The SS9 Integrated Neighbourhood Team is seeking a care coordinator to join our team on a part-time basis (22.5 hours per week), or full-time (37.5 hours per week) when combined with the Integrated Neighbourhood HCA role, which we are also advertising. The post-holder will provide extra time, capacity and expertise to our Integrated Neighbourhood Team to help us to improve the care provided to our patients. The main duties of the role include: Work closely with the INT / PACT matron to coordinate care that enables individuals to remain at home, maintain independence, and avoid unnecessary admission to hospital. Support service transformation by building strong relationships with primary care, secondary care, tertiary care, and voluntary sector colleagues. Liaise with patients, families, and carers to ensure care plans are individualised, holistic, and supporting independence. Operate within an interprofessional team- working alongside social care, community health, NHS services, and local voluntary organisations. Promote and utilise technology to improve communication, care coordination, and monitoring of patient progress. Assist in safe hospital discharges by arranging follow-up care, welfare calls, and referrals to relevant health or community services. Collaborate with the interprofessional team to develop, monitor, and update personalised care plans. Connect patients with appropriate community resources, services, and clinical pathways (e.g., pharmacists for medication reviews, health coaches for lifestyle support, social prescribing link workers). Schedule and coordinate appointments with healthcare professionals and support services as required. Facilitate clear, consistent communication between patients, families, and professionals to ensure continuity of care. Provide navigation support during transitions of care (e.g., hospital to home, between different community services). Encourage self-care, healthy lifestyle choices, and independence by signposting patients to relevant services and resources. Record assessments of patients’ health and social care needs, maintaining accurate documentation on clinical and administrative systems. Monitor and evaluate patient progress, escalating concerns to the relevant clinician or team member when necessary. Gather and review patient and family feedback to help improve service delivery. Ensure care delivery is safe, effective, and aligned with safeguarding policies and procedures. Respond to queries from patients and families, escalating appropriately where additional clinical or specialist input is required. Utilise transferable skills (e.g., phlebotomy, medical administration, or social prescribing) to enhance patient support where relevant. Be flexible to travel within the locality and work remotely when needed (a full UK driving licence is desirable). About the Candidate If you are a skilled care co-ordinator, with excellent person-centred planning experience and strong local knowledge for accessing key support, then we would love to hear from you. The ideal applicant will have the following skills, experience and qualifications: Experience of working within healthcare, the voluntary or community sector, to support vulnerable groups. Diploma Level 2 in Health and Social Care, or an equivalent qualification (desirable not essential). Familiar with local resources and services, including how to access them. Motivated by helping people, with care and empathy. Able to deliver person-centred support in a non-judgmental way. Experience of completing holistic person-centred care planning assessments. Strong listening and communication skills. About Us The Integrated Neighbourhood Team (INT) operates across both SS9 North and SS9 South Primary Care Networks (PCNs), providing essential support to patients who are housebound or transitioning from hospital care back into the community. The team’s primary aim is to deliver person-centred care in a timely and coordinated manner, helping individuals remain safely at home, optimise their independence, and reduce the likelihood of unnecessary hospital readmissions. The INT is a multidisciplinary team made up of professionals from Primary Care, Secondary Care, Tertiary Care, Social Care, and the Voluntary Sector. This includes GPs, nurses, emergency care practitioners, social prescribers, and allied health professionals. By working collaboratively, the team delivers integrated care, welfare checks, and personalised support tailored to each patient’s unique needs. Joining the INT means becoming part of a wider community committed to innovation, teamwork, and delivering high-quality, patient-centred care. Employee benefits: NHS Pension Scheme Minimum 25 days annual leave (FTE) Supportive, multi-disciplinary team environment Ongoing training and development opportunities If you are passionate about supporting patients through care transitions and want to be part of a dynamic and forward-thinking team, we would love to hear from you. Please contact [email protected] for more information. Disclosure and Barring Service Check Please note 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 to check for any previous criminal convictions.