PCN - Care Coordinator

Job Summary

An exciting opportunity has arisen for a Care Coordinator in the organisation, who must be available to work on a part-time 18 hours per week practice based with flexibility when required to work across sites within PCNs. There may be a possibility for a full time position too - this can be discussed with the Clinical Director. Practices across Waltham Forest have come to work collaboratively as Primary Care Networks (PCNs), pooling their resources and workforce to provide improved and integrated services for their patients.

PCNs typically consist of 30, patients.

Work within our network of GP Practices to provide a central co-ordination role for patient care planning. The role will be GP facing, with the core responsibility being excellent patient care. You will be expected to take part in MDT meetings with GP and Nurse and present. Co‑ordinate care packages for patients as identified by the GP across health, social care and mental health as appropriate, providing a single-point of access for staff & service users, actively managing patients care plan delivery.

Facilitate smooth and planned discharge and handover between care settings across the health and social care system, including GP, acute, community, and be responsible for facilitating inter-agency communication and support. Identify and work with a list of named patients with the aim of encouraging independence, enabling people to remain at home, reducing unnecessary admissions to hospitals and supporting early discharge from hospital, improving the quality of care.

WF GP Fed Net is a not-for-profit Federation of 36 GP Practices in Waltham Forest. We are a private limited company who provides NHS Services based in Primary Care, pooling the skills and resources of local GPs to provide large scale services as part of the local NHS Strategy to bring more services into the Community to help people stay well and at home.

• Date posted: 20 February 2026
• Pay scheme:
  Agenda for change
• Band:
  Band 4
• Salary: £32,199 a year (includes High cost area supplements)
• Contract:
  
  Fixed term, 6 months
• Working pattern:
  Part‑time (18 hours per week)
• Reference number: B
• Job locations: 500 Larkshall Road, Highams Park, London, E4 9HH

• Facilitate and ensure the effective delivery of patient-centred, personalised health and social care plans for patients, monitoring progress and reporting outcomes, contributing to patient reviews and care planning within appropriate time frames.
• Explain the management of a patient's pathway to clinical staff, liaising between services and service users, contacting services using the appropriate procedures/referral mechanisms.
• Work closely with all relevant care agencies (primary care, secondary care, community services, Mental Health, Social Services, Ambulance Service, Voluntary services and other relevant service providers) to ensure a coordinated and complete care plan for the patient, without requiring a further referral from the GP.
• Maintain accurate records and statistical returns as required by the CCG, including providing patient‑related information for entering into Clinical Reporting Systems, within the required time frame.
• Ensure that a proper handover of care between different settings has taken place, including mutual transfer of all organisations' communications & patient notes and ensuring care packages are set up.
• Collect data on patients/carers for recognised outcome measure and document for service interpretation. Ensure all patient notes are updated to reflect any changes, including details on plans.
• Manage operational meeting processes, identify patients for discussion and work closely with clinicians to define and lead the meetings. Organise and attend relevant meetings when required, including Integrated Care meetings, ensuring a programme of regular meetings is established, ensuring that all necessary documentation is circulated in advance.
• Ensure that meeting actions are recorded, disseminated and followed up in a timely way; ensure relevant practitioners are aware of meeting decisions and actions/outcomes, and chase for action resolution and update.
• Network and develop…