In partnership with Rayleigh and District Primary Care Network (PCN), GP Healthcare Alliance (a federation of GP practices in Castle Point and Rochford) is looking to recruit a full time care coordinator, to join our PCN on a full time basis for 37.5 hours per week.
This role will be working autonomously but will have the support of a multi-professional primary care team made up of doctors, nurses, and clinical pharmacists.
We are looking for a proactive individual who is passionate about improving patient care who will be covering the PCN which is made up of the following practices:
- Audley Mills Surgery
- Church View Surgery and Jones Family Practice
- Downhall Park Surgery
- Greensward Surgery
- Riverside Medical Centre
- William Harvey Surgery
The care coordinator works closely with all relevant care agencies within the integrated neighbourhood team (primary care, secondary care, community services, mental health, social services, voluntary services and other relevant service providers) to ensure coordinated patient care plans, without requiring a further referral from the GP. This includes:
- Supporting the coordination and delivery of MDTs within the PCN and ensure that actions points identified are recorded and followed up.
- Promoting the role and MDT with the PCN.
- Supporting the PCN to deliver effective, coordinated care to the care homes in their locality, working with the clinical team and other partners.
- Liaising with other clinical and non-clinical professionals within the team and other partners involved in patient care locally to holistically bring together all of a persons identified care and support needs, and explore options to meet these.
- Utilising population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care.
- Raising aware of health promotion and importance of NHS health checks.
- Establishing processes for patients to be reviewed during care home/sheltered housing ward round sessions.
- Scoping and arranging outreach sessions with the PCN team.
- Helping people transition seamlessly between services and support them to navigate through the health and care system.
- Exploring and assisting people to access personal health budgets where appropriate.
- Supporting the PCNs Patient Participation Group (PPG) with taking minutes, following up actions, distributing meeting papers and working with the team to create a forward planner of agenda items for discussion.
- Supporting delivery of the PCN engagement workstream with the local population by initiating contacts and developing/managing relationships across the network.
Please see full job description attached.