PCN Care Coordinator

• Assist with personal care plans for individual patients, ensuring preventative actions are detailed to support the appropriate use of services.
• Collate patients identified care and support needs and review the options to meet these needs and bring them into a single personalised care and support plan in line with best practice.
• Help people to manage their needs through answering queries, making and managing appointments, and ensuring that people have good quality written or verbal information to help them make choices about their care.
• Provide coordination and navigation of patients, and where appropriate their carers across health and social care services, where appropriate working hand in hand with social prescribing link workers (SPLW), health and wellbeing coaches, and other primary care professionals.
• Support in the delivery of enhanced services and other service requirements on behalf of the PCN.
• Support delivery of QOF, incentive schemes, QIPP and other quality or cost effectiveness initiatives.
• Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing and increase their activation level.
• Run regular patient searches using the clinical IT system in order to have an up to date record of progress of achievement of key performance indicators.
• Work closely with the practice/PCN information and data manager to aid with annual patient recall systems.
• Document data on the computer system using clinical coding to ensure accurate retrieval of information for monitoring and audit purpose.
• Apply infection control measures in accordance with local and national guidelines.
• Maintain recall system for national and annual health screening programs.
• Assist the clinical team in following up patients who have home treatment care, ensuring that any issues are recorded and followed up with the clinical team.
• Maintain the at risk drug database ensuring that patients are sent blood monitoring paper work in a timely manner, escalating any concerns to patient GPs.
• Process home blood pressure waiting list, to ensure that patients are contacted in priority order and equipment has is maintained and cleaned.
• Participate in any practice development sessions. 

West Suffolk Rural Primary Care Network (PCN) consists of 3 GP Surgeries, Wickhambrook, Glemsford and Guildhall Clare surgeries covering around 15,800 patients. PCN's are a national Initiative from the NHS.  The PCN offers a new way of organising care, bringing together all local health and care services in our local area to deliver more joined up care to local populations.

Wickhambrook Surgery is a happy and thriving rural 3 partner GMS GP Practice. We are a dispensing GP Practice with a clear focus on delivering the highest quality patient care to our 5300 patients.  As part of the Suffolk Rural PCN, Wickhambrook surgery sits centrally in the countryside between Haverhill, Newmarket, Bury St Edmunds, Sudbury and Clare.  We are served by a good road structure; however, bus links are infrequent so own transport is essential.  The advertised role is based at Wickhambrook surgery.

Our friendly team consists of 3 GP partners, 1 salaried GP, GP registrars, nurses and HCAs, who are all well supported by very efficient reception, admin and dispensing teams.

We welcome pre-application enquiries and can offer an informal look around our practice by appointment.