Job summary
Extended Primary care team is a small team, delivering compassionate holistic care for patients with enduring mental health issues and complex Health needs. We now have an exciting opportunity for a skilled and enthusiastic Mental Health Nurse to join our small friendly team.
As one of the team, you will ensure that you offer responsive, evidence based and recovery focused care to the patients, while building strong therapeutic relationships to support patients to move forward in their recovery.
This is a role where you can really make a difference working to reduce the amount of time our patients need to spend in hospital and helping them to work towards their recovery and back into the community. As part of the role, the candidate will take part in meeting the competencies by taking part in training and a comprehensive induction programme.
The successful post holder will need excellent communication skills and be able to communicate effectively with staff, service users and other members of the wider multi-disciplinary team. The ability to prioritise changing work demands is essential.
We are looking to appoint highly motivated, enthusiastic, flexible, resourceful and resilient individuals who are committed to providing support and assistance to patients in their recovery.
Main duties of the job
The Senior Care Planner, in conjunction with a wide range of clinical colleagues and specifically GP's, Practice Nurses and Social Care professionals, will support and facilitate a patient or client focussed, co-ordinated case management approach across primary and secondary care for people who are most vulnerable to and at high risk of repeat admissions to hospital.
* Working under the supervising Lead Care Planner as a lead clinical practitioner, the post holder will have responsibility for proactively monitoring, assessing and managing patients within the Extended Primary Care Team
* Recognising the early symptoms of disease exacerbation, acute illness and injuries, social and familial factors and based on an understanding of long term conditions, frail older people and current evidence and practice standards the post holder will support appropriate care provided in the right place at the right time.
* The post holder will contribute to case management and health advice to support self-management whilst in the community and access specialist advice when required to help people live with complex co-morbidities, including dementia and frailty.
* Reporting to the Lead Care Planner, the post holder will support developing and implementing service provision within the Extended Primary Care Team and case management across Fareham & Gosport and South East Hampshire locality.
About us
Are you committed to providing remarkable care and service?
Are you passionate about helping people and want to make a difference every day?
We want to meet you!
Southern Health is one of the largest Foundation Trusts in the UK, specialising in mental health, adult and child community health and learning disabilities. We are committed to promoting the welfare and safeguarding of children, young people and adults at risk of abuse and neglect through our 6,500 strong workforce.
Southern Health has over 300 sites across the county and we serve 1.5 million people throughout all stages of their lives. Our aim is to work alongside the people we support (and our health and care partners) to deliver the best possible care and constantly improve.
Here at SHFT we have so much to be proud of:
- Working as a team and supporting each other, we put patients and our staff at the heart of everything we do.
- We have a skilled and diverse workforce and are committed to our staff development, offering bespoke training packages, leadership pathways and career opportunities.
- We offer a variety of benefits such as an amazing pension scheme, generous annual leave, Childcare Choices scheme, many discounts (Blue Light card, The Company Shop, NHS Staff Discounts, cycle to work scheme) and much more.
Come to work with us, together we will provide outstanding treatment and care to improve lives.
Job description
Job responsibilities
Be competent at conducting physical assessment and clinical reasoning to patients in their own home
* Continuing responsibility for a caseload of patients needing complex management within the long term conditions and frail older people pathways
* Work with patients in order to support compliance and adherence to prescribed treatment
* Interpretation of clinical investigations.
* Liaise with other agencies and stakeholders to ensure timely engagement of services
* Work across primary, secondary and specialist care services
* Adopt a multi-disciplinary and multi-agency approach to care taking into account patients' needs and confidentiality requirements
* Actively engage and communicate with patients and carers in regard to an individual's care and progress
* Prioritise workloads to ensure safe and effective work load performance, with accurate documentation at all stages
* Lead and participate in the agreed audit programme
* Assessing and interpreting patient conditions, taking appropriate action and responding to the patients need for clinical interventions
* Providing support in complex care management
* Providing high standard written communication in the form of care plans, treatment escalation plans, end of life care planning and reports
* Providing data and, where appropriate, analysis that supports agreed clinical outcomes
* Contribute to the development of and work within all agreed policies, protocols and procedures
* Adhere to all standards relating to Clinical Governance and operate within the Clinical Governance Framework
* Support the supervision, training and development of other team members as required.
* Support the implementation of personalised care plans to support patients to manage their own conditions
* Maintain the quality of care planning, implementation and evaluation to ensure quality is maintained
* Ensure that medicines in your area are handled and administered according to professional and organisational guidelines to ensure safety and efficacy
* Inform the Lead Care Planner B7 of any concerns with patients, relatives, visitors or staff that may compromise patient care
* Communicate effectively with colleagues, patients and carers so that information is shared in order to meet patients' needs
* Act as a role model in the promotion of person-centred practice, and challenge practice which is not person-centred, so that a person-centred culture is maintained
* Keep updated with relevant clinical developments and use knowledge to enhance standards of care
* Ensure that discharge and transfer planning for patients is done in a proactive and adopt a multidisciplinary and multiagency approach
* Practice, role model and promote safe and effective skills in all aspects of clinical practice
* Practice, role model and promote safe and effective recording in line with trust policies and professional standards
* Encourage a culture of patient wellness and coproduction
* Demonstrate, care, compassion, competence, effective communication, courage and commitment with all patients and carers
* Ensure that patients with palliative care needs (and their families) have those needs met
* Demonstrate competence and confidence in clinical practice: this includes all clinical procedures that are relevant/specialist to the area
* Recognises own limitations in the provision of clinical care and urgency of patient's needs, referring to other healthcare professionals accordingly and is accountable for his/her own action
* Participates in setting standard and implementing other quality initiatives
* Empowering patients and facilitate a "self-management" approach for patients and carers
Job description
Job responsibilities
Be competent at conducting physical assessment and clinical reasoning to patients in their own home
* Continuing responsibility for a caseload of patients needing complex management within the long term conditions and frail older people pathways
* Work with patients in order to support compliance and adherence to prescribed treatment
* Interpretation of clinical investigations.
* Liaise with other agencies and stakeholders to ensure timely engagement of services
* Work across primary, secondary and specialist care services
* Adopt a multi-disciplinary and multi-agency approach to care taking into account patients' needs and confidentiality requirements
* Actively engage and communicate with patients and carers in regard to an individual's care and progress
* Prioritise workloads to ensure safe and effective work load performance, with accurate documentation at all stages
* Lead and participate in the agreed audit programme
* Assessing and interpreting patient conditions, taking appropriate action and responding to the patients need for clinical interventions
* Providing support in complex care management
* Providing high standard written communication in the form of care plans, treatment escalation plans, end of life care planning and reports
* Providing data and, where appropriate, analysis that supports agreed clinical outcomes
* Contribute to the development of and work within all agreed policies, protocols and procedures
* Adhere to all standards relating to Clinical Governance and operate within the Clinical Governance Framework
* Support the supervision, training and development of other team members as required.
* Support the implementation of personalised care plans to support patients to manage their own conditions
* Maintain the quality of care planning, implementation and evaluation to ensure quality is maintained
* Ensure that medicines in your area are handled and administered according to professional and organisational guidelines to ensure safety and efficacy
* Inform the Lead Care Planner B7 of any concerns with patients, relatives, visitors or staff that may compromise patient care
* Communicate effectively with colleagues, patients and carers so that information is shared in order to meet patients' needs
* Act as a role model in the promotion of person-centred practice, and challenge practice which is not person-centred, so that a person-centred culture is maintained
* Keep updated with relevant clinical developments and use knowledge to enhance standards of care
* Ensure that discharge and transfer planning for patients is done in a proactive and adopt a multidisciplinary and multiagency approach
* Practice, role model and promote safe and effective skills in all aspects of clinical practice
* Practice, role model and promote safe and effective recording in line with trust policies and professional standards
* Encourage a culture of patient wellness and coproduction
* Demonstrate, care, compassion, competence, effective communication, courage and commitment with all patients and carers
* Ensure that patients with palliative care needs (and their families) have those needs met
* Demonstrate competence and confidence in clinical practice: this includes all clinical procedures that are relevant/specialist to the area
* Recognises own limitations in the provision of clinical care and urgency of patient's needs, referring to other healthcare professionals accordingly and is accountable for his/her own action
* Participates in setting standard and implementing other quality initiatives
* Empowering patients and facilitate a "self-management" approach for patients and carers
Person Specification
Qualifications
Essential
- Registered Health Care Professional Qualification
- * Post Graduate study in health related studies relevant to long term condition management or equivalent experience.
- * Full Uk Driving Licence and use of vehicle for work
Person Specification
Qualifications
Essential
- Registered Health Care Professional Qualification
- * Post Graduate study in health related studies relevant to long term condition management or equivalent experience.
- * Full Uk Driving Licence and use of vehicle for work
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
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
