Complex Care General Practitioner

Frome Medical Practice

Information:

This job is now closed

Job summary

To provide medical services to any patients on the practice list and to temporary residents in accordance with the practice GMS contract.

As part of the complex care team, you will care for those patients identified as more vulnerable and those with complex physical and/or mental health needs, who are at high risk of hospital admission or re-admission including: focus on reducing avoidable unplanned admissions. The role will include home visiting of housebound patients in the local community including nursing/ residential homes, and palliative care patients The role will also provide the opportunity to see patients at the practice and to support chronic disease management in our most vulnerable patients.

Main duties of the job

The role involves providing mentorship and medical leadership in a complex care team, focusing on patient-centered care to prevent hospitalisation, especially for end-of-life and complex cases. This includes early intervention for frailty and vulnerability. Responsibilities encompass shared decision-making, responding to medical problems, maintaining accurate patient notes, and delivering care in homes and care homes. Managing palliative care, chronic conditions, and post-hospital discharge support is crucial. Proactive case management, participation in clinical governance, and adherence to prescribing formulary are key. Collaboration with primary and secondary care, attendance at team meetings, and occasional leadership roles are expected. Other duties include preventative health care, adherence to protocols, and providing specified services. The role extends to training healthcare professionals, supporting staff. Adherence to Best Practice Guidelines is essential, involving availability for patient care handover, maintaining high clinical standards, ensuring financial security, and professional conduct. Mandatory training and contributing to the practice's development as a learning organization are also integral.

About us

We are a single site practice and Primary Care Network in our own right with a patient population of just under 30,000, in the attractive market town of Frome and surrounding villages. Frome is ranked as one of the ten best places to live (Sunday Times and The Times) and the best place to live in the South West (Sunday Telegraph). Frome Medical Practice functions in a fantastic purpose built surgery with excellent facilities and a large supportive team around the GP. It has out-patients department, mental health services, district nurses, pharmacy, home visits team and health connectors, all on the premises.

Date posted

28 November 2023

Pay scheme

Other

Salary

£42,367.21 a year based on 4 sessions per week

Contract

Permanent

Working pattern

Part-time

Reference number

A2985-23-0013

Job locations

Frome Medical Centre

Enos Way

Frome

BA11 2FH


Job description

Job responsibilities

Provide mentorship and medical leadership within complex care team.

Working as part of a team and autonomously to promote individualised patient-centred care to prevent hospitalisation, including end-of-life and complex cases with early intervention for frailty and vulnerability.

Undertake shared decision making with our complex care patients and their carers, to ensure that care delivered is holistic and focuses on what matters most to patients.

Responding to medical problems presented by patients, including history taking, examination, investigation, diagnosis, treatment, and referral where appropriate.

Produce and maintain accurate and detailed patient notes.

Provide care to patients in their homes, as well as in care homes.

To support the wider practice delivery of care, including supporting urgent care on duty when appropriate.

Management of palliative care, end-of-life processes, complex comorbidities, and chronic conditions.

Working within the team to review and proactively contact those recently discharged from hospital, including alignment of medications and proactive onward care planning.

Proactively identify and signpost support, for patients and their carers.

Develop, maintain, and promote links with primary and secondary care.

Attend MDT/ team meetings and lead as necessary.

Implement proactive case management for all patients.

Participate in clinical governance and audit programmes.

Providing appropriate preventative health care and advice.

Adhering to the practice prescribing formulary.

Maintain clinical competence and performance through educational activity. Including in house education and attending weekly associates meetings and education meetings held on days when you are on duty.

Contributing to the development of and adhering to protocols/systems for the management of common medical conditions and management of frailty

Clinically related administrative and non-clinical duties necessary for the delivery of GMS.

Providing other services outside of GMS as specified in contracts held by the Practice.

Participating in the training and development of nurses, medical students allied health professionals and GP registrars in the practice.

Supporting the practice staff and responding to requests for advice and assistance from the practice reception, secretarial and nursing staff.

Fully participating in extended hours offered by the Practice. This includes Saturday mornings on a rota basis.

Job description

Job responsibilities

Provide mentorship and medical leadership within complex care team.

Working as part of a team and autonomously to promote individualised patient-centred care to prevent hospitalisation, including end-of-life and complex cases with early intervention for frailty and vulnerability.

Undertake shared decision making with our complex care patients and their carers, to ensure that care delivered is holistic and focuses on what matters most to patients.

Responding to medical problems presented by patients, including history taking, examination, investigation, diagnosis, treatment, and referral where appropriate.

Produce and maintain accurate and detailed patient notes.

Provide care to patients in their homes, as well as in care homes.

To support the wider practice delivery of care, including supporting urgent care on duty when appropriate.

Management of palliative care, end-of-life processes, complex comorbidities, and chronic conditions.

Working within the team to review and proactively contact those recently discharged from hospital, including alignment of medications and proactive onward care planning.

Proactively identify and signpost support, for patients and their carers.

Develop, maintain, and promote links with primary and secondary care.

Attend MDT/ team meetings and lead as necessary.

Implement proactive case management for all patients.

Participate in clinical governance and audit programmes.

Providing appropriate preventative health care and advice.

Adhering to the practice prescribing formulary.

Maintain clinical competence and performance through educational activity. Including in house education and attending weekly associates meetings and education meetings held on days when you are on duty.

Contributing to the development of and adhering to protocols/systems for the management of common medical conditions and management of frailty

Clinically related administrative and non-clinical duties necessary for the delivery of GMS.

Providing other services outside of GMS as specified in contracts held by the Practice.

Participating in the training and development of nurses, medical students allied health professionals and GP registrars in the practice.

Supporting the practice staff and responding to requests for advice and assistance from the practice reception, secretarial and nursing staff.

Fully participating in extended hours offered by the Practice. This includes Saturday mornings on a rota basis.

Person Specification

Qualifications

Essential

  • Medical Degree
  • Qualified as GP
  • Full registration with GMC

Desirable

  • MRCGP

Experience

Essential

  • Demonstrates an understanding of the wider issues of health and social needs and care within the Primary Care setting
  • Demonstrates an understanding of health education, promotion, and public health

Personal qualities & Attributes

Essential

  • Demonstrates excellent communication and interpersonal skills
  • Self-motivation and adaptability to work independently
  • Approachable and flexible
  • Confident networking skills
  • Willingness to change, ability to accept constructive criticism and have respect for other peoples views
  • Proactive
  • Team Player
  • Ability to work under pressure

Desirable

  • An interest in chronic disease

Other

Essential

  • Able to travel between sites if required
Person Specification

Qualifications

Essential

  • Medical Degree
  • Qualified as GP
  • Full registration with GMC

Desirable

  • MRCGP

Experience

Essential

  • Demonstrates an understanding of the wider issues of health and social needs and care within the Primary Care setting
  • Demonstrates an understanding of health education, promotion, and public health

Personal qualities & Attributes

Essential

  • Demonstrates excellent communication and interpersonal skills
  • Self-motivation and adaptability to work independently
  • Approachable and flexible
  • Confident networking skills
  • Willingness to change, ability to accept constructive criticism and have respect for other peoples views
  • Proactive
  • Team Player
  • Ability to work under pressure

Desirable

  • An interest in chronic disease

Other

Essential

  • Able to travel between sites if required

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Additional information

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Frome Medical Practice

Address

Frome Medical Centre

Enos Way

Frome

BA11 2FH


Employer's website

https://www.fromemedicalpractice.co.uk/ (Opens in a new tab)

Employer details

Employer name

Frome Medical Practice

Address

Frome Medical Centre

Enos Way

Frome

BA11 2FH


Employer's website

https://www.fromemedicalpractice.co.uk/ (Opens in a new tab)

For questions about the job, contact:

Date posted

28 November 2023

Pay scheme

Other

Salary

£42,367.21 a year based on 4 sessions per week

Contract

Permanent

Working pattern

Part-time

Reference number

A2985-23-0013

Job locations

Frome Medical Centre

Enos Way

Frome

BA11 2FH


Supporting documents

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