Due to staff development, The County Practice is looking to recruit a Care Co‑Ordinator focusing on our frail and elderly patients. In this role you will be working closely with our Practice team to support patients with dementia, multiple long‑term conditions and patients that are increasingly frail.
This role is now an integral part of the practice and provides a holistic, person‑centred approach for some of our most vulnerable patients. It focuses on supporting people beyond their clinical treatment, helping to ensure their wider emotional, practical and social needs are identified and met.
You will be part of a team working with our GPs, Primary care network colleagues, adult social care, care homes and most importantly, our patients.
Main duties of the job
About the role
Working closely with our GPs to coordinate and attend the weekly ward rounds at our care homes.
Working collaboratively with all teams across the practice.
Acting as the main point of contact for the care homes.
Discussing and generating Personalised care and support plans alongside ReSPECT forms for patients that are living with multiple long‑term conditions or are increasingly frail.
Conducting annual dementia reviews to support our patients and carers that are living with Alzheimer’s or dementia.
Coordinate the monthly Gold Standards framework MDT team meeting.
Organising and, where possible, carrying out housebound patients and care home residents annual long‑term condition reviews.
Coordinating and, where skills and training allow, administering annual COVID and flu vaccines for our housebound patients and anyone in a care home.
Utilising SystmOne including system reports to manage data for this group of patients, which includes QOF.
About you
We are looking for someone who:
- Is organised, proactive and empathic to the needs of this group of patients.
- Is confident in having difficult conversations with patients.
- Ability to work amongst a multi‑disciplinary team.
- HCA experience but not essential.
- Experience of building and maintaining networks and relationships.
- Previous use of SystmOne (essential).
About us
Strong focus on excellent patient care, reflected in positive feedback.
Good CQC rating and consistently high QOF achievement.
5 GP partners, 2 salaried GPs, and experienced nursing, management and admin teams.
Training practice for GP registrars and nursing students.
Supportive, team‑based culture with opportunities for development in all roles.
Active member of the Melton, Syston and Vale PCN, benefiting from collaborative working.
What we offer
27 days annual leave plus bank holidays (pro rata), rising with service.
Onsite parking.
Development opportunities within the role.
Job responsibilities
Care Co‑Ordinator Job Description.
a) Proactively identify and work with a cohort of patients classed as vulnerable. This will include those living in care and nursing homes.
b) Acting as the main point of contact for the care homes.
c) Working closely with our GPs to coordinate and attend the weekly ward rounds at our care homes.
d) Discussing and generating a personalised care and support plan along ReSPECT forms for patients that are living with multiple long‑term conditions or who are increasingly frail.
e) Conducting annual dementia reviews to support our patients and carers that are living with Alzheimer’s or dementia.
f) Working collaboratively with all teams across the practice to support these patients.
g) Assist with scheduling clinics and rotas to enhance care options for patients.
h) Help people to manage their needs, answering their queries and supporting them to make appointments.
i) Support the coordination and delivery of MDTs within PCNs.
j) Organising and if possible, carrying out housebound patients and care home resident annual long‑term condition reviews.
k) Liaise with external organisations where necessary.
l) General administration and note taking as appropriate.
Person Specification
Qualifications
- A good standard of education with an expectation of having both GCSE Maths and English at Grade C or above.
- NVQ Level 2 in Health and Social Care.
Experience
- Confidence in having difficult conversations with patients.
- Ability to work amongst a multi‑disciplinary team maintaining and building relationships.
- Experience of health or social care.
- Experience of health and social care assessments.
- Demonstrated successful outcomes delivery within determined timeframes.
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.
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