The PCC's role requires the person to be able to work with, and understand the roles of, a variety of different people working in the practice and across the PCN including doctors, nurses, healthcare assistants, social prescribing link workers, physiotherapists, physician associates, paramedics, health and wellbeing coaches, podiatrists, occupational therapists and pharmacy technicians.
The post holder will support the audit and research programme within the Practice.
Working closely with the patient, clinicians or other healthcare professional, the PCC co-ordinates patients' healthcare and directs them to the appropriate service to ensure that they get the most suitable care from whatever health or social care provider is appropriate.
The role works with all ages and ensures all standards are met for Carers and Veterans.
The role supports with case load management and identification for QoF, IIF, and vaccine campaigns.
The post holder will be responsible for various areas of data management including data analysis, auditing, coding, and ensuring patient records are up to date.
Mission statement
Working together to provide proactive, accessible and coordinated care within the community
Generic responsibilities
All staff at Parks PCN Ltd have a duty to conform to the following:
Equality, Diversity and Inclusion
A good attitude and positive action towards Equality Diversity & Inclusion (ED&I) to create an environment where all individuals are able to achieve their full potential. Creating such an environment is important for three reasons - it improves operational effectiveness, it is morally the right thing to do, and it is required by law.
Patients and their families have the right to be treated fairly and be routinely involved in decisions about their treatment and care. They can expect to be treated with dignity and respect and will not be discriminated against on any grounds including age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation. Patients have a responsibility to treat other patients and our staff with dignity and respect.
Staff have the right to be treated fairly in recruitment and career progression. Staff can expect to work in an environment where diversity is valued, and equality of opportunity is promoted. Staff will not be discriminated against on any grounds including age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation. Staff have a responsibility to ensure that they treat our patients and their colleagues with dignity and respect.
Safety, Health, Environment and Fire (SHEF)
This PCN is committed to supporting and promoting opportunities for staff to maintain their health, wellbeing and safety.
The post-holder is to manage and assess risk within the areas of responsibility, ensuring adequate measures are in place to protect staff and patients and monitor work areas and practices to ensure they are safe and free from hazards and conform to health, safety and security legislation, policies, procedures and guidelines.
All personnel are to comply with the:
Health and Safety at Work Act 1974
Environmental Protection Act 1990
Environment Act 1995
Fire Precautions (workplace) Regulations 1999
Coronavirus Act 2020
Other statutory legislation which may be brought to the post holder's attention
Confidentiality
The PCN and associated practices are committed to maintaining an outstanding confidential service. Patients entrust and permit us to collect and retain sensitive information relating to their health and other matters pertaining to their care. They do so in confidence and have a right to expect all staff will respect their privacy and always maintain confidentiality.
It is essential that, if the legal requirements are to be met and the trust of our patients is to be retained, all staff protect patient information and provide a confidential service.
Quality and Continuous Improvement (CI)
To preserve and improve the quality of PCN outputs, all personnel are required to think not only of what they do but how they achieve it. By continually re-examining our processes, we will be able to develop and improve the overall effectiveness of the way we work.
The responsibility for this rests with everyone working within the PCN and practices to look for opportunities to improve quality and share good practice and to discuss, highlight and work with the team to create opportunities to improve patient care.
Parks PCN Ltd continually strives to improve work processes which deliver healthcare with improved results across all areas of our service provision. We promote a culture of continuous improvement where everyone counts, and staff are permitted to make suggestions and contributions to improve our service delivery and enhance patient care.
Staff should interpret national strategies and policies into local implementation strategies that are aligned to the values and culture of general practice.
All staff are to contribute to investigations and root cause analyses whilst participating in serious incident investigations and multidisciplinary case reviews.
Induction
In addition to the induction process at Parks PCN Ltd, where you will be provided with a full induction programme, when attending any practice within the network you will also be required to complete their practice induction programme.
Whilst across the PCN we aim to standardise this process, inevitably there will be nuances particular to each practice. In any such instance, the practice management team will support you with this.
Learning and development
The effective use of training and development is fundamental in ensuring that all staff are equipped with the appropriate skills, knowledge, attitude and competences to perform their role. All staff will be required to partake in, and complete mandatory training as directed by the PCN Managers. It is an expectation for this post-holder to assess their own learning needs and undertake learning as appropriate.
The post-holder will undertake mentorship for team members and disseminate learning and information gained to other team members in order to share good practice and inform others about current and future developments (e.g., courses and conferences).
The post-holder will provide an educational role to patients, carers, families and colleagues in an environment that facilitates learning.
Collaborative working
All staff are to recognise the significance of collaborative working and understand their own role and scope and identify how this may develop over time. Staff are to prioritise their own workload and ensure effective time-management strategies are embedded within the culture of the team.
Team work is essential in multidisciplinary environments and the post-holder is to work as an effective and responsible team member, supporting others and exploring the mechanisms to develop new ways of working and work effectively with others to clearly define values, direction and policies impacting upon care delivery.
Effective communication is essential, and all staff must ensure they communicate in a manner which enables the sharing of information in an appropriate manner.
All staff should delegate clearly and appropriately, adopting the principles of safe practice and assessment of competence.
Plans and outcomes by which to measure success should be agreed.
Managing information
All staff should use technology and appropriate software as an aid to management in the planning, implementation and monitoring of care and presenting and communicating information.
Data should be reviewed and processed using accurate SNOMED CT to ensure easy and accurate information retrieval for monitoring and audit processes.
Service delivery
Staff will be given detailed information during the induction process regarding policy and procedure.
The post-holder must adhere to the information contained within PCN and local practice policies and regional directives, ensuring protocols are always adhered to.
Security
The security of the organisation is the responsibility of all personnel. The post holder must ensure they always remain vigilant and report any suspicious activity immediately to their line manager.
Under no circumstances are staff to share the codes for the door locks with anyone and are to ensure that restricted areas remain effectively secured. Likewise, password controls are to be maintained and are not to be shared.
Professional conduct
All staff are required to dress appropriately for their role.
PCN staff members are to familiarise themselves and comply with local practice protocol.
Leave
All personnel are entitled to take leave. Line managers are to ensure all their staff are afforded the opportunity to take a minimum of 33 days' leave each year (inclusive of Bank Holidays and pro rata for part time).
Primary key responsibilities
The following are the core responsibilities of the PCC.
Receive and collate information from transfers of care (including hospital admissions and discharges) plus out of hours calls
Liaise with service providers and clinicians to identify 'frequent flyers', and new service users utilising risk stratification tools provided
Ensure the correct coding is added to patient records
Signpost team members, service users and carers to relevant services
Coordinate and manage the administrative functions of any MDT meetings.
Liaise with all clinical and non-clinical members in the MDT to ensure effective MDT function.
Manage reporting required and associated within the DES specifications for required services.
Maintenance of IT based information systems and responsibility for key performance data:
To ensure the IT requirements for recording activity are adhered to in collaboration with other team members
To ensure accurate updates and maintenance of GP systems at all times
To provide agreed performance/activity data within the MDT and PCN and wider Royal Parks organisation.
Communication and collaborative working relationships
Demonstrates ability to work as a member of a team.
Is able to recognise personal limitations and refer to more appropriate colleague(s) when necessary.
Actively work toward developing and maintaining effective working relationships both within and outside the PCN.
Liaises with other stakeholders as needed for the collective benefit of patients including but not limited to Patients GP, Nurses, other practice staff and other healthcare professionals including pharmacists and pharmacy technicians from provider and commissioning organisations.
Work with service users, PCN practices and partners e.g. Care Homes to ensure new referrals are logged and allocated
Develop excellent working relationships with the all partners, wider service networks including the voluntary sector, GP practices, adult social care, hospitals, community pharmacists and other members of the MDT
Acting as a point of contact for residents, families and professionals who visit the care homes, such as MDT members and in-reach specialists.
Provide background information about individuals for the bi-weekly MDT meetings
Communicate effectively with service users and their families/carers, other staff both internal and external and members of the public
Manage and prioritise workload on a daily basis and deal with the competing demands
To achieve gold standards in the Carers Award
To ensure Veteran activity is promoted
To be involved in the research programme
To ensure all campaigns are advertised in the practice and on the website and yearly planner is maintained and any activity planned in advance
To ensure the programme for health checks runs smoothly and all data is maintained
Other responsibilities
To act at all times in an anti-discriminatory manner
To be able to plan and respond to workload according to operational priorities
To support the delivery of these functions across wider locality areas where necessary
To undertake any training required in order to maintain competency including mandatory training
To contribute to, and work within a safe working environment.
The Care Coordinator must at all times carry out duties and responsibilities with due regard to the GP Practice's equal opportunity policies and procedures
The Care Coordinator is expected to take responsibility for self-development on a continuous basis, undertaking on-the-job training as required
The Care Coordinator must be aware of individual responsibilities under the Health and Safety at Work Act, and identify and report as necessary any untoward accident, incident or potentially hazardous environment.
Patient Care
Communicate effectively and sensitively and use language appropriate to a patient and carer/relative's condition and level of understanding
Effectively use all methods of communication and be aware of and manage barriers to communication
Effectively recognise and manage challenging behaviours, carers and or relatives
Provide information to patients, their carers and/or relatives on behalf of the team
Supporting Care Delivery
Be the point of liaison for service users and interface with all health and social care professionals, including keeping everyone informed and updated
Follow through actions identified by the MDT including arranging tests, referrals, signposting, etc.
Follow through with service users and others involved to ensure all services and care arrangements are in place
Autonomy/Scope within Role
The post holder will be required to work within clearly defined organisational protocols, policies and procedures
Secondary responsibilities
a. Demonstrate the ownership of responsibility for personal development, learning and performance
b. Attend relevant annual updates and shared practice learning
c. Complete all required PCN mandated training
d. Undertake any tasks consistent with the level of the post and the scope of the role, ensuring that work is delivered in a timely and effective manner
e. Duties may vary from time to time without changing the general character of the post or the level of responsibility.