Care Coordinator

Key

responsibilities

Work with people,

their families and carers, to improve their understanding of their condition.

Support people to develop and review personalised care and

support plans to manage their needs and achieve better healthcare outcomes and

continuity of care.

Help people to

manage their needs by providing a contact to answer queries, make and manage

appointments, and ensure that people have good quality written or verbal

information to help them make choices about their care.

Signpost patients

where appropriate to other additional roles within the PCN for example Social

Prescribers and Health & Wellbeing coaches.

Provide

co-ordination and navigation for people and their carers across health and care

services. Helping to ensure patients receive a joined-up service and the

appropriate support from the right person at the right time.

Work

• collaboratively with GPs and other primary care professionals within the PCN to
• proactively identify and manage a caseload, which may include patients with
• long-term health conditions, and where appropriate, refer back to other health
• professionals within the PCN.

Support the

co-ordination and delivery of multidisciplinary teams with the PCN.

Raise awareness of

how to identify patients who may benefit from shared decision making and

support PCN staff and people to be more prepared to have shared decision-making

conversations.

Process and book

appointments by telephone or written format as requested via practice.

Process referrals

to community nursing and other professionals.