• Job Description

  Req#: B0083-25-0012?language=en&page=551&sort=publicationDateDesc

  Job summary

  Bolton GP Federation is looking to recruit a Care Coordinator on behalf of our Primary Care Networks (PCNs).

  You will have a broad portfolio of duties that originate from the requirements of the PCN contracts, including the Directed Enhanced Services (DES) and Impact & Investment Fund (IIF).

  Main duties of the job

  Care coordinators provide extra time, capacity and expertise to support patients. You will work closely with GPs and other primary care professionals within the PCN to proactively identify and manage a caseload of patients, making sure that holistic support is made available to them and that their complex needs are addressed. You may also be asked to contribute towards other administrative tasks within the practice or PCN.

  About us

  Bolton GP Federation is a collective vehicle where Boltons GP practices come together to deliver primary care, providing a place for collaboration, knowledge-sharing and coordination. The Federation is a voice of the priorities, needs and local intelligence of primary care into the wider healthcare system.

  We are rated Good by the Care Quality Commission (CQC) and we are proud of the services that we run, which include Primary Care Networks, Extended Primary Care, and Experienced Nurse Network and the Covid Vaccination Programme.

  Our mission is to improve health and care. We meet everyday health and care needs for people by connecting primary care systems and using creative thinking to develop, improve and support great local services.

  Details

  Date posted

  02 June 2025

  Pay scheme

  Other

  Salary

  £25,851.12 to £28,368.69 a year

  Contract

  Permanent

  Working pattern

  Full-time, Part-time

  Reference number

  B0083-25-0012

  Job locations

  Floor 2, The Hub

  Bold Street

  Bolton

  Lancashire

  BL1 1LS

  
  

  Job description

  Job responsibilities

  Key Responsibilities and Duties:

  The Care Coordinator will undertake work in line with PCN and directed priorities. The following are the core responsibilities of the role:

  Clinical Pharmacy Support

  Use clinical system risk stratification tools and Ardens Manger to identify and call/recall patients for the Clinical Pharmacy Team to review. This includes, but is not limited to, patients for:

  Structured Medication Reviews

  QOF Quality Improvement indicators

  QOF Medicines indicators

  IIF Medicines indicators

  Practice Prescribing Schemes

  Audits

  Early Cancer Diagnosis

  Support the delivery of PCN objectives under the Early Cancer Diagnosis requirements of the PCN DES. This includes but is not limited to:

  Attending Cancer Steering Group meetings

  Patient follow-up from cancer screening

  Cancer care planning

  Patient communications

  Enhanced Care in Care Homes

  You will:

  Support the practice team to identify gaps in existing care plans and help produce and annual Personalised Care and Support Plan (PCSP), referring to the patients named GP to complete.

  Liaise with care homes to schedule the monthly Clinical Pharmacist visits.

  Liaise with care homes to ensure new admissions and patients who have been discharged from hospital, are reviewed at the next Ward Round, and have an updated PCSP.

  Cardiovascular Disease Prevention and Diagnosis

  Support patient call and recall as directed by the Senior Network Manager.

  Health Inequalities

  Identify patient cohorts being targeted by the PCN health inequalities steering group, inviting them to participate in agreed interventions.

  Learning disabilities care planning.

  Supporting patients & Social Prescribing:

  Actively sign-post patients to a variety of services including Social Prescribing, making referrals as appropriate.

  Utilise population health intelligence to proactively identify a cohort of patients to deliver personalised care.

  Information Technology

  Write searches to identify target patient cohorts.

  Write and update templates and protocols to effectively capture relevant clinical and non-clinical information.

  Multi-Disciplinary Team (MDT) Meetings

  Prepare agendas for MDT meetings and contact all parties to ensure attendance and to confirm patients to be discussed.

  Care Planning

  Support the practice objectives (local and PCN-level) to ensure care plans are actively created and updated. This includes for learning disability patients, dementia patients, care home residents and cancer patients.

  Identify patients without recent care plans in place and work with their name GP to update these plans.

  Ensure that preventative actions are agreed and detailed in care plans to support the reduction of unnecessary hospital admissions.

  Investment and Impact Fund (IIF)

  Support patient call and recall as directed by the Senior Network Manager.

  Ensure the minimum number of patient contacts by aligning multiple tests and reviews.

  Support Data Collection:

  Ensure timely and accurate collation of data for the PCN

  Appropriate management of collected data, ensuring all data is kept and shared in accordance with all relevant governance requirements.

  Validate and quality assure incoming data.

  Run regular patient searches using clinical systems to have an up-to-date record of progress of achievement of Key Performance Indicators (KPIs).

  Case finding to support target achievement and enhancing register prevalence.

  PCN Duties

  Provide an agreed Care Coordinator service to all PCN practices with duties to be defined by the PCN managers.

  Job description

  Job responsibilities

  Key Responsibilities and Duties:

  The Care Coordinator will undertake work in line with PCN and directed priorities. The following are the core responsibilities of the role:

  Clinical Pharmacy Support

  Use clinical system risk stratification tools and Ardens Manger to identify and call/recall patients for the Clinical Pharmacy Team to review. This includes, but is not limited to, patients for:

  Structured Medication Reviews

  QOF Quality Improvement indicators

  QOF Medicines indicators

  IIF Medicines indicators

  Practice Prescribing Schemes

  Audits

  Early Cancer Diagnosis

  Support the delivery of PCN objectives under the Early Cancer Diagnosis requirements of the PCN DES. This includes but is not limited to:

  Attending Cancer Steering Group meetings

  Patient follow-up from cancer screening

  Cancer care planning

  Patient communications

  Enhanced Care in Care Homes

  You will:

  Support the practice team to identify gaps in existing care plans and help produce and annual Personalised Care and Support Plan (PCSP), referring to the patients named GP to complete.

  Liaise with care homes to schedule the monthly Clinical Pharmacist visits.

  Liaise with care homes to ensure new admissions and patients who have been discharged from hospital, are reviewed at the next Ward Round, and have an updated PCSP.

  Cardiovascular Disease Prevention and Diagnosis

  Support patient call and recall as directed by the Senior Network Manager.

  Health Inequalities

  Identify patient cohorts being targeted by the PCN health inequalities steering group, inviting them to participate in agreed interventions.

  Learning disabilities care planning.

  Supporting patients & Social Prescribing:

  Actively sign-post patients to a variety of services including Social Prescribing, making referrals as appropriate.

  Utilise population health intelligence to proactively identify a cohort of patients to deliver personalised care.

  Information Technology

  Write searches to identify target patient cohorts.

  Write and update templates and protocols to effectively capture relevant clinical and non-clinical information.

  Multi-Disciplinary Team (MDT) Meetings

  Prepare agendas for MDT meetings and contact all parties to ensure attendance and to confirm patients to be discussed.

  Care Planning

  Support the practice objectives (local and PCN-level) to ensure care plans are actively created and updated. This includes for learning disability patients, dementia patients, care home residents and cancer patients.

  Identify patients without recent care plans in place and work with their name GP to update these plans.

  Ensure that preventative actions are agreed and detailed in care plans to support the reduction of unnecessary hospital admissions.

  Investment and Impact Fund (IIF)

  Support patient call and recall as directed by the Senior Network Manager.

  Ensure the minimum number of patient contacts by aligning multiple tests and reviews.

  Support Data Collection:

  Ensure timely and accurate collation of data for the PCN

  Appropriate management of collected data, ensuring all data is kept and shared in accordance with all relevant governance requirements.

  Validate and quality assure incoming data.

  Run regular patient searches using clinical systems to have an up-to-date record of progress of achievement of Key Performance Indicators (KPIs).

  Case finding to support target achievement and enhancing register prevalence.

  PCN Duties

  Provide an agreed Care Coordinator service to all PCN practices with duties to be defined by the PCN managers.

  Person Specification

  Qualifications

  Essential

  • Good standard of education with excellent literacy and numeracy skills

  Desirable

  • NVQ Level 3 Business Administration (or relevant experience)

  Experience

  Essential

  • Experience of working in General Practice, the NHS or Social Care
  • Understanding of current issues facing the NHS and social care process
  • Experience of administrative duties
  • Able to demonstrate a clear understanding of working with confidential information and an understanding of service user confidentiality
  • Working in a multi-disciplinary setting where influence and negotiation is required
  • Working in a busy and demanding environment whilst delivering in a timely manner

  Desirable

  • Knowledge/familiarity with medical terminology
  • Previous experience in the Care Coordinator role.

  Skills

  Essential

  • Proven record of excellent written skills and verbal communication skills and interpersonal skills
  • Evidence of excellent knowledge of Microsoft Office
  • Able to work as part of a team
  • Excellent motivational and influencing skills
  • Able to prioritise and manage own workload and ensuring completion of tasks on time
  • Strong analytical and judgement skills
  • Ability to analyse and interpret information and present results in a clear and concise manner

  Desirable

  • Experience working with EMIS Web, Medical record system
  • Able to effectively influence others to complete agreed actions

  Personal Qualities

  Essential

  • Professional attitude, calm and efficient manner
  • Conscientious, hardworking, self- motivated, work with minimal supervision
  • Creative and tenacious in finding solutions to difficult problems
  • Ability to work with both clinical and administrative staff
  • Ability to meet deadlines and work under pressure
  • Ability to engage and sustain relationships with all professionals, other organisations and service-users
  • Honest, reliable and enthusiastic, has a flexible approach
  • Committed to personal development, willingness to undergo further training or development
  • Car user and willing to travel between PCN GP practices

  Person Specification

  Qualifications

  Essential

  • Good standard of education with excellent literacy and numeracy skills

  Desirable

  • NVQ Level 3 Business Administration (or relevant experience)

  Experience

  Essential

  • Experience of working in General Practice, the NHS or Social Care
  • Understanding of current issues facing the NHS and social care process
  • Experience of administrative duties
  • Able to demonstrate a clear understanding of working with confidential information and an understanding of service user confidentiality
  • Working in a multi-disciplinary setting where influence and negotiation is required
  • Working in a busy and demanding environment whilst delivering in a timely manner

  Desirable

  • Knowledge/familiarity with medical terminology
  • Previous experience in the Care Coordinator role.

  Skills

  Essential

  • Proven record of excellent written skills and verbal communication skills and interpersonal skills
  • Evidence of excellent knowledge of Microsoft Office
  • Able to work as part of a team
  • Excellent motivational and influencing skills
  • Able to prioritise and manage own workload and ensuring completion of tasks on time
  • Strong analytical and judgement skills
  • Ability to analyse and interpret information and present results in a clear and concise manner

  Desirable

  • Experience working with EMIS Web, Medical record system
  • Able to effectively influence others to complete agreed actions

  Personal Qualities

  Essential

  • Professional attitude, calm and efficient manner
  • Conscientious, hardworking, self- motivated, work with minimal supervision
  • Creative and tenacious in finding solutions to difficult problems
  • Ability to work with both clinical and administrative staff
  • Ability to meet deadlines and work under pressure
  • Ability to engage and sustain relationships with all professionals, other organisations and service-users
  • Honest, reliable and enthusiastic, has a flexible approach
  • Committed to personal development, willingness to undergo further training or development
  • Car user and willing to travel between PCN GP practices

  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

  Bolton GP Federation

  Address

  Floor 2, The Hub

  Bold Street

  Bolton

  Lancashire

  BL1 1LS

  
  

  Employer's website

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

  Employer details

  Employer name

  Bolton GP Federation

  Address

  Floor 2, The Hub

  Bold Street

  Bolton

  Lancashire

  BL1 1LS

  
  

  Employer's website

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

• About the company

  National Health Service (NHS) is the umbrella term for the publicly-funded healthcare systems of the United Kingdom (UK). The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay. Each service provides a comprehensive range of health services, free at the point of use for people ordinarily resident in the United Kingdom apart from dental treatment and optical care.

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