Job summary The Care Coordinator will be predominantly working with our PCN care homes andwill be the lead on organizing our Facilitation and admission avoidance assessments, and will regularly feedback how the numbers completed compare with the targets set for these. The role will be responsible for making sure PCN staff clinics are being utilized fully and will monitor the extended access clinics. There may be times when patients will need to be contacted re recall lists for smears or other health prevention clinics. Main duties of the job This role is intended to become an integral part of the PCNs multidisciplinary team, working alongside social prescribing link workers and health and wellbeing coaches to provide an all-encompassing approach to personalised care and promoting and embedding the personalised care approach across the PCN. Please note that the role of a care coordinator is not a clinical role. About us HBB PCN has four member practices across Hanley and Bentilee, within Stoke-On-Trent. Together the practices have a patient population of approximately 33,000. Network member practices: Moorcroft Medical Centre, Harley Street Medical Centre, Potteries Medical Centre, Cambridge House Surgery. Date posted 04 February 2025 Pay scheme Other Salary £12.21 an hour Contract Permanent Working pattern Full-time, Flexible working Reference number A5318-25-0000 Job locations Trent Building Victoria Road Stoke-on-Trent ST4 2LW Job description Job responsibilities The Care Coordinator will be predominantly working with our PCN care homes. They will be the lead on organizing our Facilitation and admission avoidance assessments, and will regularly feedback how the numbers completed compare with the targets set for these. The role will be responsible for making sure PCN staff clinics are being utilized fully and will monitor the extended access clinics. There may be times when patients will need to be contacted re recall lists for smears or other health prevention clinics. Care coordinators review patients needs and help them access the services and support they require to understand and manage their own health and wellbeing, referring to social prescribing link workers, health and wellbeing coaches, and other professionals where appropriate. Care coordinators could potentially provide time, capacity and expertise to support people in preparing for or following-up clinical conversations they have with primary care professionals to enable them to be actively involved in managing their care and supported to make choices that are right for them. Their aim is to help people improve their quality of life. The successful candidate will be based in a local cluster of General Practices as part of Hanley Bucknall & Bentilee Primary Care Network (PCN). They will be caring, dedicated, reliable and person-focused and enjoy working with a wide range of people They will have good written and verbal communication skills and strong organizational and time management skills. They will be highly motivated and proactive with a flexible attitude, keen to work and learn as part of a team and committed to providing people, their families and carers with high quality support. This role is intended to become an integral part of the PCNs multidisciplinary team, working alongside social prescribing link workers and health and wellbeing coaches to provide an all-encompassing approach to personalised care and promoting and embedding the personalised care approach across the PCN. Please note that the role of a care coordinator is not a clinical role. Key responsibilities Work with people, their families and carers to improve their understanding of the patients condition and support them to develop and review personalised care and support plans to manage their needs and achieve better healthcare outcomes. Answer calls to our care homes and manage the email inbox where requests are directed. Manage Care-Homes including booking in and managing annual care plans. Booking in our FAAS appointments Fill PCN appointments including extended access clinics. Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care. Lead and take minutes for MDT minutes regarding care home patients. Work with people, their families, carers and healthcare team members to encourage effective help-seeking behaviours. Support PCNs in developing communication channels between GPs, people and their families and carers and other agencies. Conduct follow-ups on communications from out of hospital and in-patient services. Maintain records of referrals and interventions to enable monitoring and evaluation of the service. Support practices to keep care records up-to-date by identifying and updating missing or out-of-date information about the persons circumstances. Person Specification E Essential D Desirable Personal qualities and attributes: Ability to actively listen, empathise with people and provide personalised support in a non-judgmental way E Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity E Commitment to reducing health inequalities and proactively working to reach people from diverse communities E Ability to support people in a way that inspires trust and confidence, motivating others to reach their potential E Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders E Ability to identify risk and assess/manage risk when working with individuals E 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 e.g. when there is a mental health need requiring a qualified practitioner E Ability to maintain effective working relationships and to promote collaborative practice with all colleagues E Ability to demonstrate personal accountability, emotional resilience and work well under pressure E Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines E High level of written and verbal communication skills E Ability to work flexibly and enthusiastically within a team or on own initiative E Ability to provide motivational coaching to support peoples behaviour change D Knowledge of, and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety E Qualifications and training NVQ Level 3 in adult care - advanced level or equivalent qualifications or working towards D 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 E (training given) Proficient in MS Office and web-based services E Experience Experience of working directly in a care coordinator role, adult health and social care, learning support or public health / health improvement D 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) D Experience of working within multi- professional team environments E Experience of supporting people, their families and carers in a related role D Experience or training in personalised care and support planning D Experience of data collection and using tools to measure the impact of services E Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation D Skills and knowledge Knowledge of the personalised care approach E Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers E Understanding of, and commitment to, equality, diversity and inclusion E Strong organisational skills, including planning, prioritising, time management and record keeping E Knowledge of how the NHS works, including primary care and PCNs E Knowledge of Safeguarding Children and Vulnerable Adults policies and processes D Ability to recognise and work within limits of competence and seek advice when needed E Understanding of the needs of older people / adults with disabilities / long term conditions particularly in relation to promoting their independence E Basic knowledge of long-term conditions and the complexities involved: medical, physical, emotional and social D Understanding of the needs of older people / adults with disabilities / long term conditions particularly in relation to promoting their independence E Other Meets DBS reference standards and criminal record checks E Willingness to work flexible hours when required to meet work demands E Job description Job responsibilities The Care Coordinator will be predominantly working with our PCN care homes. They will be the lead on organizing our Facilitation and admission avoidance assessments, and will regularly feedback how the numbers completed compare with the targets set for these. The role will be responsible for making sure PCN staff clinics are being utilized fully and will monitor the extended access clinics. There may be times when patients will need to be contacted re recall lists for smears or other health prevention clinics. Care coordinators review patients needs and help them access the services and support they require to understand and manage their own health and wellbeing, referring to social prescribing link workers, health and wellbeing coaches, and other professionals where appropriate. Care coordinators could potentially provide time, capacity and expertise to support people in preparing for or following-up clinical conversations they have with primary care professionals to enable them to be actively involved in managing their care and supported to make choices that are right for them. Their aim is to help people improve their quality of life. The successful candidate will be based in a local cluster of General Practices as part of Hanley Bucknall & Bentilee Primary Care Network (PCN). They will be caring, dedicated, reliable and person-focused and enjoy working with a wide range of people They will have good written and verbal communication skills and strong organizational and time management skills. They will be highly motivated and proactive with a flexible attitude, keen to work and learn as part of a team and committed to providing people, their families and carers with high quality support. This role is intended to become an integral part of the PCNs multidisciplinary team, working alongside social prescribing link workers and health and wellbeing coaches to provide an all-encompassing approach to personalised care and promoting and embedding the personalised care approach across the PCN. Please note that the role of a care coordinator is not a clinical role. Key responsibilities Work with people, their families and carers to improve their understanding of the patients condition and support them to develop and review personalised care and support plans to manage their needs and achieve better healthcare outcomes. Answer calls to our care homes and manage the email inbox where requests are directed. Manage Care-Homes including booking in and managing annual care plans. Booking in our FAAS appointments Fill PCN appointments including extended access clinics. Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care. Lead and take minutes for MDT minutes regarding care home patients. Work with people, their families, carers and healthcare team members to encourage effective help-seeking behaviours. Support PCNs in developing communication channels between GPs, people and their families and carers and other agencies. Conduct follow-ups on communications from out of hospital and in-patient services. Maintain records of referrals and interventions to enable monitoring and evaluation of the service. Support practices to keep care records up-to-date by identifying and updating missing or out-of-date information about the persons circumstances. Person Specification E Essential D Desirable Personal qualities and attributes: Ability to actively listen, empathise with people and provide personalised support in a non-judgmental way E Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity E Commitment to reducing health inequalities and proactively working to reach people from diverse communities E Ability to support people in a way that inspires trust and confidence, motivating others to reach their potential E Ability to communicate effectively, both verbally and in writing, with people, their families, carers, community groups, partner agencies and stakeholders E Ability to identify risk and assess/manage risk when working with individuals E 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 e.g. when there is a mental health need requiring a qualified practitioner E Ability to maintain effective working relationships and to promote collaborative practice with all colleagues E Ability to demonstrate personal accountability, emotional resilience and work well under pressure E Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines E High level of written and verbal communication skills E Ability to work flexibly and enthusiastically within a team or on own initiative E Ability to provide motivational coaching to support peoples behaviour change D Knowledge of, and ability to work to policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety E Qualifications and training NVQ Level 3 in adult care - advanced level or equivalent qualifications or working towards D 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 E (training given) Proficient in MS Office and web-based services E Experience Experience of working directly in a care coordinator role, adult health and social care, learning support or public health / health improvement D 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) D Experience of working within multi- professional team environments E Experience of supporting people, their families and carers in a related role D Experience or training in personalised care and support planning D Experience of data collection and using tools to measure the impact of services E Experience of working with elderly or vulnerable people, complying with best practice and relevant legislation D Skills and knowledge Knowledge of the personalised care approach E Understanding of the wider determinants of health, including social, economic and environmental factors and their impact on communities, individuals, their families and carers E Understanding of, and commitment to, equality, diversity and inclusion E Strong organisational skills, including planning, prioritising, time management and record keeping E Knowledge of how the NHS works, including primary care and PCNs E Knowledge of Safeguarding Children and Vulnerable Adults policies and processes D Ability to recognise and work within limits of competence and seek advice when needed E Understanding of the needs of older people / adults with disabilities / long term conditions particularly in relation to promoting their independence E Basic knowledge of long-term conditions and the complexities involved: medical, physical, emotional and social D Understanding of the needs of older people / adults with disabilities / long term conditions particularly in relation to promoting their independence E Other Meets DBS reference standards and criminal record checks E Willingness to work flexible hours when required to meet work demands E Person Specification Experience Essential See above Desirable See above Qualifications Essential See above Desirable See above Person Specification Experience Essential See above Desirable See above Qualifications Essential See above Desirable See above 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. Employer details Employer name Hanley, Bucknall, Bentilee PCN Address Trent Building Victoria Road Stoke-on-Trent ST4 2LW Employer's website https://www.harleystreetmedicalpractice.org.uk/ (Opens in a new tab)