Care Coordinator - Gravesend, United Kingdom - DGS Health LTD

Description

Job summary

We are currently looking for an individual to work within Gravesend Alliance PCN. The role will be based across Riverview Park surgery, Shrubbery Surgery and Springhead Health.

The Care Coordinator will be part of the Primary Care Network. This will involve coordinating the work of healthcare professionals and non-clinical staff involved in the care of patients registered at GP practices within the wider PCN population.

Working closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers.

We are looking for candidates who are enthusiastic and adaptable to change, and have a good level of competence in use of in systems such as EMIS. Candidates should exhibit good organisational skills and ability to communicate effectively with a wide range of healthcare professionals and other stakeholders including patients, families and carers.

Main duties of the job

A key part of the role of a care coordinator role is in the care Homes MDT: improving the continuity of care by acting as a point of contact for residents, families and professionals who visit care homes.

To support the PCN with the collation of information on people requiring an MDT review in addition to providing coordination, secretarial and administrative support to the MDTs. The focus delivery of the comprehensive model to reflect local priorities, health inequalities or population health management risk stratification. This role will be Supporting the PCN with projects such as early cancer diagnoses, learning disability checks and administrative duties relating to patient care.

work closely and in partnership with the Social Prescribing Link Workers and Health and Wellbeing Coach(es)

3. To support patients to utilise decision aids, help create single personalised care and support plans, in line with best practice

About us

The Dartford, Gravesham and Swanley area is located in North Kent, only a 15 minute commute by train from London St Pancras, and our main GP Federation office is metres away from Ebbsfleet International Rail Station. The area is undergoing considerable housing, retail and leisure development including the Ebbsfleet Garden City Area. The area also boasts the Bluewater retail centre, and there are a good variety of high performing schools including state, grammar and independent schools. All practices in the area are members of the GP Federation and we work together to design and deliver clinically led and managerially enabled services.

Job responsibilities

The Care Coordinator will be part of the Primary Care Network (PCN) Multi-Disciplinary Team (MDT) who are responsible for managing the care of people registered with practices within a particular PCN. This will involve coordinating the work of healthcare professionals and non-clinical staff including volunteers involved in the care of patients registered at GP practices within the wider PCN population.

Working closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that their changing needs are addressed.

Key role requirements

To work with the GPs and other primary care professionals within the PCN to identify and manage a caseload of patients.

To work closely and in partnership with the Social Prescribing Link Workers (SPLWs) and Health and Wellbeing Coach(es).

To support patients to utilise decision aids, help create single personalised care and support plans, in line with best practice.

To support the Clinical directors in the delivery of the DES specifications.

To help people to manage their needs through answering queries, making and managing appointments.

To provide coordination and navigation with the aid of digital tools for people and their carers across health and care services.

To support the coordination and delivery of MDTs within the PCN

Key Duties & Responsibilities:

The Care Coordinator responsibilities include but are not limited to the following:

1. To work with the GPs and other primary care professionals within the PCN to identify and manage a caseload of patients

2. To work closely and in partnership with the Social Prescribing Link Workers and Health and Wellbeing Coach(es)

3. To support patients to utilise decision aids, help create single personalised care and support plans, in line with best practice

4. To support the Clinical directors in the delivery of the DES specifications

5. To help people to manage their needs through answering queries, making, and managing appointments

6. To provide coordination and navigation with the aid of digital tools for people and their carers across health and care services

7. To support the coordination and delivery of MDTs within the PCN

COLLABORATIVE WORKING RELATIONSHIPS:

1. Works within the primary care team, contributing to leadership of service evaluation and research to promote quality improvement activity.

2. Collaborates with other members of the MDT, patients and their carers when managing and coordinating care.

3. Uses healthcare technologies to optimise service delivery, patients access, and continuity of care

MANAGEMENT:

1. Demonstrates understanding of the implications of national priorities for the team and/or service.

2. Uses resources effectively to manage patient treatment in line with local guidance and makes recommendations for change where improvements can be made.

3. Follows professional and organisational policies

EDUCATION, LEARNING AND DEVELOPMENT:

It is the responsibility of the employee to comply with all organisational and statutory requirements ( health and safety, infection control, equality and diversity, confidentiality, safeguarding adults and children, information governance).

1. Engages in annual appraisal, developing objectives to inform a Personal Development Plan, which may include 360-degree appraisal and use of patient feedback.

2. Participate in teaching and training of medical, nursing, and all other practice staff.

3. Supports the practice staff and responds to requests for advice and assistance.

4. Complete all mandatory and statutory training required by the role.

5. Takes responsibility for personal development, learning and performance and maintain education through attendance on any courses and/or study days necessary to ensure that professional development requirements are met.

6. Undertakes additional training where necessary to provide enhanced services and participate in training programmes implemented by the PCN/practices as part of this employment.

7. Understands and demonstrates the characteristics of a role model to members in the team and/or service.

8. Demonstrates an understanding of current educational policies relevant to working areas of practice and keeps up to date with relevant clinical practice.

QUALITY

Under supervision and support of GPs in the practice, the post-holder will strive to maintain quality within the practices, and will:

1. Participate in clinical governance activity and contribute to the improvement in quality of health outcomes through audit, risk management and Quality Improvement

2. Alerts other team members to concerns about risk, quality, and safety

3. Participates in investigation of incidents and events as required

4. Identifies, applies, and disseminates research findings relating to own practice

5. Collects data for audit purposes and uses clinical audit to monitor quality in the service

6. Contributes to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance

7. Works effectively with individuals in other agencies to meet patients needs

8. Effectively manages own time, workload, and resources

9. Meets timescales/deadlines for audits and written returns to ensure that the Practice meets quality standards and receives the designated funding

Responsibilities underpinning the role

Equal Opportunities

DGS Health is committed to an equal opportunities policy that affirms that all staff should be afforded equality of treatment and opportunity in employment irrespective of sexuality, marital status, race, religion/belief, ethnic origin, age or disability. All staff are required to observe this policy in their behaviour to fellow employees.

Confidentiality

All employees are required to observe the strictest confidence with regard to any patient/client information that they may have access to, or accidentally gain knowledge of, in the course of their duties.

All employees are required to observe the strictest confidence regarding any information relating to the work of the practice and its employees. You are required not to disclose any confidential information either during or after your employment with the practice, other than in accordance with the relevant professional codes.

Failure to comply with these regulations whilst in the employment of practice could result in action being taken.

Data Protection

All employees must adhere to the practice Policy on the Protection and use of Personal Information, which provides guidance on the use and disclosure of information. The practice also has a range of policies for the use of computer equipment and computer-generated information. These policies detail the employees legal obligations and include references to current legislation. Copies of the policy on the protection and use of personal information, and other information technology, can be found in the Employee Handbook.

Professional indemnity insurance

The Post holder may be required to take out their own Professional Indemnity Insurance and share the details of this indemnity with the DGS Health.

Health and safety

DGS Health expects all staff to have a commitment to promoting and maintaining a safe and healthy environment and be responsible for their own and others welfare.

Risk management

You will be responsible for adopting the risk management culture and ensuring that you identify and assess all risks to your systems, processes and environment and report such risks for inclusion within the practice risk register. You will also attend mandatory and statutory training, report all incidents/accidents, including near misses, and report unsafe occurrences as laid down within practice Incidents and Accidents Policy.

Training requirements

The Personalised Care Institute will set out what training is available and expected for Care Coordinators.

Other duties

There may be a requirement to undertake other duties as may reasonably be required to support the organisation and its member practices.

Personalised Care:

The applicant must have the ability to work within the framework of The Personalised Care Model as set out by the Personalised Care Institute

The Model helps us to deliver this shift by bringing together six, evidence-based components or programmes, each of which is defined by a standard set of practices. These are:

Qualifications

Essential

Desirable

Experience

Essential

Desirable

Knowledge

Essential

Desirable

Personal skills and attributes

Essential

Desirable