Neighbourhood Support Care CoordinatorNHS
Job summary
We are looking for an enthusiastic team player to support the PCN in delivering an effective patient focused service which promotes proactive care and effective working relationships.
This is a key role in supporting frail and vulnerable patients to remain safe, well and independent at home. The role will be supporting both proactive and reactive patients, identified through referral and risk stratification and will include basic observations and a supportive approach to person centre self-management. The post holder should work within their scope of practice, under agreed protocols, with escalation to registered clinicians as required.
The role will act as a bridge between GP Practices, MDT and other INT services.
Main duties of the job
The post holder will work across all PCN practices and as part of the wider Intergrated Neighbourhood team to ensure efficient and effective patient contacts and assit in the reduction of A&E admissions.
Job description
Promote and support a proactive approach to patient care, working with the team to identify patients needing support
Process and effectively signpost patients and their carers to the appropriate healthcare professional or health/social care, voluntary service depending on the presenting condition
Detect early signs of patient deterioration through basic observations and holistic approved assessment
Support the coordination, delivery and actions for MDTs within PCN
Increase patient confidence and understanding in their own health
Reduce crisis situations unplanned admissions and carer breakdowns
Support patients that are not managing their long term conditions, signposting to relevant services and highlighting concerns to GP practice
Liaise with PCN services, GP practices, community teams and voluntary services to support patients
Take part in hospital discharge reviews to assist in communicating and coordinating patient care
Action incoming emails and correspondence as necessary
Accurately detail information on patients records within the clinical system
Bridging the gap between GPs and realities patients face at home encompassing what really matters to them
Promote the image of the organisation and services by ensuring that all information and communication is up to date and suitably presented
Take responsibility for ensuring that internal and external communication systems are fit for purpose
Respond to telephone, email and written queries on behalf of the service area including call handling where appropriate
Demonstrate flexibility and adaptability to meet changing priorities within a dynamic operational environment
Be proactive and contribute ideas for improvement in the way the service is delivered
Support in providing telephone cover during annual leave, sickness or peak demand periods, including answering incoming calls, booking appointments, taking messages and signposting patients appropriately
Ensure that all complaints, compliments, concerns, comments and suggestions are escalated appropriately
Able to work on own initiative, prioritising work within defined policies and procedures to set timescales
Manage specific projects as requested by the PCN Operational manager and provide updates on progress
About us
Folkestone, Hythe and Rural Primary Care Network is an innovative, friendly and forward thinking organisation.
We are proud and enthusiastic to be an inventive front runner in the development of Integrated Neighbourhood Team working, which is assisting in shaping the future of primary care, ensuring that patients receive positive and effective encounters enhancing their health and well being.
We are located in the historical South Kent Coast of the Garden of England (Kent). General Practice is changing at pace and we see this as a positive and opportunistic challenge.
Our PCN includes 7 practices with a combined list size of approx 52,000 patients.