About Us: The Confederation, Hillingdon CIC works with General Practice and other healthcare providers to deliver its vision for “Hillingdon to deliver the best primary care outcomes for patients in the whole of London”. We are a not-for-profit community interest company. The Confederation works to develop and support individual GP practices, PCNs and Neighbourhoods and their changing needs. We deliver excellent clinical services ourselves both at scale and complementary to General Practice. We are the provider representative voice for local General Practice into the wider NHS and other Partners. We are ‘of the NHS’ but independent, innovative and transformational. The Confederation determines to develop as an attractive place to work, providing rewarding roles and opportunities to grow in order to attract and retain great staff that in turn delivers our vision. Our Values: Job Summary: The CVD Health & Prevention Coordinator will play a key role in delivering neighbourhood-based cardiovascular disease prevention and management programmes across the South East Neighbourhood of Hillingdon. This is a predominantly field-based role, working across community settings, outreach venues and GP practices. The post holder will lead and coordinate initiatives to identify, support and manage patients at risk of, or living with, cardiovascular disease, including hypertension, atrial fibrillation, diabetes, coronary heart disease and stroke. The role combines clinical support and care coordination, focusing on case finding, health promotion, referral facilitation and personalised care planning, with a strong emphasis on addressing health inequalities through community engagement. Primary Responsibilities Clinical Support Undertake targeted case finding and screening for CVD, including NHS Health Checks, blood pressure, atrial fibrillation and diabetes risk assessment, in line with agreed protocols. Conduct or assist with clinical risk assessments (for example blood pressure monitoring, risk scoring) and refer appropriately Accurately record findings in clinical systems and ensure appropriate communication of results, escalation of concerns and onward referral. Work with neighbourhood partners to identify barriers to access, using population health data to improve detection, prevalence and optimisation of care. Deliver health promotion advice on lifestyle, smoking cessation, weight management, physical activity and mental wellbeing, signposting to relevant services as required. Care Coordination and Addressing Health Inequalities Support patients, families and carers to understand conditions and develop personalised care and support plans. Improve health literacy and engagement, particularly within underserved or disengaged communities. Build and maintain relationships with community groups and leaders where language, culture or access present barriers. Attend and support community outreach and engagement events, including evenings and weekends, delivering screening and health education. Administrative and Operational Duties Contribute to neighbourhood KPIs and service delivery targets. Maintain high-quality, up-to-date clinical records and support data quality improvements. Access and interpret data from systems such as EMIS and WSIC for reporting, audit and service evaluation. Contribute to the development and improvement of assessment tools, service pathways, or quality improvement initiatives aligned with evidence and NICE guidance. Support audit, evaluation and reporting requirements to monitor service impact and outcomes. Collaborative Working Relationships Foster and maintain strong links with all services across the Neighbourhood, including in the PCN and neighbouring networks. Work closely with GP practices, PCNs, community services and voluntary sector partners. Develop effective relationships with a wide range of professionals, including pharmacists, social prescribers, nurses, AHPs and hospital colleagues. Foster and maintain links within the community, particularly with community leaders in key target cohorts. Explore the potential for collaborative working and takes opportunities to initiate and sustain such relationships. Recognise own limitations and appropriately escalate or refer to senior or specialist colleagues. Professional Development Actively participate in supervision, one-to-one meetings and annual appraisal. Engage in ongoing professional development relevant to the role. Adhere to organisational policies including safeguarding, confidentiality, lone working, information governance and health & safety. Knowledge, Skills and Experience Required Ability to prioritise workload, recognise risk and escalate concerns appropriately. Understanding of professional, ethical and organisational standards. Strong communication skills and ability to engage diverse communities. Demonstrates self-development through continuous professional development activity. Leadership Demonstrate understanding of, and contribute to, the workplace vision. Demonstrates ability to improve quality within the limitations of service. Review quarterly progress and develop clear plans to achieve results within priorities set by others. Demonstrate ability to motivate oneself to achieve goals. Promote diversity and equality in people management techniques and lead by example. Person Specification Essential Criteria Minimum GCSE Grade C or equivalent in English and Maths Care coordination training course or be willing to complete one before taking referrals. Experienced Care Coordinator with EMIS experience Good IT Skills Ability to actively listen, empathise with people and provide personalised support in a non-judgemental way Ability to provide a culturally sensitive service supporting people from all backgrounds and communities, respecting lifestyles and diversity Commitment to reducing health inequalities and proactively working to reach people from diverse communities Ability to support people in a way that inspires trust and confidence, motivating others to reach their potential Ability to communicate effectively, both verbally and in writing, with people, their families, carers, partner agencies and stakeholders Ability to identify risk and assess/manage risk when working with individuals Strong awareness and understanding of when it is appropriate or necessary to refer people back to other health professionals/agencies, when what the person needs is beyond the scope of the care coordinator role, e.g. when there is a mental health need requiring a qualified practitioner Ability to maintain effective working relationships and to promote collaborative practice with all colleagues Ability to demonstrate personal accountability, emotional resilience and work well under pressure Ability to organise, plan and prioritise on own initiative, including when under pressure and meeting deadlines Demonstrable commitment to professional and personal development Excellent interpersonal, influencing and negotiating skills Excellent written and verbal communication skills Desirable Criteria Ability to provide motivational coaching to support people's behaviour change