Community Advanced Nurse Practitioner
Southport and Formby Health (GP Federation)
The closing date is 21 August 2020
People living in care homes should expect the same level of support as those living in their own homes. The national framework for Enhanced Health in Care Homes (EHCH) provides steps to achieve this, through collaborative working between health, social care, voluntary, community and care home partners.
The EHCH model moves away from traditional reactive models of care delivery towards proactive care that is centred on the needs of individual residents, their families and care home staff.
We are looking for 2.5 WTE Advanced Nurse Practitioners to lead our integrated community-based care home teams, consisting of ANP, Physician Associate, Care-Coordinator, and dietician and to work with system partners to deliver the EHCH specification.
Main duties of the job
Successful candidates will lead weekly multi-disciplinary meetings and will work with the wider team to identify individual care needs and produce proactive individualised care plans for care home residents. The desired outcomes are to improve the experience of care home residents, to have a positive impact on primary care service provision, to improve interprofessional relationships and to reduce hospital admissions.
Postholders will communicate individual care plans with system partners and develop relationships with care homes, community teams, mental health services, palliative care services, social services, and the frailty teams in order to enable residents to meet their health goals and be cared for in their preferred place of care.
Southport and Formby Health Ltd is a dynamic and expanding GP federation, working with local GP Practices and other system providers to provide high quality, integrated, patient services. The federation has been commissioned to provide the Enhanced Health in Care Homes Specification across Central and North of Southport.
The postholder will:
- Offer clinical leadership and direction to members of the integrated care home team and provide direct supervision to the Physician Associate and Care Coordinator.
- Have experience of working with frailty /older population demographic.
- Provide individualised care plans for residents living in Care Homes, considering the choices and needs of individual residents, their families and care home staff.
- Work with community service providers and other relevant partners to establish and coordinate a multidisciplinary team (MDT) to deliver Enhanced Health in Care Homes
- Deliver a weekly care home round for the care homes, prioritising residents for review according to need based on MDT clinical judgement and care home advice
- Use digital technology to support the weekly home round and facilitate the medical input
- Aim for the plan to be developed and agreed with each new patient within seven working days of admission to the home and within seven working days of readmission following a hospital episode
- Consider anticipatory/advanced care planning, bearing in mind hospital admission avoidance and preferred place of care for individuals at risk of repeat admissions to hospital, considering best interest and quality of care of individuals.
- Base care plans on the principles and domains of a Comprehensive Geriatric Assessment, including assessment of the physical, psychological, functional, social and environmental needs of the patient including end of life care needs where appropriate
- Work collaboratively with other colleagues in acute and community settings as part of an integrated system that puts patients and their families/carers at the forefront of management plans.
- Make independent clinical decisions/judgements based on patients clinical needs, request/ order investigations/ tests provide review and action plan following
- Identify and/or engage in locally organised shared learning opportunities as appropriate and as capacity allows
- Will be a Non-medical independent/supplementary Nurse prescriber- following clinical assessment to prescribe appropriately within professional competency. Review effectiveness of treatment.
Abilities and skills
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.
Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).
Southport and Formby Health (GP Federation)
23 July 2020
£45,753 to £51,668 a year
Full-time, Part-time, Job share, Flexible working
37.5 hours a week