Care Navigators


Newham

Vicarage Lane Health Cetnre
10 Vicarage Lane,
Stratford,
London  E15 4ES
09.00-5.00pm

Care Navigators work to facilitate integrated working across the Extended Primary Care Teams, GP’s and other stakeholders, they work closely with GP’s, the Extended Primary Care Team and other relevant Health and Social Care Professionals to ensure care delivery is of a high quality.

The Care Navigators have been commissioned to work with people who are at very high and high risk of admission to hospital and are on the integrated care pathway. Working collaboratively with colleagues in Primary Care the Care Navigators actively seek out patients who will benefit from care navigation and coordination to avoid further unplanned hospital admissions, reduce the length of hospital stay and support and promote independence at home; they are the central point of contact for patients in this group and the interface between primary and secondary care providers as well as social care and voluntary organisations. Identifying and reporting any new problems, changes or concerns in the patient’s or carer’s circumstances to the GP, Operational Manager and Clinical Leads.

Care Navigators provide sign posting and link patients and their carer’s to other services that would benefit the patient’s quality of life, this will include promoting individual rights and recognising and respecting their contributions to care planning and delivery.

Discuss assessment outcomes with patients, carer’s and other health and social care professionals and voluntary sector to agree care plans.

There are eight Health and Social Care Navigators working across Extended Primary Care Services in Newham. Working across and with Extended Primary Care Services including the Rapid Response and In-reach Teams, Virtual Ward, District Nursing and Community Therapies.

Each of the Care Navigators is aligned and allocated to one of the eight GP clusters in the borough. Four work in the East of the borough and are based at East Ham Care Centre, four are based at Vicarage Lane Health Centre covering the West of the borough.

Care Navigators play a pivotal role in the Integrated Care Programme which aims to improve health outcomes, and promote and enable self-management.



Referrals are accepted from GP’s any part of the EPCT and self-referrals from patients and carer’s.

Simply contact the Single Point of Access number: 020 8709 5555

Self-referrals by telephone are also accepted

Referrals are accepted from GP’s any part of the EPCT and self-referrals from patients and carer’s.

Referrals are either made on an individual basis GP to Navigator, or via a Navigator clinic at the GP practice. Self-referrals by telephone.
Care Navigators work alongside the primary care team to support people with any long term complex condition
Care Navigators work to facilitate integrated working across the Extended Primary Care Teams, GP’s and other stakeholders.

They work closely with GPs, the Extended Primary Care Team and other relevant Health and Social Care Professionals to ensure care delivery is of a high quality and meets required standards and support a defined group of patients that will benefit from a case management approach to promote independence.

They aim to work collaboratively with colleagues in Primary Care to actively seek out patients who will benefit from care navigation and coordination to avoid unplanned hospital admissions, reduce the length of hospital stays and support and promote independence at home.

They do so by:

  • Being the central point of contact for patients who have been identified as moderate to high risk and their relatives/carers and the interface between primary and secondary care providers as well as social care and voluntary organisations.
  • Identifying and reporting any new problems, changes or concerns in the patient’s or carer’s circumstances to the GP, Operational Manager and Community Matrons.
  • Providing sign posting and link patients, and their carer’s to other services that would benefit the patient’s quality of life
  • Supporting GP’s to establish effective working relationships with patients, their families and carer’s. This will include promoting individual rights and recognising and respecting their contributions to care planning and delivery.
  • Discussing assessment outcomes with patients, carer’s and other health and social care professionals and voluntary sector to agree care plans.
  • Acting as the patient’s advocate and, by providing information and support, facilitate patients own choices with regard to personal care, promoting independence and self-care as appropriate.




Clinical

Conditions:

Long term conditions


Clinical speciality:

Community Health Services