Job summary
To work within the integrated 'Acute care at Home' integrating rapid response with our Virtual Ward service supporting the provision of enhanced care in the community, reducing avoidable attendance and admission to secondary care, and supporting early discharge. This will be achieved by utilising expert clinical assessment and diagnostic skills in the management of patients who require an urgent assessment. To be a key member of multi-disciplinary team and identify optimal pathways for patients, utilising community capacity, skills, and experience, to ensure care is provided at the right time and in the right setting.
This service will be transitioning to HCRG Care Group from the 1st April 2025. The successful candidate may transfer over (under Transfer of Undertakings (Protection of Employment) Regulations 2006) on the terms and conditions they are employed on. Great Western Hospitals NHS Foundation Trust is committed to ensuring a smooth transition for everyone involved.
Main duties of the job
1. The post holder will be able to combine high level assessment to establish differential diagnosis and clinical decisions to initiate medical and/or nursing/therapy treatments, appropriately refer and lead the co-ordination of care from an integrated team perspective, working with partner agencies and key stake holders.
2. To be a key driver for change to assist integrated care pathways/systems across GWH services and system partners.
3. To provide clinical and professional leadership within the acute care @home service supporting the wider community including Primary Care, Social Care, and all other provider organisations to deliver high standards of care to patients. Where appropriate this will be the avoidance of unnecessary admission to secondary care. To be an integral member of the multidisciplinary team working with a shared vision in partnership with each other.
4. Draw on clinical knowledge to be a resource for the wider multidisciplinary team (MDT) and give clinical advice.
5. To work in alignment with Primary care around established practice populations and to facilitate the establishment of a shared vision between Primary care and the Community teams.
About us
Our STAR values are at the heart of everything we do. You can expect to see them in the way we act andthe way we treat each other. Our values make us who we are. We will expect your values and behaviours toreflect the STAR Values of the organisation:Service We will put our patients first.Teamwork We will work together.Ambition We will aspire to provide the best service.Respect We will act with integrity
Job description
Job responsibilities
1. Working with partners in Primary and Social care further develop a virtual ward model/Urgent communityresponse which identifies, and case manages those patients needing complex chronic diseasemanagement or palliative care supporting the needs of the local community.2. Maintain accountability for practice following the Nursing and Midwifery Council Code of ProfessionalConduct/Health and Care professions Council Standards of conduct Performance and ethics and compliancewith Great Western Hospitals NHS Foundation Trust Policies and Procedures.3. Maintain legible, accurate and up to date records that are dated and signed in accordance with Trust Policiesand the Nursing and Midwifery Council / Health and Care Professions Council standards onrecord keeping.4. Work autonomously with patients, their families and carers managing referrals according to need andpriority.5. Negotiate and agree with the patient, carers and other care professionals, individual roles, and responsibilitieswith actions to be taken and outcomes to be achieved, referring on to other services orprofessionals as appropriate.6. Establish local networks in partnership with other health and social professionals/agencies and national linkswith other generalists to develop protocols according to national and local guidelines for the safeand effective provision of a community nursing service.7. To work with partners in nursing and residential care to ensure optimum health outcomes for theirresidents.8. Critically analyse complex clinical data and information to inform diagnosis and, where appropriate, order investigationsand/or instigate therapeutic treatments to inform clinical decision making and improvehealth outcomes.
Job description
Job responsibilities
1. Working with partners in Primary and Social care further develop a virtual ward model/Urgent communityresponse which identifies, and case manages those patients needing complex chronic diseasemanagement or palliative care supporting the needs of the local community.2. Maintain accountability for practice following the Nursing and Midwifery Council Code of ProfessionalConduct/Health and Care professions Council Standards of conduct Performance and ethics and compliancewith Great Western Hospitals NHS Foundation Trust Policies and Procedures.3. Maintain legible, accurate and up to date records that are dated and signed in accordance with Trust Policiesand the Nursing and Midwifery Council / Health and Care Professions Council standards onrecord keeping.4. Work autonomously with patients, their families and carers managing referrals according to need andpriority.5. Negotiate and agree with the patient, carers and other care professionals, individual roles, and responsibilitieswith actions to be taken and outcomes to be achieved, referring on to other services orprofessionals as appropriate.6. Establish local networks in partnership with other health and social professionals/agencies and national linkswith other generalists to develop protocols according to national and local guidelines for the safeand effective provision of a community nursing service.7. To work with partners in nursing and residential care to ensure optimum health outcomes for theirresidents.8. Critically analyse complex clinical data and information to inform diagnosis and, where appropriate, order investigationsand/or instigate therapeutic treatments to inform clinical decision making and improvehealth outcomes.
Person Specification
Qualifications
Essential
- Registered nurse
- Non -Medical Prescribing qualification (V300) or equivalent validated and accredited by NMC
- Qualified to master's level or working towards the following Modules: Physical assessment and Clinical reasoning (PACR or equivalent)
- Evidence of relevant up to date CPD
Desirable
- Post graduate community qualification e.g. community specialist practitioner Further qualifications relevant to community nursing.
- Awareness of recent Government initiatives that may affect future clinical practice
- To be knowledgeable of the clinical governance agenda and have an awareness of commissioning
Experience
Essential
- Experience at senior level working in relevant field.
- Confident to undertake home visiting to assess and treat patients
- Demonstrate clinical examination and assessment skills e.g. history taking, physical assessment.
Desirable
- Profiling community needs and targeting identified health needs of population
- Evidence of innovative and flexible approach to care and the organisation of care
- Teaching experience
Knowledge
Essential
- To be able to communicate with people from a wide range of backgrounds. To be able to work flexibly and sensitively. Wide range of interpersonal and communication skills
- Undertake specific nursing tasks requiring precision and/or intense concentration. Undertaking complex nursing skills
- Ability to sensitively inform service users on highly complex and distressing issues. Able to support and facilitate staff in dealing with these situations
- Ability to build effective working relationships with clinicians and Managers at all levels
Desirable
- Further training in dealing with difficult situations
- Specific speciality area Teaching experience
- Report writing
Person Specification
Qualifications
Essential
- Registered nurse
- Non -Medical Prescribing qualification (V300) or equivalent validated and accredited by NMC
- Qualified to master's level or working towards the following Modules: Physical assessment and Clinical reasoning (PACR or equivalent)
- Evidence of relevant up to date CPD
Desirable
- Post graduate community qualification e.g. community specialist practitioner Further qualifications relevant to community nursing.
- Awareness of recent Government initiatives that may affect future clinical practice
- To be knowledgeable of the clinical governance agenda and have an awareness of commissioning
Experience
Essential
- Experience at senior level working in relevant field.
- Confident to undertake home visiting to assess and treat patients
- Demonstrate clinical examination and assessment skills e.g. history taking, physical assessment.
Desirable
- Profiling community needs and targeting identified health needs of population
- Evidence of innovative and flexible approach to care and the organisation of care
- Teaching experience
Knowledge
Essential
- To be able to communicate with people from a wide range of backgrounds. To be able to work flexibly and sensitively. Wide range of interpersonal and communication skills
- Undertake specific nursing tasks requiring precision and/or intense concentration. Undertaking complex nursing skills
- Ability to sensitively inform service users on highly complex and distressing issues. Able to support and facilitate staff in dealing with these situations
- Ability to build effective working relationships with clinicians and Managers at all levels
Desirable
- Further training in dealing with difficult situations
- Specific speciality area Teaching experience
- Report writing
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
