Frailty Care Coordinator

Culverhay Surgery is looking for an enthusiastic Frailty Care Coordinator/Health Care Assistant to join our established and supportive team.

The role will involve working as a member of our frailty team to support a caseload of frail patients in their own homes. You will engage in positive, empathetic conversations with residents, families, and carers to identify needs and support the development, implementation, and regular review of personalised care plans.

Please note, a valid driving licence and access to your own vehicle are essential for this role.

Please see attached job description and person specification for more information.

Please email your CV and covering letter outlining why you are interested in the vacancy to Caroline Pearmain, Managing Partner, Culverhay Surgery by clicking on Apply Now.

Job Title: Frailty Care Coordinator/Health Care Assistant
Responsible to: Lead Practice Nurse (Clinical)
                          Managing Partner (Administrative)

Place of Work: Culverhay Surgery – Wotton-under-Edge, Berkeley & Frampton on Severn, Gloucestershire

Job Purpose

To work as a clinical member of the practice team, to provide a high standard of
care to patients in their own homes.

To recognise areas of frailty and support/signpost to allow ongoing independence
at home, with the aim to reduce and avoid hospital admissions.

The post holder will be expected to develop knowledge and skills in frailty to
support the work of the practice team and the work of the MDT in the community.

Key Responsibilities Care Coordinator

To communicate and liaise with the practice nurses, care coordinators, district
nurses, GPs, social prescriber, well-being coordinators and other professionals both
in the community and the practice, and visit patients in their own homes as instructed
by the primary care team.

Responsible for daily planning and operation of the workload list, in liaison with the
care coordinator team.

Discuss patient’s concerns sensitively with them/their family member or carer (as
appropriate and with patient consent) and relay information back to the lead frailty
nurse and team.

Support patients to live independently at home as well as able. To discuss future
wishes around ageing well and future care planning.

To give appropriate health advice and support and to reinforce information previously
given to patients by other health care providers.

Holistically bring together all of a person’s identified care and support needs, and
explore options to meet these within a single personalised care and support plan
(PCSP), in line with PCSP best practice, based on what matters to the person.
Help people to manage their needs through answering queries, making and
managing appointments, and ensuring that people have good quality written or
verbal information to help them make choices about their care.

Support people to access appropriate benefits where eligible.

Assist people to access self-management courses, peer support or interventions that
support them in their health and wellbeing and increase and improve their activation
level.

Carry out clinical tasks including:

• Phlebotomy.
• Undertake patient health checks in patients’ own homes.
• Carry out baseline observations such as pulse oximetry, blood pressure, BMI, temperature, pulse rate, recording findings accurately.
• Administer flu vaccinations and covid vaccinations, or have a willingness to train.

Ensure specimens are recorded and ready for onward transportation.

Ensure equipment is cleaned according to service requirements and infection control guidance.

Deliver opportunistic health promotion where appropriate.

To record accurately any activity undertaken, procedure performed, conversation held, or identified need for action within the electronic patient record.
Communication skills require tact, empathy, sensitivity and reassurance. The post holder may work with people who experience sensory loss, dementia, learning difficulties and whose first language may not be English. In addition, the post holder may be required to work with individuals or their family members/carers who do not comply with care prescribed by primary care or those who decline to cooperate to resolve identified risks e.g. leg elevation.
The post holder must communicate within a framework of confidentiality according to NHS/Practice Policy.

Participate in regular team clinical meetings, and other practice meetings.

Support the coordination and delivery of MDTs within the PCN and ICB.

Uphold all practice policies including lone worker, health and safety and human resource procedures.

Participate in audit and data collection as required.

Other Requirements

Confidentiality
In the course of seeking treatment, patients entrust us with, or allow us to gather,
sensitive information in relation to their health and other matters. They do so in
confidence and have the right to expect that staff will respect their privacy and act
appropriately.

In the performance of the duties outlined in this job description, the post-holder may
have access to confidential information relating to patients and their carers, practice
staff and other healthcare workers. They may also have access to information
relating to the practice as a business organisation.  All such information from any
source is to be regarded as strictly confidential.

Information relating to patients, carers, colleagues, other healthcare workers or the
business of the practice may only be divulged to authorised persons in accordance
with the practice policies and procedures relating to confidentiality and the protection
of personal and sensitive data.

Health & Safety

The post-holder will implement and lead on a full range of promotion and
management their own and others’ health and safety and infection control as defined
in the practice Health & Safety policy, the practice Health & Safety manual, and the
practice Infection Control policy and published procedures. This will include (but will
not be limited to):

• Using personal security systems within the workplace according to practice guidelines.
• Awareness of national standards of infection control and cleanliness and regulatory / contractual / professional requirements, and good practice guidelines.
• Responsible for the correct and safe management of the specimens process, including collection, labelling, handling, use of correct and clean containers, storage and transport arrangements.
• Management and maintenance of Personal Protective Equipment (PPE) for the practice, including provision, ordering, availability and ongoing correct usage by staff.
• Responsible for hand hygiene across the practice.
• Ownership of infection control and clinically based patient care protocols, and implementation of those protocols across the practice.
• Active observation of current working practices across the practice in relation to infection control, cleanliness and related activities, ensuring that procedures are followed and weaknesses / training needs are identified, escalating issues as appropriate.
• Identifying the risks involved in work activities and undertaking such activities in a way that manages those risks across clinical and patient process.
• Making effective use of training to update knowledge and skills, and initiate and manage the training of others across the full range of infection control and patient processes.
• Monitoring practice facilities and equipment in relation to infection control, ensuring that provision of hand cleansing facilities, wipes etc are sufficient to ensure a good clinical working environment. Lack of facilities to be escalated as appropriate.
• Safe management of sharps procedures including training, use, storage and disposal.
• Using appropriate infection control procedures, maintaining work areas in a tidy, clean and sterile, and safe way, free from hazards. Initiation of remedial / corrective action where needed or escalation to responsible management.
• Actively identifying, reporting, and correction of health and safety hazards and infection hazards immediately when recognised.
• Keeping own work areas and general / patient areas generally clean, sterile, identifying issues and hazards / risks in relation to other work areas within the business, and assuming responsibility in the maintenance of general standards of cleanliness across the business in consultation (where appropriate) with other sector managers.
• Undertaking periodic infection control training (minimum twice annually)
• Routine management of own team / team areas, and maintenance of work space standards.
• Waste management including collection, handling, segregation, container management, storage and collection.
• Spillage control procedures, management and training.
• Decontamination control procedures, management and training, and equipment maintenance.
• Maintenance of sterile environments.
• Demonstrate due regard for safeguarding and promoting the welfare of children.

Equality and diversity

The post-holder will support the equality, diversity and rights of patients, carers and
colleagues, to include:

• Acting in a way that recognizes the importance of people’s rights, interpreting them in a way that is consistent with practice procedures and policies, and current legislation.
• Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues.
• Behaving in a manner that is welcoming to and of the individual, is non- judgmental and respects their circumstances, feelings priorities and rights.

Personal/Professional development

The post-holder will participate in any training programme implemented by the
practice as part of this employment, such training to include:

• Participation in an annual individual performance review, including taking responsibility for maintaining a record of own personal and/or professional development.
• Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work
• Undertake annual mandatory training and other relevant in house courses as identified at appraisal.

Quality

The post-holder will strive to maintain quality within the practice, and will:

• Alert other team members to issues of quality and risk.
• Assess own performance and take accountability for own actions, either directly or under supervision.
• Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the team’s performance.
• Work effectively with individuals in other agencies to meet patients’ needs.
• Effectively manage own time, workload and resources.

Communication:
The post-holder should recognize the importance of effective communication within the team and will strive to:

• Communicate effectively with other team members.
• Communicate effectively with patients and carers.
• Recognize people’s needs for alternative methods of communication and respond accordingly.

Contribution to the Implementation of Services:

The post-holder will:

• Apply practice policies, standards and guidance.
• Discuss with other members of the team how the policies, standards and guidelines will affect own work.
• Participate in audit where appropriate.

You should understand that this is a description of the job as it is presently
constituted. Whilst this job description sets out the duties which such a job normally
entails, you should appreciate that this is not to be regarded as exhaustive. You
should further understand that job titles and job descriptions may be amended by the
employer, and that employees may be called upon to carry out additional or other
duties as may reasonably be required by the employer. Furthermore, it is the
practice of the employer periodically to examine and review job descriptions to
ensure that they continue to relate to the job which is being performed. In addition,
the employer, during such examination or review, may consider that changed must
be made to the job descriptions. Whilst there will be consultation on such issues,
employees should understand that, if agreement cannot be reached, then the
employer reserves the right to make changes to job descriptions where it considers
such necessary.