Care Co-ordinator - Twickenham, United Kingdom - Cross Deep Surgery

Description

JOB DESCRIPTION JOB TITLE:
Care Co-Ordinator


ACCOUNTABLE TO:
Practice Manager / GP Partners


LOCATION:

Cross Deep Surgery Summary As a Care Coordinator you will work as a key part of the Primary Care multi-disciplinary team.

You will ensure care is seamless and that everyone involved is working together.

You will provide the capacity and expertise to support patients in preparing for or in following-up clinical conversations they have with primary care professionals.

You will assist practice in our ambition to improve the quality and continuity of care by acting as a point of contact and coordinating annual reviews for patients with chronic conditions, participating in meetings and timely intervention as part of the MDT for the practice.

You will assist with Documents review and clinical coding as well as Prescribing.

You will support the practice in developing a support to Care homes and work towards the ongoing COVID Vaccination & Flu Vaccination Programme.

Your role is an essential part of our evolving dynamic and forward-thinking practice, working to provide enhanced care experience to patients in line with a with a view to improving health inequalities.

Other duties may include:

Act as a point of contact between GP, patients and carers and other agencies Liaise with GPs and practice teams to identify patients who are elderly, frail or who have long term health needs and support Develop use of Group Consultations to help support the care arrangements for patients with long term conditions.

i.e.

COPD, Asthma, Diabetes Support patients to access community care assessments as well as carers assessments Assist with managing patients to reduce unplanned hospital admissions where appropriate.

Where necessary, participate in MDT meetings to discuss patients actively being managed by the Care Homes Team and any other patients from the PCNs case load needing discussion.

Raise awareness of health promotion & screening such as NHS Health Checks and LD Health Checks in practices and coordinate invitations to ensure targets are achieved on a practice and PCN level Assist and manage recall system for chronic diseases inc acting as a point of contact for any queries regarding routine annual reviews.

Assist with ongoing monitoring of PCN requirements inc. IIF and QOF across the PCN practices. Run Audits and searches where necessary to identify patients for review. Clinical Document review and Clinical Coding, ensuring coding is in line with current contract requirements.

Participate in Document review audits and meetings. Assist with Daily Prescriptions and act as a deputy to Prescribing Admin Lead.

Assist and Co-ordinate clinics where necessary, and contact identified patients with appointments Manage patient initiated calls for help/signposting etc., ensuring patients are directed to appropriate service inc liaising with other professionals e.g.

Social Prescribers Document and monitor aspects of patient co-ordination and service delivery supporting data collection and audit using the practices clinical system Demonstrate the ability to recognise and respond appropriately when faced with a sudden deterioration or emergency situation, alerting the team or enabling a rapid response Support and raise awareness national screening and immunisation programmes and encourage uptake Monitor referrals to ensure tasks are completed and care delivered by keeping in regular telephone contact Work closely with and refer to PCN social prescribing link workers where a patient is identified as potentially benefitting from this service.