Care Coordinator

Role Purpose The Care Coordinator plays a central role in supporting patients to navigate the health and care system, ensuring they receive timely, personalised and well-coordinated care. Working across GP practices and partner organisations, the postholder supports individuals particularly those with complex medical, psychological or social needs to engage with their care plans, access appropriate services and achieve improved health outcomes. A strong commitment to reducing health inequalities, improving patient experience and promoting preventative care underpins all aspects of the role. This includes targeted outreach to increase cancer screening uptake and support earlier diagnosis across the PCN population. Key Responsibilities Patient Support & Case Management Undertake personalised care planning to identify patient needs, goals and barriers to engagement. Provide coordinated support for complex cases involving multiple long-term conditions or challenging social circumstances. Facilitate effective navigation of GP, community, mental health, social care and voluntary sector services to ensure timely and appropriate access to care. Deliver structured follow-up, monitoring and escalation to maintain patient safety and continuity of care. Support patients to develop confidence, self-management skills and a clear understanding of their care plans. Reducing Health Inequalities Deliver targeted outreach to population groups with lower engagement or poorer health outcomes. Provide personalised conversations and reminders to increase uptake of national cancer screening programmes (breast, cervical, bowel, prostate). Contribute to PCN initiatives aimed at reducing variation in access, experience and outcomes. Work sensitively with individuals affected by deprivation, language barriers, disability or social isolation. Engagement & Partnership Working Represent the PCN at community events, outreach activities and engagement sessions, promoting services and strengthening local relationships. Participate in multidisciplinary team (MDT) meetings, contributing insights to support coordinated and effective care planning. Develop and maintain constructive working relationships with GP practices, community teams, social care, secondary care and voluntary sector partners. Act as a reliable and professional point of contact for patients, carers and partner organisations. Administration & Data Quality Review cancer screening lists and contact patients to remind them about screening needs/explain the importance of screening, in order to increase uptake. Maintain accurate, timely and comprehensive records of patient interactions, care plans and outcomes. Use clinical systems and digital tools to support care coordination, reporting and pathway monitoring. Ensure all data is managed in accordance with confidentiality, information governance standards and organisational policies. Any other tasks required of this ever-evolving role, in support of the varying needs of the local population