Integrated Neighbourhood Team Co-Ordinator

1. Communication:
Act asa central pointof contact for health and social care professionals within the Integrated Neighbourhood Team (INT). Communicate effectively with GPs, acute hospital staff, Social Services, community teams, allied health professionals, voluntary organisations, patients,carersand families. Exchange factual and sensitive information professionally,maintaining confidentiality at all times. Facilitate and support multidisciplinary team (MDT) meetings by preparing agendas, circulating documentation, recording minutes and monitoring actions.

Liaise with acute hospitals to support admission avoidance andtimelydischarge planning. Communicate service capacity information and operational updates to stakeholders across multiple organisations. Provide information, guidance and signposting to patients, carers and professionalsregardingavailable services and support pathways. Escalate concerns relating to safeguarding, deterioration in patient condition, telehealthalertsor other risksin accordance withorganisational procedures. Maintain clear and effective communication through telephone, email, digitalsystemsand face-to-face interactions.

2. Analytical and judgemental:
Collect,analyse and interpret service activity data from multiple systems. Maintain spreadsheets and databases and produce reports to support service monitoring,evaluation and commissioning requirements. Monitor hospital admissions,dischargesand service utilisation,identifying trends and communicating relevant information to MDT members. Use established criteria toidentifyreferrals, pathways and patient cohorts requiring intervention. Exercise judgement when managing enquiries anddeterminingtheappropriate service, professional or agency for referral or escalation. Support the analysis of telehealth activity and outcomes to inform service improvement and planning.

Produce data reports and summaries for presentation at multidisciplinary meetings.
3. Planning and organisational

Skills:

Coordinate multidisciplinary care arrangements and community support interventions for patients receiving enhanced care services. Organise MDT meetings, case reviews, home visit schedules and associated administrative processes. Manage referrals and coordinate patient pathways across multiple organisations and services. Prioritise and manage a complex workload independently, responding to changing service demands and competing priorities. Support the planning and coordination of admissions to and discharges from enhanced care services.

Ensure appropriate services, equipment and support are available at the right time tofacilitatesafe patient care. Work flexibly across acute and community settings to meet service requirements. Coordinate telehealth installations, removals and support activities where required.
4. Clinical Duties:
Provide non-clinical coordination support to patients receiving integrated health and social care services. Support the delivery of agreed care plans through effective coordination of services and professionals. Facilitate multidisciplinary involvement in patients' care and treatment pathways. Coordinate home visits and community interventions as directed by clinical teams. Support the delivery of prescribed equipment and medication under clinician direction. Contribute to admission avoidance and early supported discharge initiatives through effective care coordination.

Provide patients and carers with information about services and support available within the community.
5. Governance:
Adhere to Trust policies, procedures, information governancerequirementsand data protection legislation. Ensureaccurateandtimelyrecording of information across all relevant systems. Contribute to the integration of health and social care services through standardised processes and effective information sharing. Support compliance with safeguarding,confidentialityand risk management policies. Participate in service monitoring and evaluation processes through the production of activity and outcome reports. Escalate incidents,risksand governance concernsin accordance with Trust procedures.

Contribute to quality improvement initiatives aimed at reducing duplication and improving integrated working.
6. Finance and Resources:
Order equipment and resourcesrequiredto support patient care and service delivery. Coordinate the distribution and retrieval of telehealth equipment. Maintainaccuraterecords relating to equipment allocation and usage. Support efficient use of health and social care resources by ensuringtimelycoordination of services. Handle and manage supplies and equipment in accordance withorganisational procedures. Contribute to monitoring resource utilisation through data collection and reporting activities.
7. Leadership and management:
Coordinate activities across multidisciplinary teams to support effective integrated care delivery. Provide information,adviceand guidance to…