Job summary
You
will be a HCPC Registered HCP who will join an already established team in the
Nottingham West Locality providing support and knowledge to the care homes
across this geographical area.
This is a pivotal role across Nottingham West
Primary Care Network, to support the delivery of the National Care Home Direct
Enhanced Service (DES) and working to the Enhanced Health in Care Homes
Framework. The post holder will work with multiple primary and secondary care
providers to continue to develop key relationships between the care homes and
other organisations. This is to improve the care for people living in long term
residential and nursing care and for those living in mental health and learning
disability care environments.
NOTTINGHAM WEST PRIMARY CARE NETWORK
Nottingham
West PCN is a group of GP practices (12) that are committed to work together to
add additional services and roles to support the workload in GP practices. We cover 108,865 patients within our
locality. Our network works closely with all practices and other key members of
the network including pharmacies, Citizens Advice, Voluntary Sector and local
district and borough councils. Our aim is to continually improve services to
patients utilising all available resources.
Our PCN work
in partnership with PICS to provide a host organisation for employment
contracts, HR and corporate support. The day-to-day work is situated in the GP
practices and line management is undertaken by staff within the
PCN.
Main duties of the job
KEY
RESPONSIBILITIES
- To work
closely with a local multi-professional team, including AHPs and pharmacists,
in supporting the delivery of the weekly care home round
- To develop
and lead innovative concepts, models, methods and practices to deliver new and
improved primary care services to meet the needs of the practice population
- To
prioritise care home residents for review according to health need based on
identification by the MDT, utilising tools identified with the Comprehensive
Geriatric Assessment and complete appropriate risk assessment
KEY
REQUIREMENTS
- Registered
Practitioner HCPC
- Evidence of
post graduate education
- Significant
experience of working across different health care settings
About us
PICS is the
employer for this role. We collaborate with patients and partners to design and
deliver clinically robust health and social care solution through Community Services,
Out of Hospital Services, GP Practices, and Primary Care Networks. Find out
more about us: http://picsnhs.org.uk/.
Benefits of working for PICS
We offer a comprehensive package which
includes:
Job description
Job responsibilities
KEY RESPONSIBILITIES
The post holder:
- Will be responsible for the direct leadership of a Multi-Professional team in care homes designated to them working collaboratively with the wider EHCH team.
- Is responsible for ensuring that the residents and care home staff within Nottingham West PCN locality receive assistance in accessing health care interventions by signposting to the most appropriate person to provide care
- Is responsible for consulting and collaborating with other Health Care professionals and specialists across both primary, secondary, social care and the voluntary care sectors
- Will take a significant role in the holistic assessment and treatment of patients in care homes with complex illnesses. To confidently consult with patients/families/carers to determine the needs of individuals and develop and review annual care plans to support care.
- Will confidently make autonomous decisions following assessments and ensuring that information is communicated back to GP colleagues in a timely and professional manner
- Complete relevant training related to AARS roles including FCP training to be compliant with national guidelines
- To lead in the weekly home rounds and have the ability and knowledge to make decisions regards the appropriateness of onward referrals and hold others to account for their delivery of actions.
- To work flexibly and work remotely as clinically appropriate and when it is required.
- Make recommendations regarding patient management in accordance with Local and National guidelines within the management of the older population.
- Work with GP leads in developing the strategic and operational management of the Enhanced Health in Care Homes Service.
- To be responsible for participating in and implementing the overall strategy for development and delivery of the Enhanced Health in Care Homes service across Nottingham West
- To establish and improve professional standards of care in the management of residents within care homes by developing partnerships with key stakeholders.
- To support and assist the management with continuing professional development, training and peer supervision.
- To develop / prescribe specialised programmes of care for patients referred to the team, monitor and evaluate effectiveness of implementation. This includes developing training programmes and providing guidance to all clinicians both professional and non-professional across the health community.
- Demonstrate a good understanding of clinical governance and risk management and apply to work effectively alerting any risks and benefits when developing services and practice in new areas.
- To undertake research and service development.
- To facilitate clinical supervision to clinicians who are working within the caseload and to clinicians working within the health community. Providing mentorship for clinicians working within the health community. Providing mentorship for clinicians developing advanced skills.
- Promote the philosophy of patient centred care, providing the right care at the right time in the right place.
- Communications across the MDT is a critical element for this role. Information will be shared across providers, and the post holder will advocate for the residents and care homes as equal members of the MDT.
- Utilising and interpreting data, to support service improvement for care homes and primary care, as well as understanding the demands on urgent and emergency services to reduce avoidable activity where possible. Data and local intelligence will be utilised to develop and influence new ways of working to improve patient care, the resilience of primary care and system partners.
- The post holder will be supported by named care home GPs and the PCN GP clinical lead, and accountable to the Primary Care clinical director.
- The post holder will promote new ways of working promoting the use of digital technology, such as remote consultations, MS Teams and virtual MDTs.
- The post holder will be required to evidence the impacts of the post and provide data monitoring to further shape the role and delivery of the Care Home DES within Nottingham West PCN.
- As a senior clinician the post holder will be required to support local and system wide meetings as appropriate and have a visible presence across the care homes and GP practices.
Professional Leadership and Development:
- To be responsible for maintaining own competency to practice through Continuing Professional Development activities and to participate in the annual appraisal process.
- To always adhere to the individual Professional code of conduct and practice.
- To reflect on own practice individually and/or through regular clinical supervision.
- To participate in any relevant training/course/conferences to maintain own professional development.
- To maintain, develop and disseminate specialist knowledge of evidence based practice.
- To critically evaluate own work through the use of evidence based projects, audits and outcome measures.
- To work autonomously as a Clinical Care Homes Lead within professional and PICS guidelines, policies and procedures.
Communication and Relationship Skills:
- Demonstrate advanced communication skills in providing advice, empowerment, facilitation, influence, motivation and counselling.
- Manage complex communication issues that may arise between differing health and social care professionals.
- Demonstrate an understanding of the need to involve patients and carers in decision making, offering them informed choices, respecting their views.
- Demonstrate the ability to recognise barriers to understanding that can be encountered with elderly frail patients, those without English as their first language, patients with disabilities and those with mental health difficulties such as dementia, anxiety, clinical depression or personality disorders.
- Seek out different styles and methods of communicating to assist longer term needs and aims.
Knowledge, Training and Experience:
- This post demands a range of developed skills from a wide and variant background, experience and a broad yet deep knowledge base underpinned with a proven track record and/or an academically scrutinised knowledge base.
- Proven Professional Development, a profile that demonstrates, advanced clinical nursing practice including medicines management.
- To have the ability to lead complex care co-ordination, proactively manage complex long term conditions.
- Support self-care, management enabling independence through concordance and using advanced consultation skills.
- Dealing with patients who have cognitive impairment and understand mental well-being.
- Dealing with care home staff and residents where English is not the first language to promote education and training.
- Offer advanced consultation skills and developed specialist knowledge within the older persons setting and generalist knowledge to undertake comprehensive assessment of health and psychosocial care needs of patients with complex disease, including holistic assessment, gathering and interpreting information, analysing results.
- Using clinical outcomes for patients by enabling them to function independently by increasing their choice to remain in their own care home setting and reduce the need for inappropriate hospital admissions/readmission.
- Utilise advanced communication skills to facilitate the understanding and concordance of medicines with patients and carers.
- Analytical judgement underpinned with specialist knowledge and experience is used to develop evidenced based holistic personal care plan with patients, carers, relatives and health care professionals based on a full assessment of medical, nursing, and social care needs.
- Work collaboratively with colleagues using databases to actively seek patients who will benefit from clinical cases management techniques to avoid unplanned hospital admissions and reduce the length of hospital admissions.
- Facilitating the care home managed patients discharge from hospital, by co-ordinating care services to be delivered within primary care working in partnership with secondary care, primary care and social service colleagues.
- Work proactively with care homes to identify patients and their families to improve end of life care by early identification of prognostic indicators and completion of advanced care plans and refer in a timely manner to the Palliative Care teams.
- Provide evidence based written information, ensuring easy access to advice and information for patients and their carers.
- Acts a role model demonstrating high standards of care and providing clinical leadership to others.
Clinical Governance:
- To maintain accurate and comprehensive documentation in line with legal, professional and organisational requirements. Ensure all information with regard to each patient related contact is recorded within SystmOne records
- Identify need for, and undertake, research, clinical audit, benchmarking and equipment trials, in order to improve effectiveness of patient care.
- Disseminate research and audit findings through presentation to multi- professional groups and publication.
- Take responsibility for the development and implementation of policies, procedures and guidelines relevant to own area of work, which may have an impact across the organization.
- Promote patient and public involvement activities in the specialist area, leading to service improvement.
- Actively promote peoples equality, diversity and rights.
Please download the supporting documentation for full role details and to support with your application.
Job description
Job responsibilities
KEY RESPONSIBILITIES
The post holder:
- Will be responsible for the direct leadership of a Multi-Professional team in care homes designated to them working collaboratively with the wider EHCH team.
- Is responsible for ensuring that the residents and care home staff within Nottingham West PCN locality receive assistance in accessing health care interventions by signposting to the most appropriate person to provide care
- Is responsible for consulting and collaborating with other Health Care professionals and specialists across both primary, secondary, social care and the voluntary care sectors
- Will take a significant role in the holistic assessment and treatment of patients in care homes with complex illnesses. To confidently consult with patients/families/carers to determine the needs of individuals and develop and review annual care plans to support care.
- Will confidently make autonomous decisions following assessments and ensuring that information is communicated back to GP colleagues in a timely and professional manner
- Complete relevant training related to AARS roles including FCP training to be compliant with national guidelines
- To lead in the weekly home rounds and have the ability and knowledge to make decisions regards the appropriateness of onward referrals and hold others to account for their delivery of actions.
- To work flexibly and work remotely as clinically appropriate and when it is required.
- Make recommendations regarding patient management in accordance with Local and National guidelines within the management of the older population.
- Work with GP leads in developing the strategic and operational management of the Enhanced Health in Care Homes Service.
- To be responsible for participating in and implementing the overall strategy for development and delivery of the Enhanced Health in Care Homes service across Nottingham West
- To establish and improve professional standards of care in the management of residents within care homes by developing partnerships with key stakeholders.
- To support and assist the management with continuing professional development, training and peer supervision.
- To develop / prescribe specialised programmes of care for patients referred to the team, monitor and evaluate effectiveness of implementation. This includes developing training programmes and providing guidance to all clinicians both professional and non-professional across the health community.
- Demonstrate a good understanding of clinical governance and risk management and apply to work effectively alerting any risks and benefits when developing services and practice in new areas.
- To undertake research and service development.
- To facilitate clinical supervision to clinicians who are working within the caseload and to clinicians working within the health community. Providing mentorship for clinicians working within the health community. Providing mentorship for clinicians developing advanced skills.
- Promote the philosophy of patient centred care, providing the right care at the right time in the right place.
- Communications across the MDT is a critical element for this role. Information will be shared across providers, and the post holder will advocate for the residents and care homes as equal members of the MDT.
- Utilising and interpreting data, to support service improvement for care homes and primary care, as well as understanding the demands on urgent and emergency services to reduce avoidable activity where possible. Data and local intelligence will be utilised to develop and influence new ways of working to improve patient care, the resilience of primary care and system partners.
- The post holder will be supported by named care home GPs and the PCN GP clinical lead, and accountable to the Primary Care clinical director.
- The post holder will promote new ways of working promoting the use of digital technology, such as remote consultations, MS Teams and virtual MDTs.
- The post holder will be required to evidence the impacts of the post and provide data monitoring to further shape the role and delivery of the Care Home DES within Nottingham West PCN.
- As a senior clinician the post holder will be required to support local and system wide meetings as appropriate and have a visible presence across the care homes and GP practices.
Professional Leadership and Development:
- To be responsible for maintaining own competency to practice through Continuing Professional Development activities and to participate in the annual appraisal process.
- To always adhere to the individual Professional code of conduct and practice.
- To reflect on own practice individually and/or through regular clinical supervision.
- To participate in any relevant training/course/conferences to maintain own professional development.
- To maintain, develop and disseminate specialist knowledge of evidence based practice.
- To critically evaluate own work through the use of evidence based projects, audits and outcome measures.
- To work autonomously as a Clinical Care Homes Lead within professional and PICS guidelines, policies and procedures.
Communication and Relationship Skills:
- Demonstrate advanced communication skills in providing advice, empowerment, facilitation, influence, motivation and counselling.
- Manage complex communication issues that may arise between differing health and social care professionals.
- Demonstrate an understanding of the need to involve patients and carers in decision making, offering them informed choices, respecting their views.
- Demonstrate the ability to recognise barriers to understanding that can be encountered with elderly frail patients, those without English as their first language, patients with disabilities and those with mental health difficulties such as dementia, anxiety, clinical depression or personality disorders.
- Seek out different styles and methods of communicating to assist longer term needs and aims.
Knowledge, Training and Experience:
- This post demands a range of developed skills from a wide and variant background, experience and a broad yet deep knowledge base underpinned with a proven track record and/or an academically scrutinised knowledge base.
- Proven Professional Development, a profile that demonstrates, advanced clinical nursing practice including medicines management.
- To have the ability to lead complex care co-ordination, proactively manage complex long term conditions.
- Support self-care, management enabling independence through concordance and using advanced consultation skills.
- Dealing with patients who have cognitive impairment and understand mental well-being.
- Dealing with care home staff and residents where English is not the first language to promote education and training.
- Offer advanced consultation skills and developed specialist knowledge within the older persons setting and generalist knowledge to undertake comprehensive assessment of health and psychosocial care needs of patients with complex disease, including holistic assessment, gathering and interpreting information, analysing results.
- Using clinical outcomes for patients by enabling them to function independently by increasing their choice to remain in their own care home setting and reduce the need for inappropriate hospital admissions/readmission.
- Utilise advanced communication skills to facilitate the understanding and concordance of medicines with patients and carers.
- Analytical judgement underpinned with specialist knowledge and experience is used to develop evidenced based holistic personal care plan with patients, carers, relatives and health care professionals based on a full assessment of medical, nursing, and social care needs.
- Work collaboratively with colleagues using databases to actively seek patients who will benefit from clinical cases management techniques to avoid unplanned hospital admissions and reduce the length of hospital admissions.
- Facilitating the care home managed patients discharge from hospital, by co-ordinating care services to be delivered within primary care working in partnership with secondary care, primary care and social service colleagues.
- Work proactively with care homes to identify patients and their families to improve end of life care by early identification of prognostic indicators and completion of advanced care plans and refer in a timely manner to the Palliative Care teams.
- Provide evidence based written information, ensuring easy access to advice and information for patients and their carers.
- Acts a role model demonstrating high standards of care and providing clinical leadership to others.
Clinical Governance:
- To maintain accurate and comprehensive documentation in line with legal, professional and organisational requirements. Ensure all information with regard to each patient related contact is recorded within SystmOne records
- Identify need for, and undertake, research, clinical audit, benchmarking and equipment trials, in order to improve effectiveness of patient care.
- Disseminate research and audit findings through presentation to multi- professional groups and publication.
- Take responsibility for the development and implementation of policies, procedures and guidelines relevant to own area of work, which may have an impact across the organization.
- Promote patient and public involvement activities in the specialist area, leading to service improvement.
- Actively promote peoples equality, diversity and rights.
Please download the supporting documentation for full role details and to support with your application.
Person Specification
Qualifications
Essential
- Please provide details of your CPD, using examples where necessary.
- Please provide your registration number of your HCPC professional registration.
Personal Qualities
Essential
- Please provide details for why you would be a great fit for this role and why you have decided to apply.
Knowledge and skills
Essential
- Please provide detailed information of how you feel that your knowledge and skills are suitable for this role; please provide examples to support your application referring to the job description and person specification for guidance.
Experience
Essential
- Please provide detailed information of how you feel that your experience is suitable for this role; please provide examples to support your application referring to the job description and person specification for guidance.
Person Specification
Qualifications
Essential
- Please provide details of your CPD, using examples where necessary.
- Please provide your registration number of your HCPC professional registration.
Personal Qualities
Essential
- Please provide details for why you would be a great fit for this role and why you have decided to apply.
Knowledge and skills
Essential
- Please provide detailed information of how you feel that your knowledge and skills are suitable for this role; please provide examples to support your application referring to the job description and person specification for guidance.
Experience
Essential
- Please provide detailed information of how you feel that your experience is suitable for this role; please provide examples to support your application referring to the job description and person specification for guidance.
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
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
Primary Integrated Community Services
Address
Unit H4 Ash Tree Court
Nottingham Business Park
Nottingham
Nottinghamshire
NG8 6PY
Employer's website
http://picsnhs.org.uk/ (Opens in a new tab)
