Care Co-ordinators

Care Co-ordinators proactively identify and work with a wide range of people from the frail and elderly to those with long term conditions. They support across health and care services by bringing together a persons identified care and support needs in order to explore their options to meet these into a single personalised care and support plan (PCSP) best practice.

Care Co-ordinators provide extra time, capacity, and expertise to support patients either in preparation or for follow-up clinical conversations they have with primary care professionals. They work closely with the GPs and other primary care professionals within the Primary Care Network (PCN) to manage a caseload of identified patients, making sure that the appropriate support is made available, ensuring Primary Care meets the ever evolving needs of it's patients.

This provides a more collaborative and coordinated care journey for patients, instead of each service encountered being seen as a single unconnected 'episode' of care.

This enables a single point of contact for patients to navigate the health and care system, breaking down traditional barriers between health and care organisations, teams and funding streams, to support the increasing number of people with long-term health conditions.

Care Co-ordinators are one of several new roles that support the NHS’s commitment to improve health through personalised care. They do this by:

• Providing a more joined-up and coordinated care journey for patients, instead of each encounter with services being seen as a single, unconnected ‘episode’ of care.
• Acting as a single point of contact for patients to navigate the health and care system.
• Breaking down traditional barriers between health and care organisations, teams and funding streams, to support the increasing number of people with long-term health conditions.

Care Co-ordinators also support multidisciplinary team meetings ( MDTs) and help people to understand their level of knowledge, skills and confidence when engaging with their health and wellbeing professionals.

Care Co-ordinators are able to visit patients in the community or care home setting to assess and discuss their care needs involving carers where appropriate and assist people to access self- management education courses, peer support or interventions that support them in their health and wellbeing journey.