workers health and wellbeing coaches and otherprofessionals where appropriate.
Carecoordinators could potentially provide time capacity and expertise to support peoplein preparing for or following-up clinical conversations they have with primarycare professionals to enable them to be actively involved in managing their careand supported to make choices that are right for them. Their aim is to help peopleimprove their quality of life.
Thesuccessful candidate will be based in a local cluster of General Practices as partof East Merton Primary Care Network. They will be caring dedicated reliable andperson focussed and enjoy working with a wide range of people. They will havegood written and verbal communication skills and strong organisational and timemanagement skills. They will be highly motivated and proactive with a flexibleattitude keen to work and learn as part of a team and committed to providing people their families and carers with high quality support.
Thisrole is intended to become an integral part of the practices multidisciplinary team working alongside social prescribing link workers and health and wellbeing coachesto provide an all encompassing approach to personalised care and promotingand embedding the personalised care approach across the team.
Theremay be a need to work remotely depending on the requirements of the role.
Pleasenote that the role of a care coordinator is not a clinical role.
Keyresponsibilities
Work with people their families and carers to improve their understanding of thepatients conditionand support them to develop and review personalised careand support plans to manage their needs and achieve better healthcare outcomes.
Help people to manage their needs through answering queries, making and managingappointments and ensuring that people have good quality written or verbalinformation to help them make choices about their care.
Assist people to access self-management education courses peer support healthcoaching and other interventions that support them in their health and wellbeing and increase their levels of knowledge skills and confidence in managingtheir health.
Support people to take up training and employment and to access appropriate benefitswhere eligible for example through referral to social prescribing link workers.
Provide coordination and navigation for people and their carers across health andcare services working closely with social prescribing link workers health andwellbeing coaches and other primary care professionals helping to ensure patientsreceive a joined-up service and the most appropriate support.
Work collaboratively with GPs and other primary care professionals within the Practiceto proactively identify and manage a caseloadwhich may include patientswith long-term health conditions and where appropriate refer back to otherhealth professionals.
Explore and assist people to access a personal health budget where appropriate.
Work with people their families carers and healthcare team members to encourageeffective help seeking behaviours
Identify unpaid carers and help them access services to support them. Conduct follow-ups on communications from out of hospital and in-patient services
Maintain records of referrals and interventions to enable monitoring and evaluationof the service
Support practices to keep care records up to date by identifying and updating missingor out-of-date information about the persons circumstances
Digital component
Inguidance with the community and engagement lead at Wideway the successfulcandidate will develop the following
ContentCreation and Management
Developand curate engaging content for the practices website social media channels newsletters and other communication platforms.
Write edit and proofread marketing materials including brochures flyers andpatient information leaflets.
SocialMedia Management
Manageand update the practices social media accounts
Createand schedule posts respond to comments and messages and track engagementmetrics.
DigitalMarketing
Assistin the development and execution of digital marketing campaigns to promote practiceservices health awareness and community events.
Monitorand report on the performance of digital marketing efforts using tools such asGoogle Analytics.
CommunityEngagement
Coordinateand promote community outreach programs and events.
Buildand maintain relationships with local organisations schools and businesses tofoster community partnerships.
PatientCommunication
Designand distribute patient satisfaction surveys and other feedback mechanisms.
Assistin the creation and distribution of patient communications includingappointment reminders and health alerts.
B randManagement
Ensureall marketing materials and communications are consistent with the practices brand and values.
Maintainand update the practices branding guidelines as necessary.
Enable access to personalised care and support
Take referrals for individuals or proactively identify people who could benefitfrom support through care coordination
Have a positive empathetic and responsive conversation with the person andtheir family and carers about their needs
Work towards increasing patients understandingof how to manage and develop health and wellbeing through offering advice andguidance
Develop an in depth knowledge of the local health and care infrastructure andknow how and when to enable people to access support and services that areright for them
Use tools to measure peopleslevels of knowledge skills and confidence in managing their health and totailor support to them accordingly.
Work with the wider practice MDTs and the social prescribing service to lookat how carers can support people this could include the initialidentification of carers onto the carer register
Support people to develop and implement personalised care and support plans
Review and update personalised care and support plans at regular intervals
Ensure personalised care and support plans are communicated to the GP and anyother professionals involved in the persons care and uploaded to the relevantonline care records, with activity recorded using the relevant SNOMED codes
Where a personal health budget is an option, to work with the person and thelocal CCG team to provide advice and support as appropriate
Coordinate and integrate care
Making and managing appointments for patients related to primary secondary community local authority statutory and voluntary organisations
Help people transition seamlessly between secondary and community careservices conducting followup appointments and supporting people to navigatethrough wider the health and care system
Refer onwards to social prescribing link workers and health and wellbeingcoaches where required
Regularly liaise with the range of multidisciplinary professionals andcolleagues involved in the personscare facilitating a coordinated approach and ensuring everyone is kept up todate so that any issues or concerns can be appropriately addressed andsupported
Actively participate in multidisciplinary team meetings in the PCN as and whenappropriate
Identify when action or additional support is needed alerting a named clinicalcontact in addition to relevant professionals and highlighting any safetyconcerns.
Record what interventions are used to support people and how people aredeveloping on their health and care journey
Professional development
Work with a named clinical point of contact for advice and support.
Undertake continual personal and professional development taking an activepart in reviewing and developing the role and responsibilities and provideevidence of learning activity as required
Adhere to organisational policies and procedures including confidentiality safeguarding lone working information governance equality diversity andinclusion training and health and safety.
Person Specification
Qualifications
Essential
1. NVQ Level 3 in adult care - advanced level
2. or equivalent qualifications or working
3. towards
Personal qualities and attributes
Essential
4. Ability to actively listen, empathise with people and provide personalised support in a non-judgmental way
5. Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity
6. Commitment to reducing health inequalities and proactively working to reach people from diverse communities
7. Ability to support people in a way that inspires trust and confidence, motivating others to reach their potential
8. Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders
9. Ability to identify risk and assess / manage risk when working with individuals
10. Have a strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role when there is a mental health need requiring a qualified practitioner
11. Ability to work from an asset-based approach, building on existing community and personal assets
12. Ability to maintain effective working relationships and to promote collaborative practice with all colleagues
13. Ability to demonstrate personal accountability, emotional resilience and work well under pressure
14. Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines
15. High level of written and verbal communication skills
16. Ability to work flexibly and enthusiastically within a team or on own initiative
17. Ability to provide motivational coaching to support peoples behaviour change
Experience
Essential
18. Experience of working directly in a care coordinator role, adult health and social care, learning support or public health /health improvement
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 of supporting people, their families and carers in a related role
22. Experience or training in personalised care and support planning
23. Experience of data collection and using tools to measure the impact of services
24. Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation
Skills and Knowledge
Essential
25. Knowledge of, and ability to work to policies and procedures, including
26. confidentiality, safeguarding, lone working, information governance, and health and safety
27. Demonstrable commitment to professional and personal development is enrolled in, undertaking or qualified from appropriate training as set out in the core curriculum by the Personalised Care Institute
28. Proficient in MS Office and web-based services
29. Skills and knowledge of the personalised care approach
30. Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers
31. Understanding of, and commitment to, equality, diversity and inclusion
32. Strong organisational skills, including planning, prioritising, time management and record keeping
33. Knowledge of how the NHS works, including primary care and PCNs
34. Knowledge of Safeguarding Children and Vulnerable Adults policies and processes
35. Ability to recognise and work within limits of competence and seek advice when needed
36. Understanding of the needs of older people / adults with disabilities / long term conditions particularly in relation to promoting their independence
37. Basic knowledge of long-term conditions and the complexities involved: medical, physical, emotional and social
38. Understanding of the needs of older people / adults with disabilities / long term conditions particularly in relation to promoting their independence
39. Other Meets DBS reference standards and criminal record checks
40. Willingness to work flexible hours when required to meet work demands
41. Access to own transport
42. Ability to travel across the locality on a regular basis
43. Proficient speaker of another language to aid communication with people in the community for whom English is a second language