About this role
Job summary
The Care Coordinator will work 25 hours per week supporting patients to access appropriate health, social care and community services while promoting personalised care. The role includes coordinating patient reviews, managing referrals, supporting carers, updating patient records, facilitating MDT working, delivering patient education and peer support groups, and signposting patients to local services. The post holder will work closely with practice staff, community organisations and external agencies to improve patient outcomes, support health promotion initiatives, maintain accurate records, and contribute to service development. They will complete Personalised Care Institute training and work towards becoming the Practice Champion for Carers, Learning Disabilities and Veterans.
Main duties of the job
Review discharge information and undertake patient follow-up contacts where appropriate.Support the completion and monitoring of long-term condition and wellbeing assessments.Facilitate effective communication between primary care, community services, and partner organisations.Organise and coordinate multidisciplinary meetings and community support activities.Promote access to local support services, wellbeing programmes, and community resources.Develop and distribute patient information, self-management resources, and health promotion materials.Lead and facilitate patient engagement activities, including support groups and educational sessions.Maintain community resource information and promote opportunities that support patient wellbeing.Support the delivery of local projects, campaigns, and outreach initiatives.Ensure appropriate recording of patient information, reasonable adjustments, and care home-related activity.Contribute to quality improvement, patient safety reporting, and service development activities.Undertake relevant training and development to support specialist champion roles within the practice.
About us
Balance Street is anestablished NHS GP practice proudly serving the community of Uttoxeter and surrounding areas of Staffordshire. We provide care for approximately 14,500 registered patients, delivering safe, effective, and compassionate healthcare tailored to individual needs. Our practice is guided by core values of respect, kindness, professionalism, teamwork, and continuous learning, which underpin our commitment to high standards of patient care and staff wellbeing. The practice is led by 5 GP partners and supported by a skilled and dedicated team of 46 employed staff, including clinical, nursing, administrative, and support colleagues, all working collaboratively within the wider NHS and Primary Care Network. We offer a comprehensive range of services, including general medical services, long-term condition management, health promotion and disease prevention, immunisations and vaccinations, family planning, minor surgery, mental health support, and enhanced services, ensuring accessible, holistic care for our patients close to home.
Job description Job responsibilities
Clinical Responsibilities - Review discharge summaries and conduct courtesy calls - Complete cancer care reviews - Check dementia reviews are completed - Update patient records with completed assessments from external resources (e.g., dementia reviews)
Communication and Coordination - Respond to tasks and emails sent internally and externally - Liaise with colleagues regarding internal and external referrals - Attend and arrange MDT meetings - Liaise with Reception with community boards
Referral Management - Source and implement referrals to external teams (e.g., Staying Well program, Everyone Health) - Support MPFT, PCN, and other services with local events - Supporting outside agencies, setting up drop-in meetings
Patient Support and Education - Post text, email, leaflets, and self-help guides to patients - Conduct monthly peer support group - Lead in facilitating and producing presentations for group clinic - Organise delivery of care choices booklets and other literature - Promote digital tools
Carer and Community Support - Identify and support carers - Keep community activities board updated - Attend local networking events - Monitor local services - Projects with signposting patients
Administrative Duties - Annual review of registers - Keep contact telephone numbers list up to date - Identify health and local campaigns - Identify and attend appropriate training sessions - Utilise IT applications for information - Send appropriate batch texts to selected groups - Updating reasonable adjustments - Care home coding - Reporting to LFPSE
Complete Personalised Care institute 2 Day training course.
Work towards training to become:
- Carers champion for the practice - Learning disability champion for the practice - Veterans champion for the practice
Person Specification
Experience Essential
Experience of working with a range of individuals, including vulnerable people. Experience of administrative duties, record keeping, and managing confidential information. Experience of working as part of a team and liaising with multiple stakeholders.
Desirable
Experience of working in a GP practice, Primary Care Network, or NHS setting. Experience of referral management and signposting services. Experience of facilitating groups, workshops, or patient engagement activities. Experience using clinical systems and patient databases.
Qualifications Essential
GCSEs (or equivalent) in English and Mathematics at Grade C/Level 4 or above. Willingness to undertake Personalised Care Institute Care Coordinator training.
Desirable
NVQ Level 2 in Health and Social Care, Business Administration, or equivalent qualification. Qualification or training in care coordination, health coaching, social prescribing, or patient support.
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 Balance Street Practice
Address Balance Street
Uttoxeter
Staffordshire
ST14 8JG
United Kingdom
Employer's website https://www.balancestreetpractice.co.uk/ (Opens in a new tab)