Care Co-ordinator

at  Market Street Health Group

Key responsibilities Work with patients, their families and carers to improve their understanding of the patients condition and support them to develop and review personalised care and support plans to manage their needs and achieve better healthcare outcomes. 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. Assist people to access self-management education courses, peer support, health coaching and other interventions that support them in their health and wellbeing, and increase their levels of knowledge, skills and confidence in managing their 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.
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; helping to ensure patients receive a joined-up service and the most appropriate support. Work collaboratively with GPs and other primary care professionals to proactively identify and manage a caseload, which may include patients with long-term health conditions, and where appropriate, refer back to other health professionals. Support the coordination and delivery of multidisciplinary teams with the PCN 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 conversations. Explore and assist people to access a personal health budget where appropriate.
Identify unpaid carers and help them access services to support them Conduct follow-ups on communications from out of hospital and in-patient services Maintain records of referrals and interventions to enable monitoring and evaluation of the service Support practices to keep care records up to date by identifying and updating missing or out of date information about the persons circumstances. Contribute to risk and impact assessments, monitoring and evaluations of the service Referrals To be responsible for the accurate typing of letters, reports, patient referrals, minutes, statements, memoranda etc using the computer general office packages. To work within established standards for quality, time scales and deadlines. To operate the e-Referrals system according to practice procedures for patient referral letters All other typing duties that may be required Communication including telephone To communicate effectively with other team members, patients and carers.
To deal with telephone enquires relating to referral letters, urgent appointments, etc from patients, the clinical team and other professionals giving due regard to patient confidentiality and customer care. To liaise with patients over the phone relating to internal and external appointments and as directed by the practice team To liaise over the phone with a wide range of NHS and other organisations on behalf of the practice team as appropriate taking messages and acting on them as necessary. Meetings To be responsible for coordinating and chairing MDT meetings (Children’s MDT, Adults MDT and Nursing Home MDTs) To circulate patients for discussion to relevant parties To be responsible for making sure actions are completed following meeting discussions To minute take Whole Practice Meetings and distribute to all staff and ensure actions are completed General To support the effective administration of the practice which will include various other admin duties and tasks including assisting in the administration of medical student teaching Triaging clinical documents Call and recalls To maintain and develop skills in the use of the practice clinical and office IT systems To provide cover at reception during receptionist meetings/training. To work within all the practice operational policies including Health and Safety.
To attend training for development within the post and to fulfil practice requirements. To provide cover for members of the secretarial team during periods of sickness and annual leave To maintain patient confidentiality at all times To carry out all duties with due regard to equality and diversity and rights of patients, carers and colleagues. To carry out all duties with due regard to quality, efficient management of time, workload and resources This job description may be amended to take account of the changing needs of the practic

Please refer the Job description for details