About this role
Job summary
The Proactive Neighbourhood Care and Remote Monitoring service will support people living with frailty, complex needs and those who are housebound. The service will combine proactive home visiting, care coordination, remote monitoring and links into wider neighbourhood and Local Authority support.
The Care Coordinator will be central to the day-to-day organisation of the service. The postholder will coordinate referrals, appointments, visits and actions, maintain oversight of the caseload and act as a key link between patients, practices, clinicians and partner organisations.
Main duties of the job
Receive and process referrals, check information and ensure patients are added to the correct pathway. Contact patients and carers, explain the service and arrange assessments, visits and follow-up. Maintain accurate caseload and action trackers and make sure outstanding actions are followed through. Coordinate clinician and driver schedules and support efficient use of available capacity. Liaise with GP practices, Local Authority teams, community services and other partners. Support remote monitoring onboarding and follow-up alongside the HCA and clinical team. Enter and update information accurately on EMIS, spreadsheets and other service systems. Support activity, outcome and performance reporting and identify gaps or delays to the Service Manager. Handle patient information sensitively and escalate clinical or safeguarding concerns promptly.
About us
The Primary Care Alliance (PCA) is the collaborative voice of general practice across the Berkshire West Place within the Thames Valley Integrated Care System. We bring together GP practices and Primary Care Networks (PCNs) to work at scale, enabling innovation, influencing system change, and delivering services that meet the needs of our local populations.
PCA plays a vital role in shaping the future of primary care by strengthening partnerships, developing the workforce, and ensuring general practice is a central and equal partner in integrated care. As a community interest company, PCA supports primary care sustainability, equity, and improved outcomes for patients across Reading, Wokingham, and West Berkshire.
Job description Job responsibilities
Receive and process referrals, check information and ensure patients are added to the correct pathway.
Contact patients and carers, explain the service and arrange assessments, visits and follow-up. Maintain accurate caseload and action trackers and make sure outstanding actions are followed through. Coordinate clinician and driver schedules and support efficient use of available capacity. Liaise with GP practices, Local Authority teams, community services and other partners. Support remote monitoring onboarding and follow-up alongside the HCA and clinical team. Enter and update information accurately on EMIS, spreadsheets and other service systems. Support activity, outcome and performance reporting and identify gaps or delays to the Service Manager. Handle patient information sensitively and escalate clinical or safeguarding concerns promptly.
Person Specification
Qualifications Essential
GCSE English and Maths, grade C/4 or above, or equivalent.
Experience Essential
Experience in an administrative, care coordination, healthcare or patient-facing role. Excellent organisation, communication and follow-up skills. Confident using IT systems, email and spreadsheets. Ability to manage a busy workload and maintain accurate records. Ability to communicate sensitively with patients, carers and professionals.
Desirable
Experience in primary care, community services, frailty or remote monitoring. Experience using EMIS or another clinical system. Care Certificate, care navigation or relevant coordination training.
Disclosure and Barring Service Check This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.
Employer details Employer name The Primary Care Alliance CIC
Address Chalfont Surgery
Chalfont Close
Reading
RG6 5HZ
United Kingdom
Employer's website https://www.primarycarealliance.nhs.uk/ (Opens in a new tab)