Care Coordinator

Key Responsibilities

1. Personalised Care Planning

• Develop and maintain care plans for patients with complex needs.
• Conduct yearly reviews for: 
  • Moderate/severe frailty (Personal Care & Support Plans)
  • Dementia
  • Learning Disabilities
• Contact patients on frailty and housebound registers for annual reviews.
• Escalate urgent concerns via pink slots and Duty Doctor lists.

2. Team Meetings

• Coordinate Clinical Meetings (CMs) and Multi-Disciplinary Team (MDT) meetings: 
  • Prepare agendas and distribute via Microsoft Teams.
  • Invite relevant internal and external participants.
  • Take accurate minutes and update meeting logs.
  • Record patient-related discussions in EMIS (hidden from online visibility).
• Ensure follow-up on all agreed actions.

3. Patient Registers

• Maintain and update registers for: 
  • Frailty
  • Dementia
  • Learning Disabilities
  • Palliative Care
  • Housebound patients
  • Safeguarding cases (adult & child MARAC)

4. Administrative Duties

• Review and action emails from patients, carers, and external agencies via the Generic Surgery Inbox.
• Prioritise tasks such as welfare calls, safeguarding concerns, cancer diagnoses, and palliative care updates.
• Accurately record all patient activity in EMIS at the time of consultation.

5. Adult and Child Safeguarding

• Act as a key point of contact for safeguarding concerns raised by patients, carers, or external agencies.
• Ensure all safeguarding cases (adult and child) are documented accurately in EMIS and flagged appropriately.
• Escalate concerns promptly in line with local safeguarding policies and MARAC procedures.
• Liaise with social services, safeguarding leads, and other agencies to coordinate safe and timely interventions.
• Maintain confidentiality and adhere to all statutory safeguarding requirements.

Skills, Knowledge and Expertise

• Good knowledge of medical terminology (Essential)
• Good understanding of local health & social care system (Essential)
• Familiarity with EMIS clinical system (Desirable)
• Experience with E-Referrals System (ERS) (Desirable)

• Strong organisational skills & time management (Essential)
• Strong verbal & written communication (Essential)
• Good note-taking/Minute-taking (Essential)
• Attention to detail (Essential)
• Analytical skills (Essential)
• Strong keyboard & computer skills (Word, Outlook) (Essential)
• Ability to follow processes accurately  (Essential)
• Ability to learn new systems quickly (Essential)

• Meticulous nature (Essential)
• Fast learner (Essential)
• Professional interaction with agencies & patients (Essential)
• Proactive approach to problem-solving  (Essential)

• Training in Minute-taking (Desirable)