Job summary
Wimborne and Ferndown PCN are looking for a keen individual to support our Ageing Well Nurse and PCN team in providing the best care to our patients. Our PCN includes the following practices: The Quarter Jack Surgery / The Old Dispensary, Walford Mill Medical Centre, Pennys Hill Practice and Orchid House Surgery.
The role of the Ageing Well Coordinator is to support the Ageing Well Nurse by supporting frail patients within our community. Job tasks can include coordinating visits, triaging tasks, completing administration tasks as required and helping to develop our Ageing Well service.
Main duties of the job
The role will include
1. Checking workload tasks and ensuring they are dealt with in a timely manner.
2. Triaging tasks and prioritising appointment booking for the Ageing Well Nurse.
3. Checking Practice's out of hour call lists to see if there are any servery frail patients which need a follow up.
4. Completing any administration tasks required by the Ageing Well Nurse.
5. You may be required to go on visits with the Ageing Well Nurse to take notes.
6. Maintain the Dorset Care Plan list and ensure patients on this register are reviewed annually.
7. Forming a good working relationship with our Care Homes.
8. Travelling between our 4 GP practices.
Additional opportunities which may develop with the role:
9. Ageing Well Coordinator to complete some Dorset Care Plan reviews after Ageing Well Nurse has completed the initial review.
10. Work with the PCN Administration Team to complete projects on Health Inequalities or other projects.
About us
Wimborne & Ferndown PCN provides services to 42,000patients across 4 Practices (Quarter Jack Surgery/ Old Dispensary, Walford MillMedical Centre, Pennys Hill Practice, Orchid House Surgery). We have adoptednew roles within the PCN to support and broaden our primary care team whichallows us to provide better care for our patients.
The PCN is headed by our committed Clinical Directors and a PCN Manager.
In addition to the PCN, our Practices are also part ofCastleman Healthcare, a non-profit company owned by 13 GP Practices in NorthPoole and East Dorset (3 PCNs). Castleman Healthcare offer additional servicesto our Patients through separate contracting arrangements, provide business andpractical support to the PCNs and support with representing the PCNs voicewithin the wider healthcare system.
Job description
Job responsibilities
Key duties
To methodically action the elementsof the project plan against nationally set criteria including but not limitedto:
Support theAgeing Well and Enhanced Health in Care Homes Project Plans
Work through the elements of theproject plans, aligning practice-based work with PCN and national directives.
Ensure key deliverables areon-track, managed and provided to patients.
Be the champion across the Networkfor the Ageing Well and Care Home projects.
Link practices, patients, theNetwork, community and hospital services together by being the conduit to theNetwork and the practices.
Urgent CommunityResponse
Be the link between the Network andthe community provider.
Personalised Careand Support Plans
Maintain a system to ensure that allcurrent and new care home residents have a care plan in place that is updatedregularly by appropriate individuals such as GPs, ANPs, Nurses, communityteams, care home staff.
Assess the need for care plans tobe put in place in the wider community for those patients living outside ofcare homes.
Helpprofessionals, cares and individuals navigate the health and care system
Be the first port of call forqueries and problems relating to the navigation of systems. Help guide, directand support patients and their carers.
Palliative andend of life care
Design and instigate a robustsystem of ensuring palliative patients are raised by the practice, discussedand MDT. Ensure patients are on the Gold Standard Framework, ensure care plansare in place shared appropriately. Ensure care homes can access palliative caresupport. Set up training sessions for care home staff to support theirpalliative patients.
Mental health andDementia Care
Ensure care plans have appropriatemental health sections within them. Research DiADEM and DEAR-GP as a means tosupport patients with dementia.
Project work
Work with the PCN Administration Team to target unwarranted health outcomes and using the local infrastructure (suchas the Social Prescriber) to improve the health of the targeted populationusing recognised Population Health Management tools (such as the DiiS orElectronic Frailty register.).
Person Specification
Qualifications
Essential
11. GCSE A-C in English and Maths
Desirable
12. HCA Experience ( qualified in phlebotomy)
Experience
Essential
13. Experience and/or knowledge of the NHS and Care Homes.
14. Data management and analysis skills.
15. Awareness of confidentiality and ability to deal appropriately with sensitive or difficult situations.
16. Ability to manage change working with Partners, Managers and Stakeholders.
17. Ability to act as a role model demonstrating effective behaviour and leading by example.
18. Ability to manage various projects in a timely manner.
19. Flexible, versatile, and self-motivated.
20. Effective communicator at all levels
21. Ability to work as part of a team or on own projects
22. Open minded and positive, focused on solutions not problems, a can do attitude.
23. Flexible working attitude
24. Demonstrate a high level of integrity and ingenuity
25. Be a strategic thinker with an ability to be innovative
26. Able to lead and inspire others
Desirable
27. Healthcare Assistant Experience.
28. SystmOne Knowledge.