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Patient Centered Home Care Project - Social Worker
Bungendore Medical Centre

Job Title:  Social Work

Organisation:  Bungendore Medical Centre/Coordinare

Reports to: Medical Team Leader

Type: Contract – Temporary

Mission Statement:  Bungendore Medical Centre is committed to providing comprehensive general best practice care to all individuals and families in Bungendore and surrounding communities in a caring, respectful, supportive and friendly environment for the benefit of each patient’s health and wellbeing.  

Our accredited General Practice provides a comprehensive range of medical services. We employ several doctors and provide health checks, immunisations, nursing and pathology collection.  We also work closely with allied health services.  Our aim is to give our patients the highest possible quality of care, by ensuring excellence in all aspects of our practice.  We endeavour to provide patients with the best and most current treatments, methods, materials and equipment within our resource capabilities

The Project

Holistic patient centred care requires a coordinated multidisciplinary response that is often challenging over geographical distances. Whilst advancing digital technology assists to overcome such barriers, reaching the most vulnerable remains complex particularly in the rural setting where technology and transport are often unreliable or absent. Reaching these most vulnerable people is essential. 

The aim of our project is to incorporate a social worker in the practice to form part of the patient’s health care team, to develop pathways and resources on how to access local, government and non-government support services. The social worker may be included in care planning and regular weekly clinical meetings. 

Overview of the work area and position 

As a Senior Social Worker, it is expected that you will contribute your expertise as an integral member of the multidisciplinary team and that you will provide, under limited supervision, high quality care to achieve sound outcomes for clients within a therapeutic environment. The Social Worker will provide ongoing and continuous care and engagement for Clients, providing a link with external supports, family and other government and non-government agencies. The Social Worker will have a key role in developing, co-ordinating and supporting a database of services that will then link in with the current Health Pathways resource.   

Reporting to the Medical team leader, this position is supported by a cohesive team of General Practitioners, Nurses, and Reception staff.

The role of the social worker is to identify health pathway options to improve service delivery efficiency and overall patient support. She/he will be expected to work with staff and Health Pathways to coordinate patient care for referred patients. This includes contributing to project evaluation and regular reporting. The Social Worker will be expected to contribute to project deliverables and regular progress reporting specifically on patient needs and trends. Services include advising family care givers, providing patient education and counselling, and making referrals for other services. They may also provide care and case management or interventions designed to promote health, prevent disease, and address barriers to access to healthcare. 

In the initial two weeks the Social Worker will contribute to finalising the collection tools and project scope to ensure that deliverables are feasible within contracted hours.

Selection Criteria

  • Demonstrated experience in local health care networks, government and non-government agencies
  • Demonstrated experience in supporting families and carers to plan, access and coordinate appropriate support services and following through to ensure effective service delivery
  • Demonstrated high level of communication skills.
  • Will have a minimum of five years working as a social worker preferably in NSW local area
  • Identify potential programs/projects that may facilitate project deliverables beyond the life of the project
  • Provide individuals, families, and groups with the psychosocial support needed to cope with chronic, acute, or terminal illnesses
  • Provide ongoing education to the Health Care Team at Bungendore Medical Centre


  • Hold a degree in Social Work
  • Be eligible for membership of the Australian Association of Social Workers (ASW)

Essential Skills:

  • Well developed knowledge about local services available
  • Well developed knowledge about accessing, enrolling and navigating around government and non-government agencies
  • Well developed skills in computer programs
  • Be patient Centred and able to balance service provider deadlines with project deliverables

Prior to commencement successful candidates will be required to:

  • Undergo a pre-employment Police check
  • Be registered under the Working with Vulnerable People (Background Checking) Act 2011


Bungendore Medical Centre
36 Ellendon Street
Bungendore NSW 2621
(Outer metro) NSW
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