Care Coordinator

Posting date:	19 February 2026
Salary:	£27,975.55 per year
Additional salary information:	£27975.55 a year
Hours:	Full time
Closing date:	05 March 2026
Location:	Sunderland, SR5 2TA
Company:	NHS Jobs
Job type:	Permanent
Job reference:	U0012-26-0006

Summary

MAIN DUTIES AND RESPONSIBILITIES Proactively identify people to support their personalised care requirements, using the available decision support aids. Telephone triage all incoming referrals to bring together all of a persons identified care and support needs, and explore their options to meet these via a single personalised care and support plan, or seamlessly refer cases, if necessary, to appropriate professionals. Help people to manage their needs, answering their queries and supporting them to make appointments or to take up training and employment, and to access appropriate benefits where eligible. Support people to understand their level of knowledge, skills and confidence when engaging with their health and wellbeing, including through use of the Patient Activation Measure. Raise awareness of shared decision making and decision support tools, and assist people to be more prepared to have a shared decision making conversation. Ensure that people have good quality information to help them make choices about their care, Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing. Provide coordination and navigation for people and their carers across health and care services, alongside working closely with social prescribing link workers, health and wellbeing coaches and other primary care roles. Maintain accurate records as required, including providing patient-related information for entering Clinical Reporting Systems, within the required time frame To be a point of contact for GP practices, MDT and Social Prescribing Link Workers, as well as a direct link for the wider system across the city. Support the identification of patients for inclusion in MDTs within PCNs. Support the collection of patient data for analysis of outcome measure for service interpretation and growth Role Specific Key Tasks Education Promote social prescribing across the PCN, Health & Social Care professionals and the wider system, including its role in self-management, addressing health inequalities and the wider determinants of health. Referrals Receive and action referrals for social prescriptions via agreed systems. Personalised Support Provide holistic, personcentred support by developing and reviewing personalised care plans, preparing people for shared decisionmaking, and helping them manage their health and wellbeing. Work proactively with diverse communities to ensure equal access to community, voluntary and statutory services, including selfmanagement and peer support. Follow up with individuals, gather feedback and outcomes, and contribute to service improvement within the PCN. Community Asset Development Support the development and sustainability of community assets by working with VCSE organisations and local groups to ensure accessible, inclusive resources that meet diverse health and wellbeing needs. Build strong partnerships with community organisations to ensure safe, timely referrals and coordinated support for individuals. Gather feedback from community partners to understand capacity, gaps and opportunities, sharing insights with the PCN to inform service development. Collaborative working Work as part of the PCN multidisciplinary team, building strong relationships with GP practices, social prescribing link workers, health coaches and other primary care professionals to deliver coordinated, personalised support. Support effective communication within the MDT by sharing timely updates, acting as a key contact across practices and partners, and ensuring smooth navigation for people with complex needs. Collaborate with VCSE organisations, local authority teams and community groups to improve access, reduce duplication and embed personalised care approaches across the system. Participate in MDT meetings, help identify individuals who may benefit from personalised care, and contribute to shared problem-solving and continuous improvement across the PCN and wider city. Data Collection & Analysis Collect, record and analyse data to support personalised care and population health management, capturing key information about individuals needs, outcomes and experiences. Ensure accurate, timely documentation in clinical systems, following data protection and governance requirements. Analyse referral patterns, presenting needs and service use to identify trends, inequalities and gaps, sharing insights to inform decision-making and service development. Gather qualitative feedback and lived experience stories to support continuous improvement and strengthen community partnerships. Professional Development Engage in ongoing professional development through supervision, training and skills development aligned with NHS Englands personalised care framework. Work with line managers to review performance, identify learning needs and set development goals. Maintain uptodate knowledge of local services, community resources and system developments, and complete all required organisational training. Participate in reflective practice, peer learning and knowledge sharing to support consistent, highquality personalised care across the MDT. Service Development Contribute to the ongoing improvement of personalised care services by identifying gaps, opportunities and innovations with MDT colleagues and community partners. Use feedback, data and lived-experience insights to support responsive, person-centred service design and reduce health inequalities. Participate in quality improvement, business planning and coproduction of new initiatives. Promote consistent practice across PCNs through shared learning, collaboration and championing approaches that improve access, experience and outcomes. Leadership Demonstrate leadership by supporting the development and delivery of high quality personalised care across the PCN. Act as a role model for person-centred, strengths based and community connected practice. Share learning, offer guidance and contribute to innovation, problem solving and service development. Uphold organisational values, promote equality and inclusion, and help foster a positive, supportive working culture. Other Undertake additional duties consistent with the role and respond flexibly to service needs and organisational priorities. Support team resilience by adapting to changing demands and assisting colleagues when required. Adhere to all organisational policies, including confidentiality, safeguarding, information governance and professional conduct. Carry out any reasonable tasks requested by management that contribute to high quality personalised care and effective service delivery. Confidentiality In the performance of the duties outlined in this job description, the post-holder may have access to confidential information relating to patients and their carers, Practice staff and other healthcare workers. All such information from any source is to be regarded as strictly confidential. Information relating to patients, carers, colleagues, other healthcare workers or the business of the Alliance may only be divulged to authorized persons in accordance with the Alliances policies and procedures relating to confidentiality, and the protection of personal and sensitive data. Health & Safety The post-holder will assist in promoting and maintaining their own and others health, safety and security as defined in the Alliances Health & Safety Policy to include: Identifying the risk involved in work activities and undertaking such activities in a way that manages those risks. Ensuring that all accidents or dangerous accidents are reported and investigated and follow up action taken where necessary. Equality and Diversity The post-holder will support the quality, diversity and rights of patients, carers and colleagues to include: Acting in a way that recognizes the importance of peoples rights, interpreting them in a way that is consistent with current legislation. Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues. Behaving in a manner which is welcoming to and of the individual, is non-judgemental and respects their circumstances, feelings, priorities and rights. Quality The post-holder will strive to maintain quality within the Alliance, 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 enhanced the teams performance. Work effectively with individuals in other agencies to meet patients needs. Effectively manage own time, workload and resources. Communication The post-holder should recognize 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 peoples needs for alternative methods of communication and respond accordingly.