Neighbourhood Care Coordinator

The Neighbourhood Care Coordinator plays a key role in supporting integrated, person-centred care across health, social care, and voluntary sector services. Working closely with GP Neighbourhood Representatives, Primary Care Networks (PCNs), multidisciplinary teams (MDTs), and community partners, the post holder coordinates care pathways for patients with complex needs, ensuring timely access to appropriate services. The role involves managing MDT meetings, coordinating referrals and caseloads, supporting personalised care planning, facilitating communication between agencies, and promoting collaborative working to improve patient outcomes and reduce unnecessary hospital admissions.,

• Coordinate and manage multidisciplinary team (MDT) meetings, ensuring agendas, actions, and records are completed accurately.
• Support patients and carers by coordinating personalised care plans and facilitating access to health, social care, and voluntary services.
• Manage referrals, patient caseloads, and MDT documentation, monitoring patient pathways and outcomes.
• Act as the key liaison between GPs, primary care, hospitals, community, mental health, social care, and voluntary organisations to ensure integrated care.
• Support system navigation, escalate complex cases, and help remove barriers to effective service delivery.
• Maintain accurate patient records using EMIS, SystmOne, and other clinical systems, ensuring compliance with GDPR and safeguarding requirements.
• Contribute to service improvement by identifying gaps, monitoring outcomes, and supporting quality initiatives.
• Organise stakeholder engagement, training, networking, and community events to promote neighbourhood working.
• Build positive relationships with patients, carers, colleagues, and partner organisations, providing professional and compassionate support.
• Work flexibly across neighbourhood teams, providing cross-cover and supporting the continuous development of integrated care services.
  
  Together First CIC is a community interest company that brings together 31 GP practices across Barking & Dagenham to deliver services at scale for the local population. The organisation works collaboratively to support general practice sustainability while improving access to care. Together First CIC provides a range of services on behalf of the borough, including extended hours GP appointments, diagnostic services, and vaccination programmes, with a strong focus on quality, equality, and continuous improvement.