Job description

Job responsibilities

1x PCN Care Coordinators wanted at North Lambeth Primary Care Network

Role Title

PCN Care Coordinator

Grade/Salary

upto £28K

Hours

37.5 hours per week.

Duration

Permanent

Reporting to

PCN Network Manager

Location

North Lambeth member practices for the Primary Care Network

Key responsibilities

1. Undertake work in line with PCN directed priorities.

2. Proactively identify and work with a cohort of people to support their personalised care requirements, using the available decision support aids

3. Ensure regular and consistent communication with the referrer regarding patient progress and any complications or guidance

4. Raise awareness of health promotion and NHS health checks in practices

5. Work with Member Practices to facilitate the .

6. Evaluate treatment programmes that promote health and well-being

7. Co-ordinate clinics, liaising with the schedulers and contacting the identified patients with appointments.

8. Manage patient initiated calls for help/signposting etc, booking into named GP urgent care slots/tel slots if necessary.

9. Document and monitor aspects of patient co-ordination and service delivery, supporting data collection and audit using the patient administration system

10. Demonstrate the ability to recognise and respond appropriately when faced with a sudden deterioration or emergency situation, alerting the team or enabling a rapid response.

11. Dependant on work plans, there may be a requirement to work across different tumour groups and teams.

12. Organise and prioritise own workload the postholder should be comfortable working independently and as a committed member of the multi-disciplinary team.

13. Support national screening programmes

14. Support immunization programmes

15. Monitor referrals to ensure tasks are completed and care delivered by keeping in regular telephone contact

16. Direct liaison with multi agencies to coordinate care for patients

17. Refer to PCN social prescribing link workers were a patient is identified as potentially benefitting from this service

18. To support patient/carer contact roles, and collate patient and carer feedback on their experiences

19. Support Quality and Outcome Frameworks and other DES/LES specifications

20. Maintain and develop engagement with all practice staff and encourage best practice

21. Act as the first port of call for patients, in their caseload in relation to their care.

22. Bring together all of a persons identified care and support needs, and explore their options to meet these into a single personalised care and support plan (PCSP), in line with PCSP best practice

23. Help people to manage their needs, answering their queries and supporting them to make appointments

24. Support people to take up training, employment and access appropriate benefits where eligible

25. Raise awareness of shared decision-making and decision support tools, and assist people to be more prepared to have a shared decision-making conversation

26. Ensure that people have good quality information to help them make choices about their care

27. Support people to understand their level of knowledge, skills and confidence their Activation level when engaging with their health and wellbeing, including using the Patient Activation Measure

28. Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing

29. Explore and assist people to access personal health budgets where appropriate

30. Provide coordination and navigation for people and their carers across health and care services, alongside working closely with social prescribing link workers and other primary care roles

31. Support the coordination and delivery of MDTs within PCNs. - Manage MDT meetings for this patients and identifying issues to be addressed, liaising with other agencies if necessary as well as GPs, Pharmacists and Nursing team.

32. Liaise directly with Care Homes and other key providers, to identify patients for discussion at MDT, and compile and circulate relevant information to attendees

33. Other duties as defined by the PCN as necessary

Confidentiality

In the course of seeking treatment, patients entrust us with, or allow us to gather, sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately.

In the performance of the duties outlined in this job description, the post-holder may have access to confidential information relating to patients, their carers, practice or staff information. All such information from any source is to be regarded as strictly confidential.

Information relating to patients, carers, colleagues, or the members practices may only be divulged to authorised persons in accordance with PGPA policies and procedures relating to confidentiality and the protection of personal and sensitive data, or under the guidance of your manager.

This role profile is not exhaustive, and you may be directed to complete other tasks according to the skills and requirements for individual roles. These duties will always be reasonable and deemed within the expectations of your position.

Job responsibilities

1x PCN Care Coordinators wanted at North Lambeth Primary Care Network

Role Title

PCN Care Coordinator

Grade/Salary

upto £28K

Hours

37.5 hours per week.

Duration

Permanent

Reporting to

PCN Network Manager

Location

North Lambeth member practices for the Primary Care Network

Key responsibilities

1. Undertake work in line with PCN directed priorities.

2. Proactively identify and work with a cohort of people to support their personalised care requirements, using the available decision support aids

3. Ensure regular and consistent communication with the referrer regarding patient progress and any complications or guidance

4. Raise awareness of health promotion and NHS health checks in practices

5. Work with Member Practices to facilitate the .

6. Evaluate treatment programmes that promote health and well-being

7. Co-ordinate clinics, liaising with the schedulers and contacting the identified patients with appointments.

8. Manage patient initiated calls for help/signposting etc, booking into named GP urgent care slots/tel slots if necessary.

9. Document and monitor aspects of patient co-ordination and service delivery, supporting data collection and audit using the patient administration system

10. Demonstrate the ability to recognise and respond appropriately when faced with a sudden deterioration or emergency situation, alerting the team or enabling a rapid response.

11. Dependant on work plans, there may be a requirement to work across different tumour groups and teams.

12. Organise and prioritise own workload the postholder should be comfortable working independently and as a committed member of the multi-disciplinary team.

13. Support national screening programmes

14. Support immunization programmes

15. Monitor referrals to ensure tasks are completed and care delivered by keeping in regular telephone contact

16. Direct liaison with multi agencies to coordinate care for patients

17. Refer to PCN social prescribing link workers were a patient is identified as potentially benefitting from this service

18. To support patient/carer contact roles, and collate patient and carer feedback on their experiences

19. Support Quality and Outcome Frameworks and other DES/LES specifications

20. Maintain and develop engagement with all practice staff and encourage best practice

21. Act as the first port of call for patients, in their caseload in relation to their care.

22. Bring together all of a persons identified care and support needs, and explore their options to meet these into a single personalised care and support plan (PCSP), in line with PCSP best practice

23. Help people to manage their needs, answering their queries and supporting them to make appointments

24. Support people to take up training, employment and access appropriate benefits where eligible

25. Raise awareness of shared decision-making and decision support tools, and assist people to be more prepared to have a shared decision-making conversation

26. Ensure that people have good quality information to help them make choices about their care

27. Support people to understand their level of knowledge, skills and confidence their Activation level when engaging with their health and wellbeing, including using the Patient Activation Measure

28. Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing

29. Explore and assist people to access personal health budgets where appropriate

30. Provide coordination and navigation for people and their carers across health and care services, alongside working closely with social prescribing link workers and other primary care roles

31. Support the coordination and delivery of MDTs within PCNs. - Manage MDT meetings for this patients and identifying issues to be addressed, liaising with other agencies if necessary as well as GPs, Pharmacists and Nursing team.

32. Liaise directly with Care Homes and other key providers, to identify patients for discussion at MDT, and compile and circulate relevant information to attendees

33. Other duties as defined by the PCN as necessary

Confidentiality

In the course of seeking treatment, patients entrust us with, or allow us to gather, sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately.

In the performance of the duties outlined in this job description, the post-holder may have access to confidential information relating to patients, their carers, practice or staff information. All such information from any source is to be regarded as strictly confidential.

Information relating to patients, carers, colleagues, or the members practices may only be divulged to authorised persons in accordance with PGPA policies and procedures relating to confidentiality and the protection of personal and sensitive data, or under the guidance of your manager.

This role profile is not exhaustive, and you may be directed to complete other tasks according to the skills and requirements for individual roles. These duties will always be reasonable and deemed within the expectations of your position.

Person Specification

Personal Qualities & Attributes

Essential

• Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines.
• Able to work as part of a team
• Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
• Ability to communicate effectively, both verbally and in writing, with people, their families, carers, partner agencies and stakeholders.
• Excellent negotiating skills
• Ability to maintain effective working relationships and to promote collaborative practice with all colleagues in PCN and the various Practice teams
• Demonstrates personal accountability, emotional resilience and works well under pressure

Skills and knowledge

Essential

• Knowledge of the personalised care approach
• Advanced experience of using word, excel and PowerPoint including ability to use word processing skills, emails and the internet to create simple plans and reports
• Creative problem solver and willing to search for hard-to-find information

Desirable

• Knowledge of general practice clinical systems, such as, EMIS ERS, Footfall
• Ability to read large amounts of information and extract the salient points, to analyse data and report on findings

Other

Essential

• Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
• Access to own transport and ability to travel across the locality on a regular basis
• Continued commitment to improve skills and ability in new areas of work

Experience

Essential

• Experience of working with healthcare professionals and or previous experience in the NHS or social care or relevant field (including unpaid work)
• Experience of data collection and providing monitoring information to assess the impact of services
• Experience of partnership/collaborative working and of building relationships across a variety of organisations
• Experience of working with or in general practice
• Working in a multi-disciplinary setting where influence and negotiation is required
• Knowledge/familiarity with medical terminology

Desirable

• Experience of supporting people, their families and carers in a related role (including unpaid work)
• Experience in use of databases
• Vulnerable adults awareness
• Experience of care of the elderly

Qualifications

Essential

• ECDL or equivalent
• Diploma/ HNC level (or relevant experience)
• NVQ Level 2 Business Administration (or relevant experience)
• Demonstrable commitment to professional and personal
• development

Desirable

• Training in motivational coaching and interviewing or equivalent

Personal Qualities & Attributes

Essential

• Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines.
• Able to work as part of a team
• Able to support people in a way that inspires trust and confidence, motivating others to reach their potential
• Ability to communicate effectively, both verbally and in writing, with people, their families, carers, partner agencies and stakeholders.
• Excellent negotiating skills
• Ability to maintain effective working relationships and to promote collaborative practice with all colleagues in PCN and the various Practice teams
• Demonstrates personal accountability, emotional resilience and works well under pressure

Skills and knowledge

Essential

• Knowledge of the personalised care approach
• Advanced experience of using word, excel and PowerPoint including ability to use word processing skills, emails and the internet to create simple plans and reports
• Creative problem solver and willing to search for hard-to-find information

Desirable

• Knowledge of general practice clinical systems, such as, EMIS ERS, Footfall
• Ability to read large amounts of information and extract the salient points, to analyse data and report on findings

Other

Essential

• Meets DBS reference standards and has a clear criminal record, in line with the law on spent convictions
• Access to own transport and ability to travel across the locality on a regular basis
• Continued commitment to improve skills and ability in new areas of work

Experience

Essential

• Experience of working with healthcare professionals and or previous experience in the NHS or social care or relevant field (including unpaid work)
• Experience of data collection and providing monitoring information to assess the impact of services
• Experience of partnership/collaborative working and of building relationships across a variety of organisations
• Experience of working with or in general practice
• Working in a multi-disciplinary setting where influence and negotiation is required
• Knowledge/familiarity with medical terminology

Desirable

• Experience of supporting people, their families and carers in a related role (including unpaid work)
• Experience in use of databases
• Vulnerable adults awareness
• Experience of care of the elderly

Qualifications

Essential

• ECDL or equivalent
• Diploma/ HNC level (or relevant experience)
• NVQ Level 2 Business Administration (or relevant experience)
• Demonstrable commitment to professional and personal
• development

Desirable

• Training in motivational coaching and interviewing or equivalent

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

Hurley Group

Address

Kennington Lane

London

SE11 4HJ

Employer's website

http://hurleygroup.co.uk/ (Opens in a new tab)