Job Responsibilities:
1. Coordinate multidisciplinary meetings across local care organisations, identifying patients in need of review and collating necessary information prior to meetings.
2. Provide admin support to multidisciplinary meetings, including taking minutes.
3. Utilise GP Practice clinical systems SystmOne and EMIS, and population health data to proactively identify relevant cohorts of patients to deliver personalised care.
4. Support patients within these cohorts to access health checks and other health services.
5. Support the PCN in improving overall patient care through promotion of local services available within the PCN and the wider health system.
6. Liaise with key stakeholders, including GPs, nurses, pharmacists, and other support staff from within the PCN practices or other provider organisations.
7. Communicate effectively and sensitively using language appropriate to the patient and their carer.
8. Raise awareness of shared decision making and decision support tools, assisting patients to prepare for shared decision making conversations.
9. Provide coordination and navigation for patients and their carers across health and social care services, linking with social prescribers and other patient link workers in the PCN.
10. Work in partnership with key providers in the local community to enable improved access to services for patients.
11. Support practices in delivering national and local targets outlined in the GP contract.
12. Contact patients to increase uptake in designated clinics such as vaccinations, cancer screening, and health reviews.
13. Identify reasonable adjustments for vulnerable groups of patients to provide a suitable environment for care delivery.
14. Coordinate case load visits for reviews or vaccinations to support the clinical team.
15. Undertake quality improvement audits to identify best practices or areas for improvement and share learning across the PCN.
16. Participate in PCN workshops/training sessions relevant to the Care Coordinator role.
#J-18808-Ljbffr