About this role
Job summary
West Kent Primary Care is looking to recruit a Care Coordinator to support Tonbridge Primary Care Network.
We are seeking a Care Coordinator to join our Primary Care Network (PCN) multidisciplinary team (MDT). The post holder will work proactively across all member practices to coordinate personalised care for our patient population, with a particular focus on individuals with complex health and care needs.
The post holder will mainly be based at Trenchwood Medical Centre, TN10 3ET.
Main duties of the job
The Care Coordinator will provide proactive, person-centred coordination and navigation for people and their carers across health, care and community services. Using population health intelligence and a personalised care approach, the postholder will support identified cohorts to prepare for shared decision-making, develop and maintain personalised care and support plans, manage appointments and queries, access reliable information and connect with appropriate services. The role will work closely with GPs, other primary care professionals, Social Prescribing Link Workers, Health and Wellbeing Coaches and wider partners, and will support coordination and delivery of multidisciplinary team meetings within the PCN.
About us
West Kent Primary Care will act as employer for this role. We are a collaborative and ambitious GP Federation working with GP practices across Sevenoaks, Weald, Tonbridge, Tunbridge Wells, Malling, and Maidstone to improve General Practice provision in the area. West Kent Primary Care are a supportive and friendly organisation whose aim is to provide high quality, seamless health care that enables people to lead healthier lives, whilst feeling supported and cared for.
What we can offer
- Favourable terms and conditions
- Match NHS Annual Leave entitlement
- NEST and NHS Pension
- A comprehensive induction into the company followed by a local induction to introduce you to the role
- Training, support, and development in your career
- Flexible working arrangements
- Recognition via Employee of the Month scheme
- Wellbeing support and Employee Assistance Programme
*Due to travel requirements for the role it would be beneficial for applicants to have a full driving license
Office Contact: 01892 481821
Job description
Job responsibilities
- Use population health intelligence, risk stratification tools and clinical system searches to proactively identify and work with agreed cohorts of patients who may benefit from personalised care and support.
- Work with GPs and other primary care professionals to identify, coordinate and manage an agreed caseload of patients, particularly those living with frailty, people with multiple long-term conditions, care home residents, housebound patients and individuals with complex health and care needs.
- Support registered clinicians in coordinating Comprehensive Geriatric Assessments (CGA), including gathering relevant patient information relating to functional ability, mobility, falls history, activities of daily living, social circumstances and other agreed assessment areas.
- Bring together information about a person's identified health, care, social and wellbeing needs to support the development and review of a single personalised care and support plan (PCSP), ensuring that plans reflect what matters to the individual.
- Work with patients and carers to identify their priorities, understand their needs and explore appropriate options for support.
- Support the coordination and delivery of PCN multidisciplinary team meetings, particularly for patients with frailty, complex needs, care home residents and housebound patients.
- Arrange MDT meetings, coordinate dates, prepare agendas, identify patients for discussion in collaboration with the clinical team and circulate invitations and relevant patient information to appropriate professionals.
- Coordinate and maintain PCN clinic schedules across member practices, hub services and other relevant community settings.
- Manage patient bookings, cancellations, rebooking and appointment changes, ensuring clinic schedules and appointment systems are kept accurate and up to date.
Person Specification
Qualifications
Essential
- Educated to GCSE / A Level
- Good standard of general education, including literacy and numeracy, or equivalent experience.
- Commitment to complete mandatory, statutory and role-specific training.
Desirable
- Enrolled in, undertaking or qualified from appropriate Personalised Care Institute training specified in the Workforce Development Framework for Care Co-ordinators, including training or an apprenticeship leading to a Level 3 standard.
- Level 3 qualification in health, care, community development, business administration or a related subject.
- Training in personalised care and support planning, shared decision-making, health coaching or motivational interviewing.
Professional skills
Essential
- Commitment to person-centred care, dignity, respect, inclusion and reducing health inequalities.
- Reliable, adaptable and able to maintain professional boundaries.
- Willing and able to travel between PCN practices and other agreed locations in a timely manner.
Desirable
- Access to transport suitable for work-related travel, subject to reasonable adjustments.
- Understanding of the local West Kent health, care and community landscape.
Experience
Essential
- Experience of supporting people, carers or service users in health, care, community, housing, education or a comparable setting.
- Experience of coordinating appointments, referrals, actions or services involving multiple stakeholders.
- Experience of handling sensitive information and maintaining accurate confidential records.
- Experience of working to procedures, deadlines and agreed objectives while managing competing priorities.
Desirable
- Experience in general practice, a PCN, the NHS, social care or the voluntary and community sector.
- Experience of supporting personalised care and support planning, multidisciplinary meetings or population health work.
- Experience of service improvement, audit, data collection or project support.
- Knowledge or use of EMIS
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
West Kent Primary Care
Address
Trenchwood Medical Centre
264 Shipbourne Road
Tonbridge
Kent
TN10 3ET
United Kingdom
Employer's website
https://westkentprimarycare.co.uk/ (Opens in a new tab)