Introduction
We are looking for an enthusiastic, flexible and innovative candidate who would enjoy the challenge of developing this role with us as a Primary Care Network. The aim is to enhance the care of some of our most vulnerable patients, both in Care Homes and their own homes.
The role will provide opportunities for developing leadership and some basic clinical skills, as well as face to face (and telephone/remote) communication with patients and their families/carers. The best candidates will be excellent communicators verbal and written have strong organisational and time management skills, experience of working in health or social care and the ability to work alongside a variety of professionals and services.
Main duties of the job
The Care Coordinator will manage a caseload of identified patients, ensuring appropriate support is made available to them and their carers/families and assessing their changing needs. The successful candidate will adopt the principles associated with the delivery of the Comprehensive Model for Personalised Care to improve patients health and wellbeing whilst bringing efficiencies to the delivery of general practice.
The PCN looks after seven care homes (mostly residential but some nursing). The Care Coordinator will be a consistent link between them and the practices, also acting as a conduit between the homes and community services (MDT), family/advocates and secondary care.
There will be opportunities to work with the GPs and Practice Managers in distinct areas of the PCN DES such as Learning Disability, Cancer screening (encouraging uptake in poor responders), Structured Medication Reviews (helping pharmacy team organise) and Enhanced Health in Care Homes.
As a single point of access for patients, their carers/families and other professionals, you will lead on coordinating, preparing and recording related Multi‑disciplinary Teams (MDTs) activities, ensuring that actions are completed.
About us
Windrush surgery is a partner led GP practice of 9000 patients situated just off the main town centre.
Our catchment areas all overlap and are the market town of Banbury and surrounding villages. We are situated within 1.6 miles of one another. Banbury is a fast expanding area, currently undergoing an ambitious town‑centre, canalside development. It has excellent sporting and cultural facilities, transport links and schools (state and independent) and yet sits in an area of stunning, accessible countryside.
We are team‑oriented, patient‑focused, learning‑centred practices and are both excited and challenged by the opportunity to expand our multi‑disciplinary teams, to include members working across practices within the PCN. We hope you will be too.
Job responsibilities
* Support and become an integral member of the general practice teams
* Coordinate the care home Multidisciplinary Team (MDT)
* Relationship building with member practices, care homes and community providers to ensure a smooth care planning process for patients
* Support the Care Home Lead GPs in their work with the homes, including smooth running of the ward rounds and rationalise home contacts with the practices
* Engage in training and skills development to become a competent vaccinator for e.g. flu vaccinations and phlebotomist and possibly do basic diabetic foot health checks
* Coordinate care via an MDT for housebound patients (including monitoring DN caseload list and coordination of annual reviews to re‑assess needs)
* Review hospital discharge lists for each practice and ensure follow‑up arrangements are in place (e.g. DN, blood tests, medication reviews, social care)
* Support housebound and vulnerable patients alongside the social prescribers, to engage in interventions that will improve their wellbeing and focus on those who need, but refuse, care
* With time, the role may include becoming a contact point within the PCN for patients who are complex or frail, frequent attenders for GP appointments
Person Specification
Qualifications
* GCSE grade A to C in English and Maths
* Driving licence and own transport
* Knowledge of using computers and typing skill
* Previous care work experience
Disclosure and Barring Service Check
This post is subject to the Rehabilitation of Offenders Act (Exemptions 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.
#J-18808-Ljbffr