Care Coordinators work alongside GPs and other primary care professionals within Primary Care Networks (PCNs) to support Multi-Disciplinary Teams to bring together multiple services around a person to ensure that their individual needs are addressed through a single personalised care plan.
Care Coordinators play an important role within a PCN to proactively identify and work with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services.
Care Coordinators could potentially provide extra time, capacity, and expertise to support patients in preparing for or in following-up clinical conversations they have with primary care professionals. They will work closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that their changing needs are addressed. This is achieved by bringing together all the information about a person’s identified care and support needs and exploring options to meet these within a single personalised care and support plan, based on what matters to the person.
Scope of Practice
- Provides co-ordination and navigation through the health and care systems
- Facilitates joint working across organisations and MDTs
- Makes referrals to services and other health and care professionals
- Helps patients prepare for/follow-up
- Supports patients to book appointments
- Signposts patients to information
- Works in partnership with MDT colleagues including social prescribing link worker(s) and health and wellbeing coach(es)
Enrolled in, undertaking or qualified from appropriate two-day care co-ordination training as accredited by the Personalised Care Institute. Accredited e-learning completed in personalised care and support planning and shared decision making.
Care Coordinators are reimbursable under the ARRS scheme. Salary range – AfC up to 4.
A named first point of contact in the PCN (including GP). Monthly supervision can be provided by an appropriate member of the MDT including an advanced practitioner.
Further guidance on supervision, education and training can be found in the workforce development framework for care co-ordinators.
Devon Training Hub have recently produced a summary guide covering the supervision of all roles including GPs, Nurses, Non-Medical Prescribers, Advanced Practitioners and new roles funded through the ARRS scheme.
The guide contains the latest information on supervision requirements for each role, which team members of the team can supervise them, & details of training requirements & CPD opportunities for supervisors.
Learning & Development
The Personalised Care Institute offers free e-learning courses, accreditation and CPD and is recommended to access all personalised care foundation learning.
IT Skills Resources
Link Workers, Care Coordinators and Health Coaches may be required to use GP Clinical IT Systems in partnership with the primary care MDT:
NHSE Future Learn Care Coordinators Workspace
NHS England has developed learning and support for care coordinators – including regular webinars, an online learning programme, regional training workshops and informal peer support. To access this learning and become part of the online learning community, or for further information, please email SSM email@example.com with your name, PCN and contact details.
Wellbeing & Coaching for Personalised Care Roles
Personalised Care Roles working in Primary Care can access the national NHSE/I coaching offer for all primary care staff ‘Looking after you too’ by clicking the link below:
There are a range of resources to help support your own health & wellbeing on the NHS People website:
Confidential support is also available by phone on 0800 06 96 222 (7am-11pm) for any general support, or 0300 303 4434 (8am-8pm) for bereavement-specific support.
For support by text message, text ‘FRONTLINE’ to 85258 (available 24 hours a day, seven days a week).
Devon Training Hub Offers
Devon Training Hub’s Personalised Care Programme offers a range of education & training modules to support Care Coordinators and other Personalised Care workers to develop skills and knowledge relevant to Primary Care. Topics include:
- GP How does it work?
- Mental Health First Aid,
- Risk Management
- Motivational Interviewing
- Trauma-Informed Care,
- Enhancing Supervision,
- Improving Physical Activity in LTCs,
- Asset Based Community Development
For information on Communities of Practice / Peer Learning Groups in Devon & the South West please contact Devon Training Hub directly or see our DTH Guide to ARRS Community of Practice.