Job summary
Harbourside Family Practice is a large well established 11,000 patient practice in Portishead.
We are looking for an enthusiastic and reliable care coordinator to join our team on a part time basis. The hours and days of work of this post are negotiable (ideally around
Care co-ordinators play a key role in proactively identifying and working with people, including the frail / elderly and those with long term conditions, to provide co-ordination and navigation of care and support across health and care services. This includes making sure that individuals have access to the reviews and appointments they need to support them to manage their conditions effectively.
You will also work closely with our social prescribers, mental health practitioners and our health and wellbeing coach.
Main duties of the job
Youwill be part of a developing multi-disciplinary team (MDT).
Youwill work closely with the MDT providing an efficient, professional, andflexible service to our patients.
Youwill take a holistic approach to bringing together a patients care and supportneeds and draw up personalised care and support plans (PCSP).
Youwill support the surgery in coordinating all key activity including access toservices, advice and information, ensuring health and care planning is timely,efficient and patient-centred.
Therole includes supporting digital initiatives while co-ordinating and navigatingthe patients journey through primary care including liaising with secondarycare hospitals. A key part of the role will be working with vulnerable andcomplex patients.
Thecandidate will need to be an excellent communicator and be able to establishefficient monitoring and quality assurance systems. Training and support willbe provided to successful applicants.
About us
We are a 4 Partner high achieving PMS Practice situated in Portishead, a beautiful coastal town in North Somerset overlooking the Severn Estuary, just five miles from the city of Bristol.
We are a forward thinking practice with a strong emphasis on teamwork and patient centred care. We work from a new purpose-built health centre with bright, modern facilities that enable us to offer high quality clinical services to our local population of 11,000 patients. We are also a training practice.
We have had consistently high QoF results and were delighted that we were assessed as Good in our latest CQC inspection. We are also a star rated practice on NHS Choices and star rated on Google Reviews.
Job description
Job responsibilities
Main Responsibilities:
To work with the GPs and other primary careprofessionals within the surgery to identify and proactively recall a selectedcohort of patients to deliver personal care. For example, patients withDementia, Cancer or Learning Disabilities who may need annual reviews of theirhealth or medications.
To work closely and in partnership with the SocialPrescribing Link Workers (SPLWs) and the wider Community Services includingSirona, to explore care options for patients based on what matters to theperson.
To support patients to utilise decision aids inpreparation for a shared decisions-making conversation and to help createsingle personalised care and support plans, in line with best practice.
To help people manage their needs through answeringqueries, making and managing appointments, and ensuring that people have goodquality written or verbal information to help them make choices about theircare annual flu or covid vaccinations. This may include supporting peopleto take up vaccinations, training and employment, self-management educationcourses and access appropriate benefits where eligible.
Also to support inthe delivery of contract specifications. This may include administrative taskssuch as: -
Inputting data around screening tests /vaccinations
Running searches to identify populations who mayneed intervention children who require calling in for immunisations.
Support and feed into the development of the MDTapproach to working with our patients
Becoming a contact point for patients who are: -
o Complex and or frail
o Frequent visitors to the GP
o Recently discharged from hospital or about to bedischarged
o Recently attended A and E and would benefit fromfollow up
o New patients to our list with follow uprequirements
Requiring activesignposting to self-care services as part of on the day and minor illnessapproach
Person Specification
Skills, Ability and Knowledge
Essential
1. Ability to organise and prioritise workload effectively
2. Ability to exercise sound judgement when faced with conflicting pressures
3. Excellent record keeping skills
4. IT literate and proficient in the use of Microsoft Office
5. Good verbal and listening skills
6. Works well as an autonomous / independent practitioner and within a team
7. Excellent communication skills including able to communicate effectively, both verbally and in writing, with a wide range of people and stakeholders
8. Excellent administration skills including able to prioritise and to finish work tasks
Desirable
9. Proficient in the use of web-based applications or programmes
10. Awareness of local referral pathways
Experience
Essential
11. Experience of supporting people, their families and carers in a related role
12. Good experience of IT systems and packages including EMIS Web and Docman 10
13. Experience of data collection and providing monitoring information
14. Experience of working within a patient facing role
15. Experience of Electronic Patient Records
16. Knowledge of the purpose of departmental policies, procedures and care pathways
Desirable
17. Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
18. Experience of supporting people with their mental health
19. Experience of collaborative working and building relationships across varied organisations
Qualifications
Essential
20. NVQ Level 3, Advanced level or equivalent qualifications
21. Demonstrable commitment to professional and personal development
Desirable
22. Training in motivational coaching and interviewing or equivalent experience
Other Requirements
Essential
23. Patient focused and compassionate about delivery of safe and effect care.
24. Ability to demonstrate commitment to the PCNs ethos and values
25. Resilient and flexible to meet service needs.
26. Ability to travel to meetings in the interests of the PCN as required
27. Ability to attend meetings outside core hours as required