Urgent Community Response (UCR) Practitioner (OOH)

Job description

Job responsibilities

Post Title: Band 6 Urgent Community Response(UCR) Practitioner

Department: Urgent Community Response, Virtual Wards or Frailty Hubs

Pay Band: TBC

Locations UCR & Frailty Hubs:

UCR/Virtual Ward- Woking Community Hospital, Heath Side Road, Woking

Bedser Hub-Woking Community Hospital, Heath Side Road, Woking

Ashford Hub, Ashford Hospital, London Road, Stanwell

Thames Medical Frailty Hub, Walton Community Hospital. Rodney Road, Walton

Responsible to: UCR Band 7 Clinicians (Days/Out Of Hours (OOH))

Accountable to: Director of Adult Services

Responsible for: Band 5 Clinicians/Senior Community Rehabilitation Assistants / Health Care Assistants

Department structure:

Introduction

The Urgent Community Response(UCR) and Frailty Teams aspire to provide a 24-hour/7-day responsive NHS community service. The Band 6 UCR Practitioner can be a Nurse or Paramedic. There is the flexibility within the multidisciplinary team to work across days, nights and to do internal rotation and you are able to work autonomously, managing patient assessments within the specialty whilst working as part of the larger multidisciplinary team, delivering individualised and personalised direct patient care to patients across North West Surrey in conjunction with the wider Integrated Care System.

The teams are commissioned to reflect the needs of the local community. Service aims include urgent case management and hospital admission avoidance, where the focus of the role is to lead the identification and clinical assessment of patients who will benefit from advanced complex hospital discharge care, or urgent responsive admission avoidance using the Virtual Ward if required, with care provided in their own home by the multi-disciplinary team.

The Frailty Team provides proactive case management, promotes self-management and adoption of a co-produced approach with patients and service users ensuring early intervention and provision of care in or as close to the patients own home as possible.

Whilst operating from a local community hub, the Frailty Team delivers a joined-up approach across NW Surrey, to deliver excellence in care and engages with all practices, community teams and wider stakeholders within NWS Alliance.

CSH Culture and Values

CSH Surrey is a values-driven business.

Our core Value is CARE, because we care about our patients and clients, our colleagues and our partners. Everything we do, we do withCARE:

• We care withCompassion: we look after each other, speak kindly and work collaboratively
• We takeAccountability: we take responsibility, act with integrity and speak with honesty
• We showRespect: we listen, value, trust and empower people and treat them with dignity
• We deliverExcellence: we are professional, aim high, value challenge and never stop learning or innovating.

1.1 To work closely with the UCR Advanced Clinical Practitioners(ACPs) & Clinical Leads for frailty, Community Nursing, Frailty GPs, Adult Social Care, community services and the third sector to provide fast reactive services for patients with decompensated frailty and ensure rapid delivery of treatment, care planning to support acute hospital admission avoidance where appropriate with a focus on the 9 Common Critical Conditions- Falls; Decompensation of Frailty; Reduced Function/Decondition/reduced mobility; Urgent equipment provision, Confusion / Delirium, Palliative / EOL crisis support; Urgent Catheter Care, Urgent support for diabetes; Unpaid Carer breakdown. [https://www.england.nhs.uk/wp-content/uploads/2021/07/B1406-community-health-services-two-hour-urgent-community-response-standard.pdf ]

1.2 To provide advanced assessment and care planning, including history taking and physical assessment for patients with frailty.

1.3 To work closely with the frailty GPs, Advanced Clinical practitioners & Clinical Leads for UCR & Frailty , adult social care and the third sector carers and patients to assist in proactively identifying and managing patients with frailty and supporting them and their carers in the development and delivery of personalised care plans.

1.4 To provide strong holistic assessment and treatment planning of patients with frailty, without direct supervision.

1.5 To work in conjunction with a wide range of clinical colleagues and specifically, primary care and community teams and Social Care professionals, leading and facilitating a patient or client focused, co-ordinated case management approach across primary and secondary care for people who are most vulnerable to, and at high risk of repeat admission to hospital.

1.6 To participate in and influence efforts across health and social services to shape multi-disciplinary pathways designed to support patient choice, improve quality of life, promote self-management and assure early intervention through the proactive provision of care in or as close to the patients own home as possible.

1.7 The UCR clinician will work across the caseload and the single point of access or (equivalent), using their clinical skills to identify the needs of patients and the correct services to liaise with.

1.8 The UCR clinician will provide expertise within their professional discipline, to the wider team.

1.9 Provide professional leadership within the team, supporting the Clinical leads for UCR & Frailty, and the Band 7 Team Leads in managing the team and ensuring safe and effective staffing levels and provision of resources to ensure continuous service delivery and enhancing clinical practice.

1.10 Advise on the promotion of health and prevention of illness and provide information to individuals and groups to prevent disease, where possible. Recognise situations that may be detrimental to health for example housing, social and economic factors and refer to an appropriate agency and liaise with members of the Community Care Team.

1.11 To provide case management using extended skills where appropriately trained to avoid hospital admission and manage sometimes complex clinical needs in the community setting.

1.12 To provide assessment of patients, using analytical and judgment skills. To provide appropriate patient centred treatment using evidence-based practice where-ever possible. Patients will present with acute or chronic conditions and complex multi-system pathologies e.g. neuro, respiratory conditions, orthopaedic rehabilitation and age related deterioration.

1.13 To devise effective, personalised plans of care for each patient with specific therapeutic knowledge, recognizing him or her as an individual. The plan of care, which has been developed in conjunction with the patient, carer, and relevant others, should be outcome based and ensure appropriate pathways of care and communication via liaison and referral to other agencies as required.

1.14 The goals and objectives of any intervention are clearly established and negotiated, and where appropriate can be assessed through use of outcome measures/ objective markers.

1.15 To provide a holistic and therapeutic treatment programme or where appropriate direct the intervention as necessary through UCR Band 5 Clinicians, Community Rehab Assistants, HCAs or other members of the multi-disciplinary team.

Person Specification

Qualifications

Essential

• Registered General Nurse/ Registered Mental Health Nurse/Practitioner or BSc/Diploma leading to inclusion on the Health and Care Professions Council Register as an Occupational Therapist, Physiotherapist or Paramedic
• Post registration qualification or University Degree
• Teaching and assessing qualification Mentorship or equivalent mentorship qualification

Desirable

• Masters degree or equivalent experience gained by undertaking on-going personal development and training
• Management/Leadership Qualification/ development programme

Experience

Essential

• A minimum of two years post registration experience
• Experience of caseload management including responsibility for complex care packages for vulnerable people
• Experience, underpinned by knowledge of working with and understanding the complex needs of patients in a primary care/community setting
• Involved in the implementation and management of change
• Evidence of innovative practice
• Experience of initiating or participating in clinical audit/research relating to clinical practice
• Participates in regular clinical supervision
• Experience of working with long-term conditions and frailty

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

CSH Surrey

Address

Woking Community Hospital

Heathside Road

Woking

Surrey

GU22 7HS

Employer's website

https://www.cshsurrey.co.uk/about-us/about-csh-surrey (Opens in a new tab)