Title: Care Co-ordinator
Responsible to on behalf of SHCP: Director of Operations,
Responsible to on behalf of the practices: Practice Managers
Location: Surrey Heath Primary Care Network
Hours per week: Full Time or Part Time
Salary: From £24,912.00 depending on experience
Holiday Entitlement: 27 days per year (based on full time hours) plus Bank Holiday entitlement
Key Relationships: Surrey Heath Leadership Team, Surrey Heath General Practitioners inclusive of GPs, Practice Managers, Practice teams. Mental Health Integrated Care[ MHICS], MDT [SPA], Social Prescribing team.

ABOUT US:

We are Surrey Heath Community Providers Limited, which is a federation of 7 GP practices across 10 sites, covering a population of over 100,000 patients across Surrey Heath. We began in 2016 and now employ around 200 members of staff across our clinical and corporate support teams. Our services include Surrey Heath Primary Care Network, PRIMACY workflow management and Upper Gordon Road Surgery.
As a GP Federation and Primary Care Network, we are proud to represent our member practices and to champion primary care by working with local general practice and system partners, in the provision of community based healthcare services. We are dedicated to providing safe and compassionate care to our patients across our range of primary care services in Surrey Heath and believe in continuous commitment to quality service delivery and positive patient outcomes.
Patients are at the heart of everything we do, and we pride ourselves in ensuring our patients feel safe, supported, communicated with and respected, at a time when they may be feeling vulnerable.
Our vision is to provide high quality, seamless health care that enables people to lead healthier lives, whilst feeling supported and cared for. .

3. EQUALITY AND DIVERSITY

Will support the equality, diversity and rights of patients, carers and colleagues, including:

• Acting in a way that recognizes the importance of people’s rights, interpreting them in a way that is consistent with Practice procedures and policies, and current legislation.
• Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues.
• Behaving in a manner which is welcoming to and of the individual, is non-judgmental and respects their circumstances, feelings priorities and rights.
• Use Confidentiality
• In the course of seeking treatment, patients entrust us with, or allow us to gather, sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately.
• In the performance of the duties outlined in their Job Description, the post-holder may have access to confidential information relating to patients and their carers, Practice staff and other healthcare workers. They may also have access to information relating to the Practice, PCN and Federation as a business organisation. All such information from any source is to be regarded as strictly confidential.
• To access information relating to patients, carers, colleagues, other healthcare workers or the business of the PCN & Practice may only be divulged to authorised persons in accordance with the PCN & Practice policies and procedures relating to confidentiality and the protection of personal and sensitive data.

QUALIFICATIONS

• 4 GCSE’s (C and above) including English and Maths or equivalent - Essential
• Relevant NVQ Level 3 qualification or equivalent - Desirable

KNOWLEDGE

• Experience of working with healthcare professionals and/or previous experience in the NHS or social care - Essential
• Experience coordinating with multiple stakeholder or individuals to meet specified outcomes- Essential
• Experience providing advice/signposting - Essential
• Experience using a patient clinical system such as EMIS - Essential
• Awareness of how and when to signpost - Essential
• Knowledge of safeguarding interventions and an awareness of the Mental Capacity Act - Essential
• Skilled in the use of person-centred measurement and outcomes delivery - Essential
• Knowledge of a range of local community groups which support wellbeing - Desirable
• Awareness of relevant Health and Social Care legislation and a developed knowledge of crisis intervention - Desirable
• Experience of undertaking quality improvement activity - Desirable
• Sound understanding of disease prevention and the NHS choices website - Desirable

SKILLS

• Excellent verbal and written communication skills with the ability to communicate effectively at all levels including with patients, carers, specialist services, GPs and colleagues - Essential
• Good technical literacy with e.g. Word, Excel, and experience using a clinical system such as EMIS - Essential
• Able to work independently and manage own workload - Essential
• Able to build strong professional relationships - Essential
• Demonstrable experience of effective planning and organisation skills to deliver targets to deadlines - Essential
• Proven record of excellent written communication skills and a high level of health literacy - Essential
• Understanding of social determinants of health and how these can be addressed with patients - Essential
• Able to analyse and interpret information and present results in a clear and concise manner - Essential

ROLE SUMMARY:

An exciting opportunity has arisen for a part time Care Co-ordinator to join Surrey Heath Primary Care Network [PCN], supporting delivery of the new Network Contract Direct Enhanced Service [DES] specifications.
We are looking for a Care Co-ordinator to support our PCN, to work closely with PCN Practices and the multidisciplinary team in coordinating all key activities including access to services, advice, and information, and ensuring heath and care planning is timely, efficient, and patient-centred. The post holder will help patients interact and engage with everyday life through activities designed to develop, maintain, or retrain skills for people with a cognitive, physical, or mental disorder, condition, or illness. You will support the provision of continuity of care and act as a point of contact for families, residents, and professionals for identified patients in your caseload.
Surrey Heath Community Providers offer a 365 day, 52 week service delivery and as part of that we offer a 7 days a week from 0800 hrs – 2000hrs service. So you may be required to work evenings, weekends, and Bank Holidays as part of your normal working hours, as per the needs of the business.
The above is only an outline of the tasks, responsibilities and outcomes required of the role. The job holder will carry out any other duties as may reasonably be required by the organisation.
The job description and person specification may be reviewed on an ongoing basis in accordance with the changing needs of Surrey Heath Community Provider Limited and the Primary Care Network

KEY RESPONSIBILITIES AND PRIMARY DUTIES MAY INCLUDE THE FOLLOWING:

• Provide coordination and navigation for people and their carers across health and care services, working closely with social prescribers, health and wellbeing coaches and other primary care professionals.
• Utilise population health intelligence to proactively identify and work with a cohort of patients to deliver personalised care
• Support PCN staff and patients to be prepared to have shared-decision making conversations including utilising decision aids and tools, and support patients to understand their level of knowledge, skills and confidence (their ‘activation’ level) when engaging with their health and wellbeing including through the use of the Patient Activation Measure.
• Help people to manage their needs through answering queries, making and managing appointments and ensuring that people have food quality written or verbal information to help them make choices about their care
• Support the practice with the Patient Participation Group [PPG]
• Holistically bring together all of a person’s identified care and support plan, in line with best practice, based on what matters to the person
• Support people to take up training and employment, and to access appropriate benefits, education courses, peer support, and/or personal health budgets where applicable
• Raise awareness within the PCN of shared-decision making and decision support tools, including how to identify patients who may benefit from this
• As part of the multidisciplinary team, build relationships with staff in GP practices within the PCN, attending relevant meetings, providing information and feedback on care coordination priorities
• Be proactive in developing strong link with local agencies, and in encouraging equality and inclusions
• Liaise directly with care homes and other key providers, and compile and circulate relevant information across stakeholder groups
• Understand, out in place and adhere to safeguarding protocols for vulnerable individuals
• Capture key information to enable comprehensive and accurate records of support, inputting these into clinical systems as required and adhering to data protection legislation
• All our Registered healthcare professionals are also expected to support the ‘evergreen’ local COVID vaccination programme with the preparation and administration of vaccines, including clinical eligibility assessment, consent, administration and aftercare advice, in line with the relevant prescribing mechanism (e.g. National Protocol).
  This is not intended to be an exhaustive list of responsibilities, and it is expected that you will participate in a wide range of activities and any other duties as reasonably required by the Line Manager