Care Co-ordinator Whitby Health Partnership
Whitby Health Partnership are looking to recruit a Patient Care Co-ordinator. the role will assist patients (either directly or by liaising with their carers or Care Home staff) to identify needs & wishes & develop personalised care plans. They liaise between patients, families, Clinicians, GP surgeries, Community services, Care Home staff & other health care & voluntary sector services to work towards the specified aims of each patient
The role requires you to be able to work with, & understand the roles of, a variety of different people working in the practice & across the PCN including doctors, nurses, healthcare assistants, social prescribing link workers, physiotherapists, physician associates, paramedics, health & wellbeing coaches, podiatrists, occupational therapists, pharmacy technicians & others.
Main duties of the job
Working closely with our GPs, Nurses and clinicians, the Care Care-Coordinator will be part of the Multi-Disciplinary Team (MDT) within the Whitby Health Partnership. The post holder will contribute to tackling inequalities in health and social care by working closely with our Care Homes to improve the continuity of care by acting as a point of contact for residents, families and professionals who visit care homes, such as MDT members and in-reach specialists. you will co-ordinate complex hospital discharges to make sure investigations and follow up happen in frail and vulnerable patients and will act as a point of contact for carers with concerns. You will champion the frail including those who are housebound and ensure they are coded and prioritised for annual vaccinations and disease and drug management reviews. You will supply secretarial and administrative support as required.
Work with the GPs and other primary care professionals within the PCN to identify and manage a caseload of patients, and where required and as appropriate, refer people back to other health professionals within the PCN.
Supporting the practices recall processes.
Manage and maintain GP and ANP Rota.
About us
Whitby Health Partnership, in Ellesmere Port, is a supportive environment in which you can develop your special interests. We have around 16,500 patients and use EMIS web. We are part of the One Ellesmere Port PCN and work collaboratively with the other Ellesmere Port practices.
You will enjoy working with a diverse and skilled team, who are open to new ideas. The team includes 12 GPs, ANPs, practice nurses, GP assistants, a prescribing pharmacist, physios, social prescribing link workers and a mental health OT.
The practice is dedicated to providing the best possible care for patients, whilst fostering a vibrant and energetic working atmosphere.
Job responsibilities
Primary Duties and Areas ofResponsibility
Overall responsibility for arranging the MDTmeetings and the smooth running of integrated care of the frail and vulnerable.The key role of the Care Coordinator will be to schedule the MDT meetings,manage the meeting agenda items; ensuring that all new referrals are identified,and information circulated to team members in advance of the meeting. The role will also contribute to completion& update of care plans for frail elderly patients including those withdementia which involves information on next of kin, power of attorney and consentfor others to discuss medical record etc.
Safeguarding Administration
Family Liasion for vulnerable patients and carer
Working with the PCN on projects such as vacination clinics, local health initiatives and research.
Completing dementia reviews in care home patients
-Working with LD registered patients to ensure they recieve optimal care
-Ensuring adequate records are kept for patients with DNACPR
Receive and co-ordinate information from transfersof care (including hospital admissions and discharges) plus out of hours callsand present this information to the MDT as required.
Liaise with all clinical and non-clinical members toensure effective care.
Manage reporting required and associated within theDES specifications for required services.
Administration support of new patients who requireadvanced care planning, DoLs status and power of attorney, contacting previousmedical centres for missing information.
The care-coordinator acts as a point of contact forthe frail and vulnerable who may be in care homes or housebound, seeing thequeries through to completion and linking in with the relevant clinicians toenable this completion which will include the GPs, ANPs and clinicalpharmacist.
care-coordinator will be the main link between themedical centre and the community care team.
Take minutes of meetings and disseminate; chaseprogress against actions identified in these meetings and ensure follow upwhere necessary.
Liaise with service providers and clinicians toidentify frequent flyers, and new service users utilising risk stratificationtools provided and present this information to the appropriate person.
Signpost team members, service users and carers torelevant services including the Social Prescribing Link Worker Service
To ensure the IT requirements for recording activityare adhered to in collaboration with other team members
To provide agreed performance/activity data withinthe required timescales
Demonstrates ability to work as a member of ateam.
Is able to recognise personal limitations andrefer to more appropriate colleague(s) when necessary.
Actively work toward developing andmaintaining effective working relationships both within and outside the PCN.
Liaises with other stakeholders as needed forthe collective benefit of patients including but not limited to Patients GP,Nurses, other practice staff and other healthcare professionals includingpharmacists and pharmacy technicians from provider and commissioningorganisations.
Develop excellent working relationships with the allpartners, wider service networks including the voluntary sector, GP practices,adult social care, hospitals, community pharmacists and other members of theMDT
Acting as a point of contact for residents, familiesand professionals
Meet regularly with the clinical lead and reviewcase load.
Communicate effectively with service users and theirfamilies/carers, other staff both internal and external and members of thepublic
Manage and prioritise workload on a daily basis anddeal with the competing demands.
Person Specification
Qualifications
- Qualifications (Training or equivalent)
- GCSE grade C/4 or above in English and Maths (or equivalent)
- Care Coordinator training or equivalent relevant experience
- Evidence of ongoing professional development
- Training in Primary Care systems (including EMIS Web)
- Additional training in Safeguarding
Experience
- Minimum of 2 years experience of working with healthcare professionals and or previous experience in the NHS or social care or relevant field (desirable)
- Experience currently or previously within a care co-coordinator role
- Experience in use of databases including EMIS
- Experience of administrative duties
- Able to demonstrate a clear understanding of working with confidential information and an understanding of service user confidentiality
- Working in a multi-disciplinary setting where influence and negotiation is required
- Knowledge/familiarity with medical terminology
- Understanding of health and social care processes
- Vulnerable adults awareness
Aptitude and Personal Qualities
- Professional attitude and assertive approach
- Committed to development
- Conscientious, hardworking and self- motivated to work with minimal supervision
- Creative and tenacious in finding solutions to difficult problems
- Ability to work with information, clinicians, social workers and managers
- Ability to meet deadlines and work under pressure
- Ability to engage and sustain relationships with all professionals, other organisations and service-users
- Approachable and flexible
- Honest and reliable
- Sensitive to patients needs
- Willingness to undergo further training or development
- Requires a flexible approach, and a highly motivated post holder. The role may need to be reviewed and developed in the future in line with changing priorities
- Access to and ability to use transport as travel between sites across the county will be required for meetings and training
- Willingness to undergo further training and development as the job develops
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.
Depending on experienceBand 4 scale depending on experience
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