Job Summary:The Frailty Care Coordinator is a new role to the practice and willplay a pivotal role in supporting the management and coordination of care forpatients identified as living with frailty. The role involves working closelywith the multidisciplinary team to ensure personalised care plans are developedand implemented, enhancing the quality of care and improving patient outcomes.
Main duties of the job
Key Responsibilities:
* Patient Identification and Engagement:
* Utilise population health intelligence where available and tools such as the electronic frailty index to identify patients living with frailty.
* Engage with patients and their families to understand their needs and preferences.
* Care Coordination:
* Develop and maintain personalised care and support plans in collaboration with patients, carers, and healthcare professionals.
* Coordinate and facilitate multidisciplinary team (MDT) meetings to discuss and review patient care plans.
* Communication and Liaison:
* Act as a point of contact for patients, families, and healthcare professionals regarding frailty care.
* Liaise with social prescribing link workers, healthcare professionals, and other relevant services to ensure comprehensive care.
* Monitoring and Evaluation:
* Monitor patient progress and update care plans as necessary.
* Collect and report data on frailty management outcomes to support continuous improvement.
* Education and Support:
* Provide information and support to patients and carers to help them manage their health and wellbeing.
* Raise awareness within the practice of frailty management and the role of the care coordinator.
* Safeguarding and Risk Management:
* Ensure safeguarding processes are followed for vulnerable individuals.
About us
Working Conditions:
* Part time position (initially 2-6 sessions) with occasional flexibility required to meet patient and practice needs.
* Based at The Abingdon Surgery with potential travel to patient homes or other healthcare settings.
Job responsibilities
Job Title:Frailty Care Coordinator
Location:The Abingdon Surgery
Reports to:Dr Lynette Saunders, GP Partner, The Abingdon Surgery; Abingdon Central PCN Clinical Director
Job Summary:The Frailty Care Coordinator is a new role to the practice and will play a pivotal role in supporting the management and coordination of care for patients identified as living with frailty. The role involves working closely with the multidisciplinary team to ensure personalised care plans are developed and implemented, enhancing the quality of care and improving patient outcomes.
Key Responsibilities:
* Patient Identification and Engagement:
* Utilise population health intelligence where available and tools such as the electronic frailty index to identify patients living with frailty.
* Engage with patients and their families to understand their needs and preferences.
* Care Coordination:
* Develop and maintain personalised care and support plans in collaboration with patients, carers, and healthcare professionals.
* Coordinate and facilitate multidisciplinary team (MDT) meetings to discuss and review patient care plans.
* Communication and Liaison:
* Act as a point of contact for patients, families, and healthcare professionals regarding frailty care.
* Liaise with social prescribing link workers, healthcare professionals, and other relevant services to ensure comprehensive care.
* Monitoring and Evaluation:
* Monitor patient progress and update care plans as necessary.
* Collect and report data on frailty management outcomes to support continuous improvement.
* Education and Support:
* Provide information and support to patients and carers to help them manage their health and wellbeing.
* Raise awareness within the practice of frailty management and the role of the care coordinator.
* Safeguarding and Risk Management:
* Ensure safeguarding processes are followed for vulnerable individuals.
* Identify and manage risks associated with frailty care.
Qualifications and Experience:
* Relevant healthcare qualification or experience in a similar role.
* Experience working within a multidisciplinary team in a healthcare setting.
* Knowledge of frailty management and care coordination.
* Excellent communication and interpersonal skills.
* Ability to work independently and as part of a team.
* Experience in primary care or community health settings.
* Familiarity with NHS systems and processes.
Person Specification
Qualifications
* Qualifications and Experience:
* Relevant healthcare qualification or experience in a similar role.
* Experience working within a multidisciplinary team in a healthcare setting.
* Knowledge of frailty management and care coordination.
* Excellent communication and interpersonal skills.
* Ability to work independently and as part of a team.
* Experience in primary care or community health settings.
* Familiarity with NHS systems and processes.
Disclosure and Barring Service Check
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 (formerly known as CRB) to check for any previous criminal convictions.
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