Woodlands Medical Practice is looking to recruit an enthusiastic and reliable individual to join the admin team.
The applicant will be able to work under their own initiative and be able to contribute to the overall work of the practice team. Previous experience of working in a similar role is desirable but not essential, as full training will be given.
The role of a Care Coordinator is to provide extra capacity inprimary care and to use expertise in supporting patients to prepare for orfollow up on clinical conversations and appointments with primary careprofessionals through enhanced care navigation and advocacy. The role ispivotal to ensuring all patients receive the nest possible care and service.
Key activities include access to services, advice and information and ensuringhealth and care planning is timely and patient-centred. This will includesupporting digital initiatives and coordinating the patient journey throughprimary care.
The Care Coordinator will work within eachpractice setting and alongside the MDTs, to use their enhanced skills as thefirst point of contact for patients requiring support and assistance to enablethe seamless integration of their care journey through the healthcare systems.
The Care Coordinator will have a key rolein supporting delivery of the new Network Contract specifications by workingalongside GPs and AHPs.
Main duties of the job
* Arranging annual health and wellbeing reviews for patients with learning disabilities and severe mental illness.
* Supporting patients with non-diabetic hypoglycaemia with brief intervention and referral to the NHS national diabetes prevention programme.
* Contacting patients who are eligible for NHS weight management programmes and referring where appropriate to further services.
* Supporting with COVID-19 vaccinations, including coordinating the housebound programme and working in our vaccine hubs.
* Calling patients who have not attending cancer screening, to offer appointments and increase cancer screening uptake.
* Supporting practice by contacting patients to invite them for targeted immunisation programmes, such as: polio catch-up campaign, MMR catch-up, pneumococcal and shingle vaccinations
* Supporting practice in delivering a long term condition model of care.
* Supporting patients in conversations regarding urgent care plans.
* Supporting patients with cancer and coordinating care reviews.
* The post holder will be expected tocarry out work duties and tasks in accordance with all relevant codes ofpractice.
* This job description is intended to provide an outline of the key tasks and responsibilities only. There may be other duties required of the post-holder commensurate with the position.
About us
Woodlands Medical Practice is located in East Finchley
We are a training Practice working with training GPs and medical students
High QOF achievers
We are part of PCN2 which are a large innovative PCN.
Our doctors, nurses and all other staff are dedicated to offering a professional service. We are a friendly surgery committed to delivering excellent care to our patients, and a positive working environment for our staff.
Job responsibilities
The Care Coordinator responsibilitiesinclude, but are not limited to the following:
1. Work with GPs and other primary care professionals,including social prescriber link workers, to identify and manage a caseload ofpatients,
2.Coordination of care for patients across health, socialcare and mental health as appropriate, providing a single-point of access forstaff & service users, actively managing patients' care plan delivery
2.Facilitating the smooth and planned discharge andhandover between care settings across the health and social care system,including GP, acute, community, and be responsible for facilitatinginter-agency communication and support
3.Identify and work with a list of named patients withthe aim of encouraging independence, enabling people to remain at home,reducing unnecessary admissions to hospitals and supporting early dischargefrom hospital, improving the quality of care.
4.Provide feedback to the practices, troubleshoot andescalate actions as necessary, providing advocacy for service users.
KEY DUTIES AND RESPONSIBILITIES
1. Facilitate and ensure the effective delivery ofpatient-centred, personalised health and social care plans for patients,monitoring progress and reporting outcomes, contributing to patient reviews andcare planning within appropriate time frames
2.Supporting patients to use decision aids, help createsingle personalised care and support plans in line with best practice.
3.Explain the management of a patient's pathway toclinical staff, liaising between services and service users, contactingservices using the appropriate procedures/referral mechanisms and helpingpatients in making and managing appointments.
4. Work closely with all relevant care agencies (primary care, secondary care,community services, Social Prescribers, Link workers, Community Pharmacists,Mental Health, Social Services, Ambulance Service, Voluntary services and otherrelevant service providers) to ensure a coordinated patient care plan, withoutrequiring a further referral from the GP.
5.Ensure that a proper handover of care between differentsettings has taken place, including mutual transfer of all organisations'communications & patient notes and ensuring care packages are set up
6.Collect data on patients/carers and ensure all patientnotes are updated to reflect any changes, including details on plans.
7.Use healthcare technologies to optimise servicedelivery, access and coordinating care.
8.Organise and attend relevant meetings when requiredincluding Integrated Care meetings, ensure a programme of regular meetings isestablished, ensuring that all necessary documentation is circulated inadvance.
9.Ensure that meeting actions are recorded, disseminatedand followed up in a timely way; ensure relevant practitioners are aware ofmeeting decisions and actions / outcomes, and chase for action resolution andupdate.
10.Network and develop strong relationships with alllevels of the NHS's key local players including the CCG, GPs and other primarycare contractors, Social Services, Mental Health Trusts, Community Trusts, andother providers including the voluntary sector
11.Be a contact point for GPs / practices and establishsystems and processes which will ensure a timely and appropriate response toqueries from clinicians and other stakeholders
12.Identifying and working within the Primary Care teamsto support personalised care for patients and bringing together all of aperson's identified care and support needs to create a single personalised careand support plan.
13.Help people to manage their needs, answering theirqueries and supporting them to make appointments, follow ups and to advocatefor them in their care journey.
14.Supporting people to take up training and employmentaccessing benefits where eligible and refer to social prescribers whereappropriate.
15.Raising awareness of shared decision making andassisting people to have a shared decision-making conversation and ensuringthat people have good quality information to help them make choices about theircare.
16.Assisting people to access self-management educationcourses, peer support or interventions that support them in their health andwellbeing
17. Toassist patients in streamlining their own care and onboarding to new technologysuch as the NHS Apps and use of practice websites for access.
18. Tocoordinate and manage the Patient Participation Groups in collaboration with Practice managers and clinical teams and to innovate ways toenhance engagement.
19. ToCapture Patient Positive experiences and feedback to grow confidence within thepractice and aid with the delivery of an effective patient journey,
20. Workwithin the policies of scheme and Practices.
21. Maintaina good working knowledge of health and safety procedures
22.Promote client involvement in the management of the service.
23. Participatein regular appraisals and practice reviews.
24. Attendtraining and development activities as identified and participate in meetingsas required.
25. Maintaina good working knowledge of Health and Safety procedures and fire precautions,and operate the correct procedures and participate in policy development anddata collection where appropriate.
26. Workflexibly to meet the needs of patients and be able to adapt to change
27. Toundertake any other duties appropriate to the grade and purpose of the job asmay be agreed by the post holder.
This job description is intended to provide an outline of the key tasks and responsibilities only. There may be other duties required of the post-holder commensurate with the position. This description will be open to regular review and may be amended to consider development within the Organisation. All members of staff should be prepared to take onadditional duties or relinquish existingduties to maintain the efficient running of the Practice
Person Specification
Qualifications
* Relevant degree or equivalent level of training and experience
* Evidence of consistent pattern of learning or working within similar sectors or relevant education, training and experience
* Qualification in health or social care allied profession
Experience
* Good phone and written communication
* Managing multiple patients or cases at once
* Knowledge of the needs of vulnerable adults, safeguarding and the associated legislative framework
* Understanding of basic health and social care terminology
* Good interpersonal skills
* Ability to communicate confidently with staff
* Ability to work well across teams
* Good time management and privatizations skills, ability to work to strict deadlines
* Ability to work on own initiative without direct supervision
* IT skills and experience in the use of Microsoft Excel
* Coordination of services from a variety of organisations
* Experience of working in primary care
* Experience of working in a GP practice
* Experience of health social care assessments
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.
#J-18808-Ljbffr