Care Home MDT Coordinator

at  Your Healthcare CIC

Key Result Areas Supporting the functioning of the care home multidisciplinary team (MDT) Working in partnership with the PAC locality coordinator or manager to share information and identify care home residents for MDT discussion. Liaise with Care Home Care Planning Practitioner to identify care home residents for MDT discussion and ensure the right professionals are involved, notified, and prepared. Produce summary notes of MDT discussions/meetings including agreed actions. Information gathering through coordinating professional input and outputs from the quarterly risk-stratification tool using the local case-management system to access key information.
Participate in the review of patient outcomes and goals in keeping with the requirements of the role. Alongside the Care Home Care Planning Practitioner act as a contact point for all Care Home MDTs that you will be supporting. In conjunction with the PAC team and wider stakeholders, continually work to review and improve processes to ensure MDTs function in the most effective way. Monitor key actions and highlight review periods set by MDTs.
Support the development of Integrated Neighbourhood Teams (INTs) within Kingston and Richmond. This will involve working closely with PCNs to support their growth as an INT Working in partnership with the Urgent Care & Support Service in Kingston and Care Home Support Team in Richmond, monitoring hospital admissions for care home residents, supporting the Care Home Care Planning Practitioner to enable proactive working. Information management, analysis and evaluation Establish agreed performance and reporting systems and undertake case tracking of individuals discussed to support the proof-of-concept evaluation Working with the MDT to distribute, process and analyse wellbeing surveys to patients and users to support the proof-of-concept evaluation Access required to organisational information systems for information gathering and inputting as required to support MDTs. Communication and working with others Establish good working relationships across a range of professionals within multi-disciplinary teams including health, social care and voluntary sector staff.
Liaise with the core MDT membership, the HIU team, and LAS, alongside other service providers, to identify patients suitable for referral to MDTs in Care Homes Provide admin support to the MDT to set up huddles as required. Engage with PAC Quality Improvement (QI) meetings as appropriate to share good practice. Present and communicate information in a range of formats to support engagement. Report any issues or updates to the programme team in a timely manner.
Role development Work with the wider team and programme manager to develop the role, required responsibilities, functions and requirements going forward. Work flexibly to meet the needs of the MDTs and highlighting any gaps in provision / service

Please refer the Job description for details