Overview
We are seeking 2 x enthusiastic and organised Care Coordinators to join the growing multi-disciplinary team within the North Wilts Border Primary Care Network (PCN). Building on our successful care coordination model, this role is key to delivering personalised, joined-up care for our patients. You will work closely with PCN practices and a wide range of health professionals including GPs, nurses, paramedics, pharmacists, and others. You will be responsible for coordinating access to services, information, and support ensuring that care is timely, efficient, and centred around the needs of each patient.
This is a vital role that contributes directly to enhancing patient experience and outcomes, preventing avoidable hospital admissions, and supporting the NHS Long Term Plan and PCN priorities through integrated, person-centred care. You will act as a key point of contact, bridging the gap between patients and clinical teams. Your work will help free up valuable clinical time while ensuring that patients feel informed, supported, and confident in managing their own health and wellbeing.
Main duties
* Utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care
* Holistically bring together all identified care and support needs, exploring options to meet them within a single personalised care and support plan
* Help people to manage their needs by answering queries, arranging and managing appointments, and ensuring that patients have clear information to help them make choices about their care
* Support people to understand their knowledge, skills and confidence when engaging with their health and wellbeing, including through the Patient Activation Measure
* Assist people to access self-management education courses, peer support or interventions that support their health and wellbeing and increase activation
* Provide coordination and navigation for people and their carers across health and care services, working with social prescribing link workers, health and wellbeing coaches, and other primary care professionals
* Coordinate, administer and deliver MDTs within the PCN and support the development of effective MDT meetings
* Work with GPs and other primary care professionals to identify and manage a caseload of patients, referring to other health professionals within the PCN as appropriate
About us
North Wilts Border PCN is a collaborative NHS partnership made up of six GP surgeries, delivering high-quality, patient-centred care to over 54,000 people across our local communities. We are rooted in our community and committed to staying connected with and supporting the people we serve. We are a teaching and training network, supporting medical students and GP trainees from the region. Our diverse multidisciplinary team includes Specialist Practitioners, Health & Wellbeing Coaches, Care Coordinators, and Clinical Directors.
We place value on the contributions of our Living Well team and are committed to supporting the personal and professional development of all staff.
What we offer
* A supportive and inclusive team culture that is well-led
* Opportunities for professional development and leadership
* Flexible working arrangements
* Mentorship and clinical supervision
* Involvement in innovative projects and service development
* Employee Assistance programme
* NHS Pension
* Cost coverage of an Enhanced DBS
* Excellent Induction
* 25 days annual leave pro rata
Job details
Date posted: 06 September 2025
Salary: Depending on experience
Contract: Permanent
Working pattern: Full-time
Location: Tinkers Lane Surgery, Tinkers Field, Royal Wootton Bassett, Swindon, Wiltshire, SN4 7AT and other listed sites within the area
Reference: W0050-25-0007
Job responsibilities
PRIMARY RESPONSIBILITIES
* Management of Carers award & GP-friendly award
* Group consultation & patient education workshops for LTC
* Long term condition reviews
* Physical health checks: Learning Disability reviews, SMI reviews, Diabetic foot-checks, NHS health checks, etc.
* Phlebotomy
* Blood pressure checks
* ECG testing (not reading/assessing results)
* Coordinate care for patients with complex or ongoing needs, expediting care where necessary
* Identify patients requiring care coordination using agreed criteria and tools
* Vaccination administration or training where needed
* Provide clear information about care and coordinate appointments
* Ensure care is personalised and culturally sensitive
* Navigate and coordinate care across health and care systems, ensuring timely referrals and seamless transitions
* Monitor referrals to clinical and non-clinical services
* Empower patients to manage their own care and engage with their health
* Support anxious or overwhelmed patients to reduce stress and build confidence
* Liaise with Adult Social Care for safeguarding or care assessments
* Uphold policies including safeguarding, confidentiality, lone working, information governance, health and safety, equality, diversity and inclusion
SECONDARY RESPONSIBILITIES
In addition to primary responsibilities, may be asked to:
* Support patients in accessing benefits, training and employment opportunities
* Manage a caseload as a single point of contact across primary, community, secondary care and care home settings
* Participate in local initiatives and shared learning
* Tackle health inequalities with identified population groups
* Maintain own learning and development, including PDP targets
Person specification
Experience (essential):
* Experience in a primary care setting or GP practice
* Experience working with multiple stakeholders
* Experience managing a patient caseload
* Experience in health or social care settings without direct supervision
* Experience organizing and prioritising workload
* Awareness of limits to knowledge base
Experience (desirable):
* Understanding of evaluating/per performance of health services
* Experience using clinical IT systems (SystmOne)
* Understanding of health and social care environment and referral pathways
Qualifications (essential):
* 5 GCSEs or equivalent
* NVQ Level 3 in Health & Social Care
* Good IT skills (MS Office)
* Commitment to continuing professional development
Qualifications (desirable):
* Phlebotomy qualification
* Blood pressure taking
* ECG testing
* Experience with vital observations
Skills and attributes (essential):
* Ability to work independently and proactively
* Multitasking and prioritisation
* Problem solving and initiative
* Adaptability and resilience
* Focus in busy environments
* Desire to improve performance
* Confidentiality and professional trust
* Excellent timekeeping
Communication (essential):
* Excellent interpersonal skills
* Ability to handle difficult conversations
* Coaching approach in conversations
* Ability to engage with a wide range of professionals
* Maintain relationships and networks
Attitude and behaviour (essential/desirable):
* Care, compassion and sensitivity
* Teamwork and valuing diversity
* Positive relationships with colleagues, patients and carers
* Ability to work under pressure
* Motivated and reliable
* Alignment with Trust values
Disclosure check
This post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions Order) 1975 and a DBS check will be undertaken.
Employer details
North Wilts Border PCN Ltd
Address: Tinkers Lane Surgery, Tinkers Field, Royal Wootton Bassett, Swindon, Wiltshire, SN4 7AT
Employer's website: https://northwiltsborderpcn.nhs.uk/
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