Care Coordinator | NHS Midlands and Lancashire Commissioning Support Unit
| Dyddiad hysbysebu: | 24 May 2024 |
|---|---|
| Cyflog: | Heb ei nodi |
| Gwybodaeth ychwanegol am y cyflog: | £25,147 - £27,596 per annum |
| Oriau: | Full time |
| Dyddiad cau: | 23 June 2024 |
| Lleoliad: | Bootle, Liverpool, L20 8AH |
| Cwmni: | Midlands and Lancashire CSU |
| Math o swydd: | Permanent |
| Cyfeirnod swydd: | 6342728/877-SSPCN-6342728 |
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Care co-ordinators help to co-ordinate and navigate care across the health and care system, helping people make the right connections, with the right teams at the right time. They can support people to become more active in their own health and care and are skilled in assessing people’s changing needs. Care co-ordinators are effective in bringing together multidisciplinary teams to support people’s complex health and care needs.
They can be an effective intervention in supporting people to stay well particularly those with long term conditions, multiple long-term conditions, and people living with or at risk of frailty.
Please note this role is not eligible for Vacancy Sponsorship.
Working closely with GPs, Community Services, Care Homes and Practice Teams to manage a caseload of patients, acting as a central point of contact to ensure appropriate support is made available to patients and their carers; supporting them to understand and manage their condition and ensuring their changing needs are addressed. We are seeking Care Coordinators to work in the following service areas: Enhanced Health at Home.
Key Responsibilities:
• Work with people, their families, and carers to improve their understanding of the patient’s condition and support them to develop and review personalised care and support plans to manage their needs and achieve better healthcare outcomes
• Help people to manage their needs through answering queries, making, and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care
• Support people to understand their level of knowledge, skills, and confidence, when engaging with their health and wellbeing
• Work as part of the multidisciplinary team, building relationships with staff in GP practices within the PCN, care homes & other organisations.
Within South Sefton PCN our aims are to:
• Improve resilience in General Practice
• Build a stronger and more sustainable general practice service across the Primary Care Network footprint
• Facilitate collaborative working between all Primary Care Network practices
• Engage with local health and care providers to develop place-based care to assist in the transformation of local services to improve the health and wellbeing of the Primary Care Network population
• Work with Patient Participation Groups to improved patient access, experience and quality
• Reach out to strengthen and develop working relationships with non-NHS community groups
• Develop signposting with Primary Care Network practices to streamline the patient journey to enhance more achievable and sustainable outcomes
• Further develop digital technology as a primary resource for practices and patients
• Work in collaboration with the local GP Federation to build and strengthen relationships
As Care Coordinator your key responsibilities will include, but not be limited to:
Multidisciplinary Team (MDT)
1. Arrange the EHAH led Huddles/MDT meetings, manage the meeting agenda items; ensuring that all new referrals are identified,
and information circulated to team members in advance of the meeting. Record actions agreed at the meetings or take minutes and
circulate as required.
2. Consult with all members of the MDT to ensure its effective function.
3. Work closely within the PCN roles, Community Services, Community Matron, MDT and with GP practices within the PCN to ensure that
the comprehensive records of MDT case discussions are entered into clinical systems, adhering to data protection legislation and data
sharing agreements.
4. Work as part of the MDT and wider PCN / Care Community to achieve its ICP (integrated care provider) directed objectives.
Referrals
5. As part of the PCN MDT, build relationships with staff in each GP Practice within the PCN, attending practice meetings as required providing information and feedback on care coordination priorities.
6. Consult directly with Community services, Acute Trust Ward Managers, Social Care, Practice staff and other key providers to identify
patients for discussion at MDT, and compile and circulate relevant information to attendees.
7. Refer patients to local services as required utilising providers referral processes.
Working with patients
8. Using clinical systems and data analysis to ensure a proactive approach to identifying patients that would benefit from review.
9. Alerting, referring or liaising with the relevant Service, Community Matron, professionals, family, and other services as required.
10. Raise awareness of shared decision-making and decision support tools and assist people to be more prepared to have a shared decision making conversation.
11. Work with patients, Carers, and professionals to deliver personalised care and support planning for patients.
12. Help people to manage their needs through answering queries, making, and managing appointments and ensure that patients have excellent quality information to help them make choices about their care.
13. Support people to understand their level of knowledge, skills and confidence when engaging with their health and wellbeing, including
through use of the tools.
14. Provide co-ordination and navigation for patients and their carers across health and care services, consulting with practice and PCN staff
including social prescribing link workers and health and wellbeing coaches.
15. Seek advice and support from the Community Matron/GP supervisor/Clinical Lead and/or identified individual(s) to discuss patient related concerns (e.g. abuse, domestic violence, and support with mental health), referring the patient back to the GP or other suitable
health professional if required.
16. To manage communications and social media pages to ensure patients have relevant and timely information to help them manage their health needs.
Personal/Professional development:
The post-holder will participate in any training programme implemented by the practice as part of this employment, with such training to
include:
Participation in an annual individual performance review, including taking responsibility for maintaining a record of own personal and/or professional development.
Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work.
Complete mandatory training during probationary period.
Quality:
The post-holder will strive to maintain quality within the service and will:
Alert other team members to issues of quality and risk.
Assess own performance and take accountability for own actions, either directly or under supervision.
Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the team’s performance.
Work effectively with individuals in other agencies to meet patients’ needs.
Effectively manage own time, workload and resources.
Communication:
The post-holder should recognise the importance of effective communication within the team and will strive to:
Communicate effectively with other team members.
Communicate effectively with patients and carers.
Recognise people’s needs for alternative methods of communication and respond accordingly.
Contribution to the implementation of services:
The post-holder will:
Apply all policies, standards and guidance.
Discuss with other members of the team how the policies, standards and guidelines will affect own work.
Participate in audit where appropriate.
Work with practices and patients to fulfil SMI health checks, long term condition management & LD health checks
This role is an expanding role that may require input into additional programmes and services
This advert closes on Sunday 9 Jun 2024