Job summary
An exciting opportunity has arisen for a Care Co-ordinator to join Surrey Heath Primary Care Network [PCN], supporting delivery of the new Network Contract Direct Enhanced Service [DES] specifications.
We are looking for a Care Co-ordinator to support our PCN, to work closely with PCN Practices and the multidisciplinary team in coordinating all key activities including access to services, advice, and information, and ensuring heath and care planning is timely, efficient, and patient-centred.
The post holder will help patients interact and engage with everyday life through activities designed to develop, maintain, or retrain skills for people with a cognitive, physical, or mental disorder, condition, or illness. You will support the provision of continuity of care and act as a point of contact for families, residents, and professionals for identified patients in your caseload.
Main duties of the job
1. Provide coordination and navigation for people and their carers across health and care services, working closely with social prescribers, health and wellbeing coaches and other primary care professionals.
2. Utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care
3. Support PCN staff and patients to be prepared to have shared-decision making conversations including utilising decision aids and tools, and support patients to understand their level of knowledge, skills and confidence (their activation level) when engaging with their health and wellbeing including through the use of the Patient Activation Measure.
4. Help people to manage their needs through answering queries, making and managing appointments and ensuring that people have food quality written or verbal information to help them make choices about their care
5. Support the practice with the Patient Participation Group [PPG]
6. Holistically bring together all of a persons identified care and support plan, in line with best practice, based on what matters to the person
7. Support people to take up training and employment, and to access appropriate benefits, education courses, peer support, and/or personal health budgets where applicable
About us
We are Surrey Heath Community Providers Limited, which is a federation of 7 GP practices across 10 sites, covering a population of over 97,000 patients across Surrey Heath. We began in 2016 and now employ around 200 members of staff across our head office sites, and our primary care and unplanned care services.
As a GP Federation, we are proud to represent our member practices and to champion primary care by working with local general practice and system partners in the provision of community based healthcare services. We are dedicated to providing safe and compassionate care to our patients across our range of primary care and unplanned healthcare services in Surrey Heath, and believe in continuous commitment to quality service delivery and positive patient outcomes.
Patients are at the heart of everything we do, and we pride ourselves in ensuring our patients feel safe, supported, communicated with and respected, at a time when they may be feeling vulnerable. Our vision is to provide high quality, seamless health care that enables people to lead healthier lives, whilst feeling supported and cared for.
Job description
Job responsibilities
Please see Supporting Documents for full Job Description, Person Specification and list of responsibilities
Person Specification
Knowledge
Essential
8. Experience of working with healthcare professionals and/or previous experience in the NHS or social care.
9. Experience coordinating with multiple stakeholder or individuals to meet specified outcomes.
10. Experience providing advice/signposting.
11. Experience using a patient clinical system such as EMIS.
12. Awareness of how and when to signpost.
13. Knowledge of safeguarding interventions and an awareness of the Mental Capacity Act.
14. Skilled in the use of person-centred measurement and outcomes delivery.
Desirable
15. Knowledge of a range of local community groups which support wellbeing.
16. Awareness of relevant Health and Social Care legislation and a developed knowledge of crisis intervention.
17. Experience of undertaking quality improvement activity.
18. Sound understanding of disease prevention and the NHS choices website.
Personal Attributes
Essential
19. Creative, flexible and sensitive approach to working with people with diverse support needs.
20. Ability to motivate people.
21. Ability to reflect on and share best practice with peers.
22. Able to travel locally as required.
23. Passionate about combatting disadvantage and inequality in healthcare
24. Able to work as part of a team.
Qualifications
Essential
25. 4 GCSEs (C and above) including English and Maths or equivalent
Desirable
26. Relevant NVQ Level 3 qualification or equivalent
Skills
Essential
27. Excellent verbal and written communication skills with the ability to communicate effectively at all levels including with patients, carers, specialist services, GPs and colleagues.
28. Good technical literacy with Word, Excel, and experience using a clinical system such as EMIS.
29. Able to work independently and manage own workload.
30. Able to build strong professional relationships.
31. Demonstrable experience of effective planning and organisation skills to deliver targets to deadlines.
32. Proven record of excellent written communication skills and a high level of health literacy.
33. Understanding of social determinants of health and how these can be addressed with patients.
34. Able to analyse and interpret information and present results in a clear and concise manner.