Job summary
INTERNAL ADVERT
This advert is only open to applicants who are
currently employed by County Durham and Darlington NHS Foundation Trust.
To
work as an autonomous practitioner with a variable caseload of complex
patients, supporting admission avoidance and management of frailty within their
home environment.
The post holder will have
expert knowledge and advanced clinical reasoning skills in the management of
frailty, to providing specialist support and advice to the GPs and other
healthcare staff as required.
They will have
- specialist skills in the
assessment and treatment of frailty, including completion of evidenced based
assessments and interventions, routinely carrying out the extended role of an
Advanced Therapy Practitioner working outside of traditional roles but within
the agreed competence-based framework once competencies have been achieved.
- will work alongside the
frailty team GPs and other professionals involved in the frailty assessments,
interventions and reviews to ensure every patient living with frailty that is
reviewed via the team presenting with a health or social care need receives the
most appropriate care in the most appropriate setting in a timely manner.
-
Require flexible approach to working with normal days beinf Mon- Fri with
potential 7 day working after service development
Main duties of the job
Assist in the development of the Community
Frailty Team and pathways for the care of frail housebound patients.
Responsible for the ongoing
assessment and treatment of patients and their management plans based upon up
to date evidence base.
Lead the team in service
delivery and collation of data.
Integral post in relation
to MDT function.
Ensure effective
communication with colleagues, Patients, families and carers.
Evaluating outcomes and
ensuring quality metrics are recorded, analysed and shared with implementation
group
About us
If you are being interviewed you must accept an interview slot in the system to continue, even if you have arranged with the manager
You must be able to produce ALL certificates stated essential in the person specification or you will not be able to complete pre-employment checks
We provide hospital services from two acute sites - Darlington Memorial Hospital and University Hospital of North Durham. We have a centre for planned care in Bishop Auckland and provide care from community hospitals in Chester-le-Street, Shotley Bridge, Barnard Castle, Sedgefield and Weardale as well as over 80 other community based settings and providing care in patients' homes.
We particularly welcome applications from disabled and Black, Asian and Minority Ethnic (BAME) candidates as BAME and disabled people are currently under-represented
Full Job Descriptions can be found in the adverts supporting documents
Over reliance on
AI-generated content is discouraged and may diminish the applicant's chances of
success
For the most up-to-date information on visa requirements and eligibility, please check online to determine whether you can apply.
From April 9th 2025 - Healthcare assistants - You must have a minimum of two years
of experience working within the NHS as a HCA for the Trust to consider
sponsorship (we will only consider sponsorship if you meet this criteria and
have a current visa expiring within 3 months)
Job description
Job responsibilities
Be
responsible for the efficient, effective and safe management of patients
referred or identified to the Community Frailty Team.
Be able to manage your own
caseload in response to unpredictable patterns of work. Accept referrals from other health care
professionals and work unsupervised.
To be professionally and
legally accountable for all aspects of your own work, including the management
of patients in your care. To ensure a
high standard of clinical practice for patients under your management.
To work with GPs, nursing,
allied health professionals and the wider MDT to provide the highest possible
standards care for all patients you come into contact with.
Use expert knowledge of
frail patients with complex frailty syndromes to provide a highly specialist
assessment.
To ensure assessment is
evidence based, detailed and holistic. Ensuring patient preferences are
incorporated and that physical, psychological and social factors are
considered.
To make professionally
autonomous decisions and be accountable for the direct delivery of care,
exercising judgement on the parameters of safe practice and guided by broad
policies and guidelines e.g. NICE guidelines. They are accountable for his/her
actions or omissions. They can discuss /
refer to other members of the multidisciplinary team in circumstances where
this is necessary and appropriate.
To develop and deliver
personalised, effective programs of care, recording, documenting and
maintaining these within trust policy.
Responsible for solving
wide ranging routine and complex problems and issues exercising highly
developed specialist knowledge for advanced judgments/decision making,
demonstrating expanded and autonomous knowledge and advanced skills within
clinical practice.
To routinely carry out the
extended role of an Advanced Therapy Practitioner working outside of
traditional role but within the agreed competence-based framework once
competencies have been achieved.
To contribute to the
development and implementation of the competence-based framework including
training modules to ensure that competencies are met.
To recognise and advocate
the different strengths of team members, to carry out agreed generic tasks
identifying where tasks are profession specific.
Provide highly specialised
advice to patients, carers and relatives to ensure compliance with the
diagnosed condition, treatment and interventions. Advise on health promotion
and prevention of disease in accordance with NHS policy and agendas in order to
achieve optimum health and independence.
To exercise highly
developed skills to identify patients who may be at potential risk e.g.
vulnerable adults, self-neglect, patients at risk of abuse or where abuse is
suspected. To act accordingly within guidelines to safeguard these patients.
Actively participate in
MDTs communicating planned patient care from Community Frailty Team.
To formulate and deliver an
individual intervention plan based on advanced clinical knowledge of current
practice, evidence based practice and community support options. To identify
and coordinate appropriate transfers/signposting to appropriate specialist
services/agencies, and complete trusted assessor pathway where local agreements
are in place.
Assist the team to develop
innovative and flexible approaches to care.
Ensure that personal
performance meets the job requirements, professional codes and standards, trust
and post competency standards at all times.
To be aware of and respond
to operational pressures, supporting operational management across the service
as appropriate.
Responsibility
for recording and evaluating patient outcomes and agreeing on and recording
quality metrics for the evaluation of service provision.
Job description
Job responsibilities
Be
responsible for the efficient, effective and safe management of patients
referred or identified to the Community Frailty Team.
Be able to manage your own
caseload in response to unpredictable patterns of work. Accept referrals from other health care
professionals and work unsupervised.
To be professionally and
legally accountable for all aspects of your own work, including the management
of patients in your care. To ensure a
high standard of clinical practice for patients under your management.
To work with GPs, nursing,
allied health professionals and the wider MDT to provide the highest possible
standards care for all patients you come into contact with.
Use expert knowledge of
frail patients with complex frailty syndromes to provide a highly specialist
assessment.
To ensure assessment is
evidence based, detailed and holistic. Ensuring patient preferences are
incorporated and that physical, psychological and social factors are
considered.
To make professionally
autonomous decisions and be accountable for the direct delivery of care,
exercising judgement on the parameters of safe practice and guided by broad
policies and guidelines e.g. NICE guidelines. They are accountable for his/her
actions or omissions. They can discuss /
refer to other members of the multidisciplinary team in circumstances where
this is necessary and appropriate.
To develop and deliver
personalised, effective programs of care, recording, documenting and
maintaining these within trust policy.
Responsible for solving
wide ranging routine and complex problems and issues exercising highly
developed specialist knowledge for advanced judgments/decision making,
demonstrating expanded and autonomous knowledge and advanced skills within
clinical practice.
To routinely carry out the
extended role of an Advanced Therapy Practitioner working outside of
traditional role but within the agreed competence-based framework once
competencies have been achieved.
To contribute to the
development and implementation of the competence-based framework including
training modules to ensure that competencies are met.
To recognise and advocate
the different strengths of team members, to carry out agreed generic tasks
identifying where tasks are profession specific.
Provide highly specialised
advice to patients, carers and relatives to ensure compliance with the
diagnosed condition, treatment and interventions. Advise on health promotion
and prevention of disease in accordance with NHS policy and agendas in order to
achieve optimum health and independence.
To exercise highly
developed skills to identify patients who may be at potential risk e.g.
vulnerable adults, self-neglect, patients at risk of abuse or where abuse is
suspected. To act accordingly within guidelines to safeguard these patients.
Actively participate in
MDTs communicating planned patient care from Community Frailty Team.
To formulate and deliver an
individual intervention plan based on advanced clinical knowledge of current
practice, evidence based practice and community support options. To identify
and coordinate appropriate transfers/signposting to appropriate specialist
services/agencies, and complete trusted assessor pathway where local agreements
are in place.
Assist the team to develop
innovative and flexible approaches to care.
Ensure that personal
performance meets the job requirements, professional codes and standards, trust
and post competency standards at all times.
To be aware of and respond
to operational pressures, supporting operational management across the service
as appropriate.
Responsibility
for recording and evaluating patient outcomes and agreeing on and recording
quality metrics for the evaluation of service provision.
Person Specification
Qualifications
Essential
- Degree in Physiotherapy
- Professional UK registration - HCPC
Desirable
- Post-graduate qualifications to MSc level.
Experience
Essential
- Comprehensive experience at senior level incorporating experience within a range of specialisms in acute inpatient care.
- Experience of completing detailed person centered assessment, taking into account the physical, psychological and social aspects that impact on the individual and their ability to function.
- Highly experienced in the therapeutic management of frailty including the implementation of evidence based interventions.
- Experience in the discharge planning and management of highly complex patients with the ability to problem solve and make complex decisions.
- Experience of acting as an advocate for patients, helping to ensure patient is at the centre of all decisions made about their care and support.
- Evidence of the ability to autonomously manage a highly complex caseload of patients.
- Experience of working within multidisciplinary cross-agency teams.
- Evidence of the use of outcome measures in order to evaluate interventions or service provision, leading to service improvements and improved quality standards.
- Experience of providing clinical supervision and training for students, support staff, peers and members of the MDT.
- Extensive experience in the application of the mental capacity act in practice completing mental capacity assessment and best interest decisions as appropriate.
- Experience of assessing, managing, and reducing risks where able. Discussing identified risks with patients to enable them to make informed decisions about their care and support.
Desirable
- Evidence of working on strategic planning and development
- Experience of completing comprehensive geriatric assessment and formulation of treatment plans following assessment.
- Experience in the use of the Clinical Frailty Scale in practice.
- Experience of working in a generic role.
- Experience of working within a Front of House department or admissions avoidance role.
- A working knowledge of the local area, community services available within CDDFT and other local patient/client support services particularly those relevant to frail older patients.
- Experience of leading on an audit task and interpreting findings.
- Involvement in project teams for developing and implementing departmental business plans and/or organisation wide developments.
- Evidence of being highly efficient in time management and highly organised in order minimise waste of resources within a team.
- Experience of managing team members including performance management and completion of processes required by HR.
- Experience of managing patients who are palliative or end of life, helping to ensure that their needs are met and the needs of their family and carers are also taken into consideration.
Special Skills & Knowledge
Essential
- Ability to carry out comprehensive patient centred assessment.
- Ability to develop specialist programmes of care for individuals or groups of patients providing high quality evidence based interventions and advice.
- Ability to demonstrate specialist clinical skills underpinned by current evidence and appropriate to the relevant speciality.
- Willingness to work across multi-disciplinary boundaries, recognising where additional training and competencies are required to enable safe & high quality care.
- Able to present information, written and orally, in a clear and logical manner
- Good level of competence in the use of Information technology including use of electronic patient records.
- Evidence of ability to lead in service developments, adequate experience to support the initiation and development of a new team recording and interpreting outcomes.
- Experience of teaching in clinical practice. Including the development of members of the multi-disciplinary team.
- Experience and skills in delivering effective supervision and mentorship of students, qualified staff and support staff.
- Adherence to current statutory requirements, standards and regulations. Ability to demonstrate how standards of proficiency relevant to own profession are being met, understating of extended-scope roles.
- Broad awareness and understanding of current health issues and ability to demonstrate a good understanding of DOH plans and recent initiatives and local strategy, particularly in relation to frailty.
- Understanding of effective clinical governance including implications, quality, outcomes and audit.
- Demonstrable knowledge of legislation relevant to area of clinical practice.
- Ability to manage risk and complete comprehensive risk assessments as appropriate.
- Advanced communication skills with the ability to communicate effectively at different levels of the organisation and with staff, patients, visitors, or external organisations both verbally and in writing in the exchange of highly complex, sensitive or contentious information which may require the use of negotiation and/or persuasive skills.
Desirable
- In depth knowledge of Clinical Commissioning Groups, Local Authority and a working knowledge of District Council Business
- An understanding of the various IT packages and systems in use across the agencies
Special Requirements
Essential
- Ability to travel independently across the County to fulfill the requirements of the post
Statutory Registration
Essential
Person Specification
Qualifications
Essential
- Degree in Physiotherapy
- Professional UK registration - HCPC
Desirable
- Post-graduate qualifications to MSc level.
Experience
Essential
- Comprehensive experience at senior level incorporating experience within a range of specialisms in acute inpatient care.
- Experience of completing detailed person centered assessment, taking into account the physical, psychological and social aspects that impact on the individual and their ability to function.
- Highly experienced in the therapeutic management of frailty including the implementation of evidence based interventions.
- Experience in the discharge planning and management of highly complex patients with the ability to problem solve and make complex decisions.
- Experience of acting as an advocate for patients, helping to ensure patient is at the centre of all decisions made about their care and support.
- Evidence of the ability to autonomously manage a highly complex caseload of patients.
- Experience of working within multidisciplinary cross-agency teams.
- Evidence of the use of outcome measures in order to evaluate interventions or service provision, leading to service improvements and improved quality standards.
- Experience of providing clinical supervision and training for students, support staff, peers and members of the MDT.
- Extensive experience in the application of the mental capacity act in practice completing mental capacity assessment and best interest decisions as appropriate.
- Experience of assessing, managing, and reducing risks where able. Discussing identified risks with patients to enable them to make informed decisions about their care and support.
Desirable
- Evidence of working on strategic planning and development
- Experience of completing comprehensive geriatric assessment and formulation of treatment plans following assessment.
- Experience in the use of the Clinical Frailty Scale in practice.
- Experience of working in a generic role.
- Experience of working within a Front of House department or admissions avoidance role.
- A working knowledge of the local area, community services available within CDDFT and other local patient/client support services particularly those relevant to frail older patients.
- Experience of leading on an audit task and interpreting findings.
- Involvement in project teams for developing and implementing departmental business plans and/or organisation wide developments.
- Evidence of being highly efficient in time management and highly organised in order minimise waste of resources within a team.
- Experience of managing team members including performance management and completion of processes required by HR.
- Experience of managing patients who are palliative or end of life, helping to ensure that their needs are met and the needs of their family and carers are also taken into consideration.
Special Skills & Knowledge
Essential
- Ability to carry out comprehensive patient centred assessment.
- Ability to develop specialist programmes of care for individuals or groups of patients providing high quality evidence based interventions and advice.
- Ability to demonstrate specialist clinical skills underpinned by current evidence and appropriate to the relevant speciality.
- Willingness to work across multi-disciplinary boundaries, recognising where additional training and competencies are required to enable safe & high quality care.
- Able to present information, written and orally, in a clear and logical manner
- Good level of competence in the use of Information technology including use of electronic patient records.
- Evidence of ability to lead in service developments, adequate experience to support the initiation and development of a new team recording and interpreting outcomes.
- Experience of teaching in clinical practice. Including the development of members of the multi-disciplinary team.
- Experience and skills in delivering effective supervision and mentorship of students, qualified staff and support staff.
- Adherence to current statutory requirements, standards and regulations. Ability to demonstrate how standards of proficiency relevant to own profession are being met, understating of extended-scope roles.
- Broad awareness and understanding of current health issues and ability to demonstrate a good understanding of DOH plans and recent initiatives and local strategy, particularly in relation to frailty.
- Understanding of effective clinical governance including implications, quality, outcomes and audit.
- Demonstrable knowledge of legislation relevant to area of clinical practice.
- Ability to manage risk and complete comprehensive risk assessments as appropriate.
- Advanced communication skills with the ability to communicate effectively at different levels of the organisation and with staff, patients, visitors, or external organisations both verbally and in writing in the exchange of highly complex, sensitive or contentious information which may require the use of negotiation and/or persuasive skills.
Desirable
- In depth knowledge of Clinical Commissioning Groups, Local Authority and a working knowledge of District Council Business
- An understanding of the various IT packages and systems in use across the agencies
Special Requirements
Essential
- Ability to travel independently across the County to fulfill the requirements of the post
Statutory Registration
Essential
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).
Employer details
Employer name
County Durham & Darlington NHS Foundation Trust
Address
Sedgefield Community Hospital
Salters Lane
Sedgefield
Stockton-on-tees
Cleveland
TS21 3EE
Employer's website
https://www.cddft.nhs.uk/ (Opens in a new tab)
