Practice Care Coordinator
| Dyddiad hysbysebu: | 28 Mai 2025 |
|---|---|
| Cyflog: | Heb ei nodi |
| Gwybodaeth ychwanegol am y cyflog: | Negotiable |
| Oriau: | Llawn Amser |
| Dyddiad cau: | 13 Mehefin 2025 |
| Lleoliad: | Newham, E16 4QH |
| Cwmni: | NHS Jobs |
| Math o swydd: | Parhaol |
| Cyfeirnod swydd: | A2741-25-0002 |
Crynodeb
1. Personalised Care Coordinators manage a defined caseload patients requiring proactive and ongoing care coordination. work directly with patients and carers to co-produce personalised care and support plans using agreed assessment tools and templates Act as a consistent point of contact, helping patients navigate their care journey, including before and after clinical appointments. 2. Multidisciplinary Collaboration Work is part of the multidisciplinary team (MDT), collaborating with GPs, nurses, pharmacist, social prescribers, health coaches, community and secondary care teams. Facilitate communication and coordination between services to support safe, effective and joined-up care. 3. Clinical Project Support Assist in the planning, implementation, and evaluation of clinical and quality improvement projects led by the practise or PCN. Contribute to population health management initiatives by identifying and targeting cohorts of patients for proactive interventions (e.g., hypertension, diabetes, frailty). work with the clinical team to trial and embed new care models and pathways. 4. Enhanced Services Delivery support the practise in meeting Enhanced Services (ES) and Direct Enhanced Services (DES) requirements, such as: o structured medication reviews(SMRs) o Care planning for patients with learning disabilities, mental health conditions, and severe frailty o Support for anticipatory care and cancer reviews o Data collection and patient engagement related to annual recall programmes and IIF (investment and impact fund) indicators track progress against ES targets and assist with the submission of accurate data to commissions. 5. Monitoring and Follow-up Maintain and review personalised care plans at regular intervals, ensuring they reflect changing needs and preferences Use practise clinical system (e.g., EMIS) To document intervention, flag key updates, and support accurate coding. 6. Community and self-management support Signpost patients to relevant local services, support groups, and self-management resources. Promote independence and help literacy by supporting patients to understand their condition and care options.