Admin/Care Co-ordinator

a. To work closely with practice and PCN healthcare roles, the CARE COORDINATOR is to identify and work with a cohort of people to support their personalised care requirements, including patients discharged from health or social care settings to ensure any follow up actions are included and considered as part of the patients personalised care plan, using any available decision support tools, templates and software b. Collate patients identified and support needs into a single personalised care and support plan c. To use primary care software to coordinate recall lists for patients who are being monitored for chronic health conditions. This is a vital role in ensuring patients receive their annual review. d. To work with the PCN to proactively case find using population health intelligence data e. To help people to manage their needs by answering their queries and supporting them in making appointments and ensuring patients have good quality written or verbal information to help them make choices about their care. f. To monitor all referrals, missed appointments, investigations, this will include cancer 2ww referrals and missed follow up appointments. g. To record patient's demographic and simple health information as part of their personalised care plan/record. h. Work closely with other social and health care professionals i. To signpost patients to SPLW to access appropriate benefits where eligible as well as taking up employment and training j. To assist patients to be better prepared to have conversations on shared decision making and to improve awareness of shared decision making and related support tools k. To provide patients with high quality, easy to understand information to assist them in making choices about their care l. To liaise with other CARE COORDINATORs in other practices within the PCN and share best practice m. To assist patients to access self-management education courses, peer support or interventions that support them in their health and well-being n. To provide coordination and navigation of patients, and where appropriate their carers, across health and social care services, where appropriate working hand in hand with social prescribing link workers (SPLW) and cancer care coordinators o. To support in the delivery of enhanced services and other service requirements on behalf of the PCN p. To attend and participate in the delivery of multi-disciplinary teams (MDT) within PCNs. q. To undertake all mandatory training and induction programmes r. To contribute to and embrace the spectrum of clinical governance s. To develop yourself and the role through participation in training and service redesign activities t. To attend a formal appraisal with their manager at least every 12 months. Once a performance/training objective has been set, progress will be reviewed on a regular basis so that new objectives can be agreed. u. To contribute to public health campaigns (e.g. flu/covid clinics) through advice or direct care v. To maintain a clean, tidy, effective working area at all times

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