Job summary The Care Coordinator plays a crucial role within our Primary Care Network (PCN) by supporting patients in navigating and coordinating their health and social care needs. Working closely with central Sutton GP Practices, healthcare professionals, including Social Prescribing Link Workers and Health and Wellbeing Coaches, the Care Coordinator ensures patients receive a personalised and holistic approach to their care, helping them make informed decisions about their health and wellbeing. Ensure patient referrals are directed to organisations with basic safeguarding processes and supportive environments. Work with designated PCN contacts to discuss patient-related concerns, including safeguarding, mental health, and domestic violence issues. Main duties of the job Utilise population health data to proactively identify and support a patient cohort with personalised care plans. Guide patients through shared decision-making processes by providing necessary tools and resources. Develop and coordinate comprehensive, personalised care and support plans that reflect each patient's unique needs and preferences. Assist patients with managing their health by answering queries, arranging appointments, and providing quality information to empower informed choices. Support patients in accessing training, employment, and eligible benefits, and refer them to Social Prescribing Link Workers when needed. Facilitate patients' access to self-management education, peer support, and interventions for improved control over their health. Help patients explore options for personal health budgets as appropriate. Coordinate patient care across health and social services, collaborating closely with primary care professionals and multidisciplinary teams (MDTs) within the PCN. Work alongside GPs and other primary care providers to manage patient caseloads and refer patients back to relevant healthcare professionals as required. Promote shared decision-making within the PCN by raising awareness of decision support tools and encouraging conversations around patient-centred care. About us Sutton Primary Care Networks is the collaborative vehicle for the four Sutton PCNs and the former Sutton GP Federation working together as a single entity. We are a Community Interest Company that aims to reinvest surpluses back into general practice and primary care for the benefit of our practices and the people who form the communities we serve. Sutton has four PCNs whose boundaries are based on historical relationships and groupings of organisations. There are some similarities of residents health and care needs unique to a particular PCN, and many more needs that are shared across all four PCNs. Our four PCN represent all 22 GP surgeries in Sutton. Their collective footprints cover all of the London Borough of Sutton and its residents who are able to access and benefit from the services and improvements offered by Primary Care Networks. Primary Care Networks (PCNs) are a key part of the NHS Long Term Plan, with all general practices being required to be in a network by June 2019, and CCGs/Integrated Care Boards (ICBs) being required to commit recurrent funding to develop and maintain them. Date posted 20 January 2025 Pay scheme Other Salary £30,187.50 a year depending on experience for full-time/part-time Contract Permanent Working pattern Full-time, Part-time Reference number A2700-25-0004 Job locations Thomas Wall Centre 52 Benhill Avenue Sutton Surrey SM1 4DP Job description Job responsibilities Assist in the supervision of other staff or learners where appropriate. Work with the practice & Sutton PCNs teams to ensure delivery of services and programmes. Actively engage in the performance cycle to identify training and support requirements. Communication The post-holder should recognise the importance of effective communication within the team and will strive to: Sutton Primary Care Networks Communicate effectively with other team members as required Communicate effectively with patients and carers Recognise peoples needs for alternative methods of communication and respond accordingly Personal/Professional Development The post-holder will participate in any training programme implemented as part of this employment, such training to include: Participation in an annual appraisal, including taking responsibility for maintaining a record of own personal and/or professional development Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work. Attending relevant professional courses and study days. Ensure they are carrying out regular clinical audits of their own and nursing team clinics and consultation Job description Job responsibilities Assist in the supervision of other staff or learners where appropriate. Work with the practice & Sutton PCNs teams to ensure delivery of services and programmes. Actively engage in the performance cycle to identify training and support requirements. Communication The post-holder should recognise the importance of effective communication within the team and will strive to: Sutton Primary Care Networks Communicate effectively with other team members as required Communicate effectively with patients and carers Recognise peoples needs for alternative methods of communication and respond accordingly Personal/Professional Development The post-holder will participate in any training programme implemented as part of this employment, such training to include: Participation in an annual appraisal, including taking responsibility for maintaining a record of own personal and/or professional development Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work. Attending relevant professional courses and study days. Ensure they are carrying out regular clinical audits of their own and nursing team clinics and consultation Person Specification Qualifications Essential Relevant qualification or experience in a similar role within health or social care Good standard of education Evidence of professional development within the health sector Good IT skills and experience in the use of General Practice experience Familiarity with IT systems currently in use in health and social care settings Experience of health and social care assessments Demonstrate successful outcomes delivery within determined timeframes Microsoft Office products, Managing document and data IT Knowledge & computer skills Desirable Degree Qualification in Health or Social care allied profession General Practice experience Familiarity with IT systems currently in use in health and social care settings Experience of health and social care assessments Demonstrate successful outcomes delivery within determined timeframe Person Specification Qualifications Essential Relevant qualification or experience in a similar role within health or social care Good standard of education Evidence of professional development within the health sector Good IT skills and experience in the use of General Practice experience Familiarity with IT systems currently in use in health and social care settings Experience of health and social care assessments Demonstrate successful outcomes delivery within determined timeframes Microsoft Office products, Managing document and data IT Knowledge & computer skills Desirable Degree Qualification in Health or Social care allied profession General Practice experience Familiarity with IT systems currently in use in health and social care settings Experience of health and social care assessments Demonstrate successful outcomes delivery within determined timeframe 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. UK Registration Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window). Additional information 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. UK Registration Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window). Employer details Employer name Sutton Primary Care Networks Address Thomas Wall Centre 52 Benhill Avenue Sutton Surrey SM1 4DP Employer's website https://www.suttonpcns.co.uk/ (Opens in a new tab)