The Care Coordinator is an important non-clinical role within the North Havering Primary Care Network working closely with the Personalised Care Team comprising of Social Prescribers, Health and Well-being Coaches as well as the PCNs full ARRS (Additional Roles Reimbursement Scheme) Team, and working directly with GPs and the practice colleagues to manage a caseload of patients, often living with or at risk of frailty and those with long-term conditions.
Main duties of the job
1. To work with the GPs and other primary care professionals within the Primary Care Network (PCN) to identify and manage a caseload of patients who would benefit from support through care coordination.
2. To work closely and in partnership with the Social Prescribing Link Worker and Health and Well-being Coaches to assist people to access self-management education courses, peer support, health coaching and other interventions that support them in their health and wellbeing, and increase their levels of knowledge, skills and confidence in managing their health.
3. Work with patients, their families and carers to improve their understanding of the patients condition and support them to develop and review personalised care and support plans.
4. Identify unpaid carers and help them access services to support them and place them on the carers register.
5. To support patients to utilise decision aids, help create single personalised care and support plans, in line with best practice.
6. To support the PCN in the delivery of the DES specifications, such as tackling health inequalities through targeted work with specific groups identified.
7. To help people to manage their needs through answering queries, making, and managing appointments and ensuring that people have good quality written or verbal information.
8. To provide coordination and navigation with the aid of digital tools.
9. To support the coordination and delivery of MDTs within the PCN.
About us
Havering Health is a membership organisation, and our remit is to deliver services on behalf of our Practices, PCNs and Partners. With them, we share the responsibility for delivering high quality, patient-focused services at scale for our communities. Working in this way, we are able to maximise the opportunity of delivering flexible care as close to our community as possible as well as developing new services and responding to needs at speed and with impact.
Havering Primary Care Networks (PCNs) are groups of GP practices that have come together to work more closely together to improve the quality of care for patients in Havering. The ARRS staff provide a valuable resource and additional services to the PCNs and Practices in supporting the delivery of high-quality and integrated care to patients across Havering. This staff group supports the other hard-working staff in general practice.
Job responsibilities
The Care Coordinator is a crucial role within the MDT by championing a proactive approach to patient care and is a single point of contact for patients and teams, including clinical and non-clinical staff in primary care, care homes, local authority, community services, secondary care and the voluntary sector.
Person Specification
Experience
* At least 2 years' experience of working in health, social care or other support roles in direct contact with people, families or carers (in a paid or voluntary capacity).
* Experience of working within multi-professional team environments.
* Ability to collect and record information and data, for record-keeping, monitoring and evaluation.
* Experience or training in person-centred care planning.
* Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation.
Qualifications
* Good standard of general education.
* Grade C GCSE English and Maths or equivalent qualifications.
* Excellent computer skills including email, word and excel.
* Has enrolled in, undertaking or qualified from appropriate training as set out by the Personalised Care Institute.
* Strong organisational skills including planning, prioritising, time management, report writing and record keeping.
* Ability to recognise gaps in services and to identify and act on safety concerns.
* Ability to recognise and work within limits of competence and seek advice when needed.
* Evidence of good verbal and written communication skills.
* Ability to build and maintain long-term working relationships with colleagues.
* A professional and compassionate attitude to patient care, providing support while maintaining professional boundaries.
* Ability to work effectively under pressure, delivering against agreed objectives.
* Ability to remain diplomatic when dealing with sensitive matters or having challenging discussions with patients or carers.
* Ability to work safely unaided in home settings.
* Willingness to take a proactive and flexible approach to the role as it develops over time.
* Experience of using the EMIS computer system.
* Up-to-date knowledge of the services and organisations available to support patients and carers.
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.
£25,000 to £30,000 a year, dependent on experience.
#J-18808-Ljbffr