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Frailty Care Coordinator - A3666-25-0001

Gloucester

Job summary

North and South Gloucester Primary Care Network seek a dedicated Frailty Care Coordinator to join our growing Living Well Team. This exciting new role offers a unique opportunity to make a real difference in the lives of the ageing population within our community.

As a key member of the PCN, you will collaborate closely with our GP practices, the Living Well Team and a wide range of health, social care and community partners. This position will evolve alongside our Team, allowing you to play a vital role in shaping the future direction of the team.

You will be the main point of contact for the team, triaging referrals from our practices and ensuring these are signposted appropriately. The organisation of Multi-Disciplinary Team meetings, including accurate record-keeping and follow-up on agreed actions, will be a key responsibility. You will also manage your own small caseload, visiting patients at home to complete and review Personalised Care and Support Plans, Me at my Best, and What Matters to Me forms.

We are looking for a confident communicator with exceptional interpersonal skills, a strong sense of organisation, and a patient, empathetic approach. Previous experience of working in a patient-facing health, social care or related support role, either in a clinical or non-clinical role, is essential.

The role is offered for between 30 to 37.5 hours per week, initially for a fixed term of 12 months with a view to permanency subject to confirmation of future funding.

Main duties of the job

• Act as the focal point of contact for the Team.
• Triage/screen incoming referrals and signpost appropriately.
• Provide coordination and navigation for people and their carers across health and care services, alongside working closely with our Living Well Team (Social Prescribing Link Works, Frailty Nurses and Care Coordinators) and all members of our primary care teams.
• With the support of the Practices and Network proactively identify a cohort of people in need of anticipatory coordinated support, using local knowledge and population health intelligence
• Manage the Team shared email inbox, ensuring that all messages are dealt with efficiently and any necessary actions are assigned appropriately.
• Manage the Team shared email inbox, ensuring tasks are triaged appropriately.
• Lead on the organisation, coordination and delivery of Multi-Disciplinary Team meetings within the Network, including producing the agenda and taking minutes, recording and following up actions within defined timescales agreed during the meeting.
• Improve continuity of care by acting as a point of contact for people, families and professionals.
• Identify and manage own caseload of patients, carrying out home visits to complete/review Personalised Care and Support Plans, Me at my Best and What Matters to Me forms.
• Ensure people have good quality information to help them make choices about their care and structure conversations using a coaching approach.

About us

North & South Gloucester (NSG) Primary Care Network (PCN) consists of five surgeries located around Gloucester The Alney Practice, Brockworth Surgery, Churchdown Surgery, Hucclecote Surgery and Longlevens Surgery.We are a growing PCN with over 58,000 patients and a PCN staff of over 40.We are passionate about developing and delivering excellent quality local services to meet the needs of our communities. We work closely together with a wide range of local providers, including acute trusts, social care, the voluntary and community sector, and patient participation groups to offer proactive, personalised, preventative, and co-ordinated health and social care to our local population.

Job description

Job responsibilities

This role will operate within the Frailty Team which forms part of our wider Living Well Team made up of Frailty Nurses, Social Prescribing Link Workers, Health and Wellbeing Coach and Care Coordinators. This is a new role for our network, expanding our Frailty Team to address the needs of our population.

Skills and Attributes

Essential

• Ability to work independently and proactively.
• Be able to manage multiple demands and prioritise appropriately.
• Ability to seek solutions and solve problems using your own initiative.
• Adaptability, flexibility and ability to cope with uncertainty and change.
• Be able to focus in a busy work environment.
• Demonstrate a strong desire to improve performance and make a difference by focusing on goals.
• Work in confidential manner and maintain trust of colleagues and patients.
• Excellent time keeping

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Contract: Fixed term

Duration: 12 months

Working pattern: Full-time, Part-time, Flexible working

For the full Job Description and Person Specification or to apply online, please click on Apply Now.

Further details to the right of this advert.

Closing date for applications: 02 March 2025

Salary: Depending on experience up to £25,000 per annum (37.5 hours per week)

Hours Per Week: 30 to 37.5

Apply Now

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