Job Purpose
The Care Coordinator plays a key role in supporting patients to access the right care, at the right time, from the right service. Working as part of the multidisciplinary team (MDT), the post holder will proactively identify patients who would benefit from additional support, helping them to understand and manage their health, navigate services and improve their overall wellbeing.
The role focuses on providing personalised, patient-centred care by coordinating services across primary care, community services, hospitals, social care and voluntary organisations. Care Coordinators help reduce health inequalities, improve patient outcomes and support patients to become active partners in managing their own health.
The post holder will work closely with GPs, nurses, pharmacists, social prescribers, care homes, community teams and external organisations to ensure patients receive coordinated, joined-up care.
Key Responsibilities
Patient Care Coordination
- Act as a central point of contact for identified patients and their carers.
- Proactively identify patients who may benefit from care coordination using clinical searches and referrals.
- Develop positive relationships with patients, carers and families to understand what matters most to them.
- Support patients to understand their health conditions, treatment plans and available healthcare services.
- Assist patients in developing personalised care and support plans.
- Arrange and coordinate appointments across primary, community and secondary care services.
- Support patients following hospital discharge to ensure appropriate follow-up is completed.
- Monitor patient progress and review care plans where appropriate.
- Identify patients requiring additional support and escalate concerns to the appropriate clinician.
Multidisciplinary Team Working
- Work closely with GPs, Practice Nurses, Clinical Pharmacists, Social Prescribers, Care Homes and Community Teams.
- Participate in multidisciplinary team (MDT) meetings.
- Coordinate actions arising from MDT discussions.
- Liaise with hospitals, community providers, social care and voluntary organisations to improve continuity of care.
- Promote collaborative working across the wider Primary Care Network (PCN).
Supporting Patients
Support patients to:
- Understand their care and treatment options.
- Access community services and voluntary sector organisations.
- Improve confidence in managing long-term conditions.
- Access health coaching, self-management programmes and education.
- Reduce social isolation where appropriate.
- Access benefits advice, housing support or employment services through referral pathways.
- Access Personal Health Budgets where appropriate.
Population Health & Long-Term Condition Support
Support clinical teams by:
- Identifying patients requiring reviews.
- Contacting patients to arrange appointments.
- Supporting annual reviews for patients with long-term conditions.
- Supporting frailty, learning disability, mental health and cancer care pathways.
- Assisting with proactive care planning for vulnerable patients.
- Supporting delivery of NHS and local enhanced services.
Population Health & Long-Term Condition Support
Support clinical teams by:
- Identifying patients requiring reviews.
- Contacting patients to arrange appointments.
- Supporting annual reviews for patients with long-term conditions.
- Supporting frailty, learning disability, mental health and cancer care pathways.
- Assisting with proactive care planning for vulnerable patients.
- Supporting delivery of NHS and local enhanced services.
Administration & Clinical Systems
- Maintain accurate records using EMIS Web.
- Code patient activity using appropriate SNOMED codes.
- Record all patient contacts promptly and accurately.
- Manage patient recalls and follow-up appointments.
- Complete administrative tasks associated with care coordination.
- Produce reports and audits where required.
- Ensure information governance and confidentiality standards are maintained at all times
Safeguarding
- Recognise safeguarding concerns relating to children and vulnerable adults.
- Escalate concerns promptly in line with Practice Safeguarding Policies.
- Maintain mandatory safeguarding training.
Quality Improvement
- Support audits and quality improvement initiatives.
- Contribute to improving patient pathways and services.
- Collect patient feedback where appropriate.
- Participate in service evaluation and reporting.
Professional Responsibilities
The post holder will:
- Work within the scope of the Care Coordinator role.
- Maintain patient confidentiality.
- Work in accordance with Practice policies.
- Participate in supervision and appraisal.
- Complete mandatory training.
- Undertake continuing professional development.
- Demonstrate flexibility to meet the needs of the Practice.
- Promote equality, diversity and inclusion.
- Maintain excellent communication with patients and colleagues.
Person Specification
Essential
Qualifications
- Personalised Care Institute Care Coordinator training (or willingness to undertake).
- Good IT skills including Microsoft Office.
- Ability to use clinical systems Emis and Docman.
Experience
- Experience working within health, social care or a customer-focused support role.
- Experience working directly with patients or service users.
- Experience working as part of a multidisciplinary team.
- Experience managing sensitive information confidentially.
Knowledge
- Understanding of personalised care.
- Understanding of confidentiality and information governance.
- Knowledge of safeguarding principles.
- Understanding of health inequalities.
- Basic understanding of the NHS and Primary Care.
Skills
- Excellent communication and listening skills.
- Strong organisational and time management skills.
- Ability to prioritise workload.
- Compassionate and empathetic approach.
- Ability to work independently and as part of a team.
- Ability to build positive relationships with patients and colleagues.
- Accurate record keeping.
- Good problem-solving skills.
Desirable
- Experience working within General Practice.
- Experience using EMIS Web.
- Knowledge of Primary Care Networks.
- Experience supporting patients with long-term conditions.
- Experience of care planning.
- Experience participating in MDT meetings.
- Knowledge of community and voluntary sector services across Salford.
Personal Attributes
The successful candidate will demonstrate:
- A caring, compassionate and patient-centred approach.
- Professionalism and integrity.
- Excellent interpersonal skills.
- Flexibility and adaptability.
- Emotional resilience.
- Commitment to improving patient care.
- Commitment to equality, diversity and inclusion.
- A positive and proactive attitude.
- Ability to work under pressure while maintaining high standards.
Other Requirements
- Enhanced DBS clearance.
- Commitment to ongoing professional development.
- Flexibility to work across both Langworthy Medical Practice and the University of Salford Health Centre where service needs require.
Benefits:
- Company pension
- Free parking
- On-site parking
Education:
- GCSE or equivalent (required)
Work authorisation:
- United Kingdom (required)
Work Location: In person
