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Permanent – Part time 15 hrs/ 2 days a week An exciting opportunity has arisen to recruit a Band 4 Care Coordinator to join the busy HPB and NET team. We are looking for a highly motivated, organised and compassionate person to join our team at the Royal Surrey County Hospital. The post holder will enable and assist the CNS team to deliver high standards of holistic care throughout patient treatment pathways. The role involves the completion of holistic assessments, Implementing personalised care plans and signposting patients, carers and their families to support agencies highlighted through the assessment process, supported by the CNS team. The post requires excellent communication skills and the ability to manage a diverse and complex patient group often dealing with sensitive information. Previous oncology experience is an advantage. The ability to work on your own initiative and as part of a multidisciplinary team are essential.
Under the direction, guidance and supervision of the Cancer Clinical Nurse Specialists or a registered practitioner the post holder will coordinate the care and support people to navigate the complex health and social care system during anand following completion of cancer treatment.
Coordinate care and education and support for people with non-complex care needs (Level One – Supported self-management – (National Cancer Survivorship Initiative NCSI risk stratification model)
Coordinate education and support for people with non-complex care needs (Level One –Supported self-management – NCSI risk stratification model)
To have made an effective contribution to reaching the Trust’s vision, strategic objectives and key work programmes
Triage incoming calls, using a risk assessment framework and initiate appropriate response according to protocols and individual pathways, using good communication skills, basic clinical awareness and appropriate tools and procedures, liaising as appropriate when non-routine and refer complex decisions to the team for assessment and review.
Provide basic telephone advice and refer on or signpost to other sources of support
Coordinate the necessary assessments, appointments or investigations to fast track people back into the system if required
Demonstrate the ability to recognise and respond appropriately when faced with a sudden deterioration or an emergency situation, alerting the team or enabling rapid response as appropriate
Communicate and signpost to appropriate needs related information
Guide people through the use of self-assessment resources
Document and monitor all aspects of care coordination and service delivery, supporting data collection for audit
Demonstrate in practice the Macmillan Human Rights
Coordinate the care for a defined group of patients assessed by a registered practitioner as having level one care needs for supported self-management.
Organise and prioritise the designated workload in relation to identified needs
Contribute to the holistic needs assessment and the development of an individual care plan
Implement, monitor and review the care plan with the patient and carer, in line with standard operating procedures and protocols and modify as appropriate
Evaluate outcomes of care delivery with the registered practitioner
Coordinate and organise appointments and assessments as required
Make pre planned outbound telephone calls to patients to assess ongoing needs to enable a proactive prevention approach
Identify indicators of need or changes in need through telephone contact and respond appropriately
Coordinate the handover with other teams to facilitate safe and effective transition of care between services in order to provide seamless support for people
Act as advocate and facilitator to resolve issues that may be perceived as barriers to care
Support people to access appropriate information and support, by sign posting to a range of support services and take an approach, which helps people to self-manage where appropriate
Support people to access appropriate information and support, by sign posting to a range of support services and take an approach, which helps people to self-manage where appropriate
Advise patients on individual self-care management principles and provide consistent planned aftercare to reinforce and further promote this information
Deliver patient-centered, self-management support and education as necessary to noncomplex patients, including how to self-assess
Support the delivery of patient and carer training and education, including use of equipment
Encourage and support active and healthy lifestyle choice
Coach patients and carer’s to understand what signs, symptoms or situations to be aware of that would indicate concern
Planning/inviting/organising of Health and Well-Being events or other supported self- management events
Coordinate remote surveillance and monitoring through appointments for investigations and feedback of results for non-complex cases
Coordinate face-to-face appointments for those with complex results from remote surveillance and monitoring investigations
Comment on proposed changes to policies and procedures
Support and contribute to audit processes, governance, research, clinical research trials and service development
Coach patients and carer’s in the safe use of any equipment to be used at home
Provide general supervision of less experienced staff and support to other new Macmillan Cancer Support Workers and potentially undertake NVQ Assessments
Demonstrate self-directed learning, actively seeking role development opportunities to enhance practice, knowledge and role progression
Identify personal education needs and skills development with the registered practitioner
Make sure that people affected by cancer are aware that they are interacting with a Macmillan professional and know about the full range of resources and services available through Macmillan
Actively engage with Macmillan Cancer Support to contribute expertise and experience and support the Macmillan Corporate Strategy
Carry out some administration duties required by the roll
Order supplies and equipment
Understand that there will be frequent exposure to distressing/highly distressing situations and provide appropriate support/advice