PCN Care Coordinator inRugby inRugby PUBLISHED 9 DEC 2023

The Care Coordinator has the following key responsibilities, in delivering health services:

• utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care;
• support patients to utilise decision aids in preparation for a shared decision-making conversation;
• holistically bring together all of a persons identified care and support needs, and explore options
• to meet these within a single personalised care and support plan (PCSP), in line with PCSP best practice, based on what matters to the person;
• 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, using tools to understand peoples level of knowledge, and the confidence in skills in managing their own health;
• support people to take up training and employment, and to access appropriate benefits where eligible for example, through referral to social prescribing link workers;

• explore and assist people to access personal health budgets where appropriate;
• provide coordination and navigation for people and their carers across health and care services,
• working closely with social prescribing link workers, health and wellbeing coaches, and other primary care professionals; and i. support the coordination and delivery of MDTs within the PCN

In addition to this, the Care Co-ordinator will deliver the following wider responsibilities:

• 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;
• raise awareness within the PCN of shared decision-making and decision support tools; and
• raise awareness of how to identify patients who may benefit from shared decision making and support PCN staff and patients to be more prepared to have shared decision-making conversation
• Any other duties as may be requested by the Clinical Lead or Operations Director of the PCN.

Rugby Health PCN has a great opportunity for a Care Coordinator to join us to provide coordination and help to those who are likely to experience health inequalities, assisting them to navigate the care and support available across health and care services.

The successful candidate will play a key role in proactively identifying and working with people, including the frail/elderly/ housebound and vulnerable, supporting them to understand and manage their condition and ensuring their changing needs are addressed. This will involve working closely with our Practices and as part of an Multi Disciplinary Team including Social Prescribers, the Health and Wellbeing Coach and the Enhanced Nurse Practitioner.

The post-holder should have excellent IT skills (Microsoft Office) and experience of working in a Primary Care setting would be desirable.

The Care Coordinator must be able to work confidently and effectively in a varied, and sometimes challenging environment. The successful candidate will have excellent interpersonal and communication skills, and be organised, patient and empathetic as they will interact with a diverse range of people from different cultural and social backgrounds.

This post will be based at our GP surgeries where the service will be provided from, and it will focus on coordinating planned reviews and completion of personalised care and support plans.

The Care Coordinator has the following key responsibilities, in delivering health services:

• utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care;
• support patients to utilise decision aids in preparation for a shared decision-making conversation;
• holistically bring together all of a persons identified care and support needs, and explore options to meet these within a single personalised care and support plan (PCSP), in line with PCSP best practice, based on what matters to the person;
• 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, using tools to understand peoples level of knowledge, confidence in skills in managing their own health;
• support people to take up training and employment, and to access appropriate benefits where eligible for example, through referral to social prescribing link workers;

Please refer to attached Job Description for full responsibilities.