Care Coordinator Service Overview and Future Projects

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Adele Bromley and Kasey-Lee Clarke are care coordinators at Leek and Biddulph PCN, providing personalized care plans and proxy ordering services in care homes. They work on various projects, such as health inequalities initiatives for patients with learning difficulties, menopause awareness, and upcoming projects focused on prostate cancer and long-term conditions support. The team is dedicated to addressing changing patient needs and promoting proactive healthcare interventions.


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  1. CARE CO-ORDINATOR SERVICE

  2. WHO ARE WE? Adele Bromley Kasey-Lee Clarke Hi my name is Kasey-Lee and I joined Leek and Biddulph PCN in January 2023. Hi my name is Adele and I joined Leek and Biddulph PCN in July 2022. I like to spend time with my family. I also like going the gym and watching endless Netflix series. Before working within the PCN, I looked after children in a residential setting. Previously worked at Royal stoke as a Rota Coordinator (Specialised Surgery) managing consultant and Junior doctors rotas, ensuring wards were adequately staffed over both sites UHNM & County Hospital. Worked in Health and Social care for many years in a different settings, Care Homes, Supported living and Domiciliary care.

  3. WHAT HAVE WE DONE SO FAR? Proxy Ordering The Care Co s have been visiting Care Homes to discuss the benefits of proxy ordering. 9 Care Homes have signed up to this service. They will be continuing the work with the Care Homes to explain the benefits. Care Plans/Care Homes They have completed care plans for each patient living in a care setting. Going forward they will continue to review and update care plans Adele and Kasey have been working with Care Homes to arrange home visits to review each new resident in the Care Home. They have to identify if the patient needs to be referred to other services such as incontinence, PCN Occupational Therapist/Dietitian. Occupational Therapy Support Working to support the Occupational Therapy team by promoting the new Care Home Service which has both social and wellbeing benefits for residents. a day per week dedicated to actioning the Occupational Therapist referrals and adding them to EMIS, and refer them to other MPFT Services should the referral be rejected by the Occupational Therapists.

  4. WHAT HAVE WE DONE SO FAR? Health Inequalities Work The Care Co s have ran a successful project to support ladies with Learning Difficulties and arrange cervical screening and worked with Learning difficulties specialist nurses. Further to the Cervical screening project the Care Co-ordinators are due to start a new project working with patients with Learning Difficulties/Autism and also Black males over the age of 45 to support with information/promote self-awareness or arrange appointments if the patient requests or has concerns. Menopause This project is designed to provide information to ladies about the menopause and how to recognise the signs and stay well. The project is aimed at patients with Learning difficulties/ Autism from the age of 45. Patients were initially contacted by telephone and had a discussion about the menopause and what this means to them. Adele and the specialist LD nurses sourced a really informative accessible information booklet that contains guidance on recognising the sign and symptoms of the Menopause and how to stay well. All patients were happy to receive the information which is to be sent by post.

  5. WHATS UP NEXT? We have a number of upcoming projects: Prostate Cancer This is a project designed to educate and encourage ethnic males and males with past family history to be self aware and to offer support and further intervention if required. Long Term Conditions Making sure support is available to people with long term conditions and ensuring their changing needs are addressed. Ensuring that existing patients with long term conditions reviews and appointments are up to date. FAARs Scheme This is a new project to support Moorland Medical Centre to complete the FAARs (Facilitation Admissions Avoidance Scheme) reviews which will be part of the role going forward.

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