Integrated Neighborhood Team Clinical Coordinator

Job overview

The post holder will be a key member of the Integrated Neighbourhood Teams (INT) and be responsible for the smooth operation of co-ordinating regular multi-disciplinary team meetings, and support the integration of health, social care and community-based services in Blackburn with Darwen.

The post holder will be the link between primary care, voluntary sector, social care and community health provider services. The post holder will be expected to work from multiple co-location sites in Pennine Lancashire.

You will adopt a case management approach to promote the benefits of co-ordinated, health, social and community care for patients. This will be facilitated through the organisation and planning of regular multi-disciplinary team meetings. You will need to be appropriately trained to undertake the comprehensive planning and delivery of health, social care and community services, to support advise and facilitate INT members and colleagues to deliver quality patient centred care to support the best outcomes for our patients.

Car driver with access to a vehicle is essential for this role.

Please refer to job description for further details.

Main duties of the job

• Chair and facilitate the regular INT multi-disciplinary discussions. To document and record the outcomes of the meetings and provide high-quality activity reporting using appropriate systems and processes.
• To liaise with and build effective working relationships with health, social and community care providers to ensure effective, high-quality MDT working and ensure patients/local peoples individualised care needs are met.
• Be an active member of the neighbourhood teams by regularly undertaking informal and formal promotion activity, attending service/provider team meetings, events, forums and contributing to continuous INT improvement.
• Liaise with health, social care and community services within the neighbourhood to develop and secure up to date risk profiling lists. You will also develop clear pathways between INTs and GSF meetings linked to risk stratification.
• Working autonomously, you will use your highly specialised level of knowledge to coordinate INT meetings and support INT members to develop a case management approach. On occasion, you may be required to carry a small case load and support fellow INT colleagues with case management of complex cases.
• Be responsible for arranging, coordinating, and ensuring high quality, regular INT meetings take place and to ensure that all appropriate people attend or contribute to the meeting. Reporting and escalate to relevant people where this is not happening in a professional manner.

Detailed job description and main responsibilities

Communication and Relationship Skills

• Establish and maintain effective communication with INT members, GP’s and partner professionals and agencies.
• Use developed negotiation and networking skills to meet the needs of INT and patients/local people.
• In circumstances that may be highly sensitive and contentious including the safeguarding of vulnerable adults communicate effectively and sensitive with patients/local people, health, care and community partners
• Remain professional and calm in situations of conflict, seeking support from others in keeping with organisational systems and policies.
• Proactively improve communication and engagement with partners involved in the care of individual patients/local people to achieve positive outcomes and enhance patient/local person experience.
• Ensure written communication complies with all relevant legal and professional requirements including for example Record Keeping, Caldicott and Storage policies and produce accurate, complete and contemporaneous records of any communication, assessment and interventions using both written and electronic systems.

Analytical and Judgement Skills

• To triage and assess service user’s health and social care needs. This includes a comprehensive assessment of psychological and or physical health, medical history, social care needs.
• Provide a comprehensive assessment of service user’s strengths, problems and needs to inform their case management plan and care planning.
• Provide a comprehensive assessment and case management plan of patient / local person’s clinical and care risk.
• Develop and exercise high levels of judgment and decision making in the care and treatment planning of patients / local people
• To interpret and analyse clinical and non-clinical facts from a variety of mediums to develop specialised case management and care plans for patients/local people, their families and carers incorporating individual treatment plans and goals based upon clinical reasoning skills.

Planning and Organisational Skills

• The post holder will be responsible for embedding the quality strategy within INTs and specific development projects.
• Support developments to ensure all service lines are efficiently managed with quality at their heart. Contribute to the monitoring of quality and practice standards within the field of practice.
• Participate in projects that enable patients/local people and carers to be involved in the development of INTs, services and related projects.
• Support the patient/local persons demand within the business unit, prioritizing against the service specifications and patient has identified needs.
• Support the development of patient / local person related outcome measures for the business unit
• Ensure that services provided are delivered in accordance with service specifications, agreed care pathways and best practice guidelines.
• To assist in the investigation of clinical complaints, where appropriate, in line with LSCFT policy and procedure.

Patient and Client Care

• In conjunction with key partners / the INT, develop the ability to contribute to the prevention of avoidable hospital admissions and delivery of care and interventions in accordance with patient choice regarding preferred place of care.
• Demonstrate leadership, support, and supervision for others in relation to transfer of care and admission avoidance.
• Share good practice and promote active learning and development within a supportive environment.
• Gain a valid consent to assessment, interventions and onward referral in accordance with the legal framework and Organisational policy.
• Professional conduct and activity that is consistent with service/organisational objectives including communication and collaboration with key partners and stakeholders to secure care closer to home and positive outcomes for patients.
• Continually review, evaluate and develop own clinical practice to reflect service need and provide quality outcomes for patients.
• Act always in accordance with your Code of Conduct and Professional Practice and take personal responsibility for maintaining an active professional registration and the maintenance of a personal, professional portfolio.

Applicant requirements

You must have appropriate UK professional registration.

This post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 and it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service.