Primary Care Diabetes / Long Term Conditions Co-ordinator
We are looking for an organised individual to help actively improve the health and well-being of our patients with long-term conditions. This post is for 20 hours a week.
The postholder will work as part of a multi-disciplinary team including admin staff, GPs, nurses, and social prescribers.
Long-term conditions include, but are not limited to, diabetes, asthma, COPD, frailty, dementia, heart failure, and mental health conditions.
Main duties of the job
Main responsibilities include organising appointments for patients with long-term conditions, managing recalls for blood tests, and actively following up patients who do not attend appointments.
About us
Island City Network PCN is made up of The Island City Practice and Derby Road Group Practice, with a combined population of circa 53,876 patients.
We have a range of key staff members already working to enhance the health of our patient population including 3 Clinical Pharmacists, 5 Pharmacy Technicians, 4 Social Prescribing Link Workers, 4 Care Coordinators, 2 Physios, 4 Paramedics, 1 Practice Nurse, and 2 Mental Health Facilitators.
Management is provided by the Clinical Director and PCN Manager.
Previous applicants need not apply.
Job responsibilities
The postholder will use available population data to work with the identified group of patients to ensure that all patients receive the same level of patient care and that vulnerable patients are managed and followed up.
The postholder will support patients to receive holistic care and signpost patients to suitable care providers within the PCN such as the social prescribers or the pharmacy team.
The postholder will develop an understanding and signpost patients to local services available for patients with long-term conditions such as educational resources and charity providers.
The postholder will support carers of patients with long-term conditions and be able to signpost carers to appropriate sources of support.
The postholder will actively participate in MDTs within the PCN.
Person Specification
Qualifications
* Ability to actively listen, empathise and provide personalised support in a non-judgemental way, to inspire trust and confidence and motivate patients to reach their health and wellbeing potential.
* Ability to provide a culturally sensitive service, supporting people from all backgrounds and communities, respecting lifestyle and diversity.
* Commitment to reducing health inequalities and proactively working to reach people from diverse communities.
* High level of written and verbal communication skills and the ability to communicate effectively both verbally and in writing, with people, their families, carers, and other services.
* Ability to maintain effective working relationships with all colleagues and to work flexibly and enthusiastically within a team or working under own initiative.
* Ability to organise, plan and prioritise under own initiative and when under pressure and meeting deadlines.
* Knowledge of and ability to work to policies and procedures including confidentiality, safeguarding, information governance, and health and safety.
* Meets DBS reference standards and criminal records checks.
* Willingness to work flexible hours when required to meet work demands.
* Strong organisational skills.
* Ability to work independently and within a team.
* Previous primary care experience working with SystemOne.
* Knowledge of the services and teams that support patients within the community.
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.
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