Key responsibilities:

The following are the core responsibilities of the care coordinator. There may be on occasion, a requirement to carry out other tasks; this will be dependent upon factors such as workload and staffing levels:

a. Support Quality and Outcome Frameworks, PCN and other LES and DES specifications
b. Maintain and develop engagement with appropriate DCM colleagues and encourage ‘best practice’
c. Act as the first port of call for patients, in their caseload in relation to their care.
d. Support and Manage clinical call and recall
e. Bring together all of a person’s identified care and support needs, and explore their options to meet these into a single personalised care and support plan (PCSP)
f. Working across DCM Primary Care to manage the needs of patients in Care Homes, supported accommodation or trying to remain living at home
g. Performance targets - Ensure all patients receive enhanced care in a timely fashion and any other aspect of managing the patient facing service.
h. Support with the performance/KPIs dashboards.
i. Undertake audits for dashboards/KPIs
j. Support with any admin related task to the central team
k. To work as part of a multi-disciplinary team in a patient facing role to assess and respond to patients and colleagues using their expert knowledge
l. To be responsible for arranging assessment of new patients with subsequent production and completion of individual care plans by appropriate clinicians
m. To provide personalised support to individuals, their families and carers to ensure that they are active participants in their own healthcare and to empower them to take more control in managing their own health and well-being, to live independently and to improve their health outcomes Undertake work in line with PCN directed priorities.
n. Proactively identify and work with a cohort of people to support their personalised care requirements, using the available decision support aids
o. Ensure regular and consistent communication with the referrer regarding patient progress and any complications or guidance
p. Support national screening and immunisation programmes and health checks/screening
q. Monitor referrals to ensure tasks are completed and care delivered by keeping in regular telephone contact
r. Direct liaison with multiple agencies to coordinate care for patients
s. Refer to social prescribing link workers or health coaches were a patient is identified as potentially benefitting from this service
t. To support patient/carer contact roles, and collate patient and carer feedback on their experiences
u. Raise awareness of shared decision-making and decision support tools, and assist people to be more prepared to have a shared decision-making conversation
v. Ensure that people have good quality information to help them make choices about their care
w. Support people to understand their level of knowledge, skills and confidence – their “Activation “level – when engaging with their health and wellbeing, including using the Patient Activation Measure
x. Assist people to access self-management education courses, peer support or interventions that support them in their health and wellbeing
y. Explore and assist people to access personal health budgets where appropriate.
z. Provide coordination and navigation for people and their carers across health and care services, alongside working closely with social prescribing link workers and other primary care roles.
aa. Support the coordination and delivery of MDTs for their patient cohort
Administrative duties (additional where required)
• To process registering new patients, making up notes and entering their details on the computer system.
• To process new arrivals and deductions.
• To support with GP Links.
• Management of the generic inbox
• Scanning and coding all clinical documents.
• Using the electronic filing system to complete filing.
• Dealing with internal and external post
• To complete admin tasks and support with AccuRx Total Triage
• To undertake photo-copying and other basic office duties as directed by members of the team.
• To deal with queries for further information from hospitals or other local providers about patients.
• To assist in preparing and sending out practice correspondence.
• Ensure that the system is operational at the beginning of each day & switched on to the answer phone with the correct tape at lunchtime & at the end of each day.
• Clerical Duties
• Ensure that prescriptions are handled accurately and efficiently following protocol
• Monitor incoming electronic test results to ensure prompt review by clinicians
• Data entry of new and temporary registrations and relevant patient information e.g. smoking status, BP, ethnicity, medication from hospital letters
• Scan all patient information in computerised record i.e. medical documents, hospital reports and letters as necessary
• Deal with referrals to primary and secondary care
• Action tasks set by clinicians via the clinical systems and email
• Handling of document via clinical systems and practice protocols

Secondary responsibilities
In addition to the primary responsibilities, the Care Coordinator may be requested to:
a. Participate in practice audit as directed by the audit lead
b. To be flexible to cover shifts in the event of staff holidays and sickness.
c. Provide lunch cover where needed.
d. To undertake any other duties required by the needs of the practice & commensurate with the post.
e. Following mandatory training - to act as a chaperone when required. To participate and contribute to team meetings and other meetings as required.
f. To undertake training as required including mandatory and statutory training, core skills training and ongoing developmental training.
g. To have knowledge of all Practice procedures.
h. To work in accordance of written protocols.
i. To participate in appraisal scheme.
j. To present a positive image of the practice at all times.

Care Co-ordinator Job Listing

Related vacancies