To ensure completion of new referrals by checking the agreed criteria. To accept or decline referral as appropriate. To arrange home assessments in liaison with the Case Coordinator and carry out assessments as scheduled. To co-produce a personalised care plan with the service user with the objective of ensuring health and wellbeing needs are met, supporting independence, and enabling the individual to better manage their health and wellbeing. To record care plans for all service users, ensuring records are accurate and recorded promptly, on SystmOne and OneDrive. To signpost or refer service users to relevant agreed services, using professional reasoning and patient advocacy. To work collaboratively and provide regular feedback to GP practices. To assist the CCT Lead in developing and maintaining good working relationships with GP practices, adult social care, hospitals, pharmacists, and voluntary and statutory agencies.