NHS West Midlands, England, United Kingdom
Join or sign in to find your next job
Join to apply for the PCN Frailty Care Coordinator role at NHS
NHS West Midlands, England, United Kingdom
2 days ago Be among the first 25 applicants
Join to apply for the PCN Frailty Care Coordinator role at NHS
Job Summary
The Frailty Care Coordinator will support patients identified as living with or at risk of frailty, helping them to live longer and avoid crisis events. This role aims to improve patient outcomes through proactive, personalised care planning and coordination, while also supporting carers and families. The coordinator will help reduce avoidable hospital admissions and support practices in managing complex frailty cases.
Job Summary
The Frailty Care Coordinator will support patients identified as living with or at risk of frailty, helping them to live longer and avoid crisis events. This role aims to improve patient outcomes through proactive, personalised care planning and coordination, while also supporting carers and families. The coordinator will help reduce avoidable hospital admissions and support practices in managing complex frailty cases.
Main duties of the job
* Identify patients at risk of frailty within the PCN using risk stratification tools.
* Proactively contact and review patients identified as frail through the frailty team.
* Develop and deliver personalised care plans tailored to each patient's needs and circumstances.
* Support practices with complex frailty cases through Multi-Disciplinary Team (MDT) meetings.
* Signpost and refer patients to appropriate community, voluntary, and social care services.
* Book and coordinate regular review appointments as appropriate.
* Monitor hospital discharges for patients with frailty and provide necessary follow-up support and interventions.
* Provide advice and ongoing support to families and carers.
About Us
Shrewsbury PCN is made up of 11 GP practices supporting over 104,000 patients in and around Shrewsbury, Shropshire.
We are passionate about leading a network that is supportive and collaborative, where members and staff feel appreciated and empowered to make a difference. Our ambition is to deliver exceptional care and have a positive impact on the community we serve.
Details
Date posted
10 July 2025
Pay scheme
Other
Salary
Depending on experience £12.80 - £13.31
Contract
Permanent
Working pattern
Full-time, Part-time, Flexible working
Reference number
A5355-25-0009
Job locations
Morgan Place
Anchorage Avenue, Shrewsbury Business Park
Shrewsbury
Shropshire
SY2 6FG
Job Description
Job responsibilities
* Build trusting and supportive relationships with patients and their families, acting as a named point of contact.
* Liaise with GPs, nurses, allied health professionals, social care, and voluntary services to ensure coordinated care.
* Educate and support patients and carers to understand frailty as a manageable condition.
* Maintain accurate and up-to-date patient records and care plans.
* Support practices in recognising and managing frailty, helping reduce demand on acute appointments and GP time.
* Contribute to achieving the risk stratification element of the Capacity and Access Improvement Plan (CAIP).
* Support future planning and resource use across the PCN to improve outcomes and efficiency.
Job description
Job responsibilities
* Build trusting and supportive relationships with patients and their families, acting as a named point of contact.
* Liaise with GPs, nurses, allied health professionals, social care, and voluntary services to ensure coordinated care.
* Educate and support patients and carers to understand frailty as a manageable condition.
* Maintain accurate and up-to-date patient records and care plans.
* Support practices in recognising and managing frailty, helping reduce demand on acute appointments and GP time.
* Contribute to achieving the risk stratification element of the Capacity and Access Improvement Plan (CAIP).
* Support future planning and resource use across the PCN to improve outcomes and efficiency.
Person Specification
Experience
Essential
* Experience of working in a role that requires a high degree of autonomy
* Experience of working across a variety of multidisciplinary teams
Desirable
* Experience in care coordination, health or social care, or similar patient-facing roles
* Experience in working in primary care or community settings
Knowledge and Skills
Essential
* Strong organisational skills, including planning, prioritising, time management and record keeping
* Ability to work collaboratively, liaising with other stakeholders as needed for the collective benefit of patients
* Ability to recognise and work within limits of competence and seek advice when needed
* Ability to prioritise own workload
* Computer efficient
* Excellent written and verbal communication skills
* Excellent team working skills
* Able to work independently, showing initiative
Desirable
* Knowledge of frailty and its impact on patients and carers
* Knowledge of primary care and how it operates
* Able to use clinical information systems
* Training in personalised care planning or motivational interviewing
Qualifications
Essential
* Educated to GCSE level or equivalent
Personal Attributes
Essential
* Ability to demonstrate personal accountability, resilience and work well under pressure
* Flexible and adaptable to team and service needs
* Reliable, punctual and confident
Other
Essential
* Meet DBS reference standards and criminal records checks
* Access to own transport / full clean driving license
* Ability to travel across the locality as and when needed
Person Specification
Essential
* Meet DBS reference standards and criminal records checks
* Access to own transport / full clean driving license
* Ability to travel across the locality as and when needed
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.
Employer details
Employer name
Shrewsbury Primary Care Network
Address
Morgan Place
Anchorage Avenue, Shrewsbury Business Park
Shrewsbury
Shropshire
SY2 6FG
Employer's website
http://www.shrewsburypcn.co.uk/ (Opens in a new tab)
Employer details
Employer name
Shrewsbury Primary Care Network
Address
Morgan Place
Anchorage Avenue, Shrewsbury Business Park
Shrewsbury
Shropshire
SY2 6FG
Employer's website
http://www.shrewsburypcn.co.uk/ (Opens in a new tab)
LNKD1_UKTJ
Seniority level
* Seniority level
Entry level
Employment type
* Employment type
Part-time
Job function
* Job function
Other
* Industries
Hospitals
Referrals increase your chances of interviewing at NHS by 2x
Sign in to set job alerts for “Care Coordinator” roles.
Birmingham, England, United Kingdom 4 days ago
Birmingham, England, United Kingdom 1 day ago
Coventry, England, United Kingdom 1 day ago
Birmingham, England, United Kingdom 7 hours ago
Birmingham, England, United Kingdom 1 week ago
Birmingham, England, United Kingdom 2 weeks ago
West Midlands, England, United Kingdom 2 days ago
Birmingham, England, United Kingdom 1 week ago
Birmingham, England, United Kingdom 5 days ago
Birmingham, England, United Kingdom 6 days ago
Solihull, England, United Kingdom 1 month ago
Birmingham, England, United Kingdom 3 days ago
Birmingham, England, United Kingdom 1 week ago
Walsall, England, United Kingdom 1 week ago
Birmingham, England, United Kingdom 7 hours ago
Birmingham, England, United Kingdom 3 days ago
Clinical Governance Administration Assistant
Oldbury, England, United Kingdom 1 week ago
West Midlands, England, United Kingdom 12 hours ago
Birmingham, England, United Kingdom 1 day ago
Band 4 Team Administrator - Little Bromwich Centre
Birmingham, England, United Kingdom 2 days ago
Birmingham, England, United Kingdom 5 days ago
West Midlands, England, United Kingdom 1 month ago
West Bromwich, England, United Kingdom 2 days ago
Coventry, England, United Kingdom 1 week ago
Retail Operations Directors Executive Assistant
West Midlands, England, United Kingdom 6 days ago
Birmingham, England, United Kingdom 1 week ago
Birmingham, England, United Kingdom 2 weeks ago
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr