Care coordination is essential for well supported self-management for patients. Ensuring that people understand their different health conditions and helping them to navigate the system improves the patient experience and saves time and resources.
Care coordinators provide time, capacity, and expertise to support patients to have better clinical conversations and follow up on issues that are not clear to them, helping to close any gaps that might impair their recovery.
Working closely alongside GPs and other primary care colleagues, care coordinators can also do case finding. They may have a caseload of identified patients for whom they ensure that appropriate support is available to them and their carers, and that their changing needs are addressed. They focus on groups who reflect local primary care network priorities, health inequalities or ‘at risk’ patients. In north east London the majority of care coordinators work within a single practice.
The role also supports PCNs to deliver Enhanced Health in Care Homes.