Job overview
In partnership with members of the multi-disciplinary team, the post holder will develop, implement and evaluate a seamless specialist service, ensuring that patients receive the highest standard of clinical care. The focus of the role is to lead the identification and clinical assessment of patients who will benefit from advanced discharge or admission avoidance with care provided, in their own home, by the Guy’s and St Thomas’ @Home multi-disciplinary team.
The post holder be expected to spend more than 50% of their time seeing patients and will provide Specialist Nursing Support for the service providing acute care for patients within a Community setting by providing assessments and care for patients with ambulatory care sensitive conditions who would otherwise be admitted to acute hospital care. The post holder will demonstrate a high level of expertise with regard to advanced physical assessment in this field providing advice, education and support to health care professionals and patients.
The post holder will accept referrals from consultants, GPs and other referrers while promoting the service. The post holder will be responsible for contributing to the ongoing development of clinical practice, research and standards of care within the service, as well as policies, protocols, guidelines and service developments.
Closing date: 15th April 2026
Main duties of the job
This role involves, managing patient assessments and care within the speciality whilst working as part of the multidisciplinary team, delivering individualised and personalised direct patient care. You will be expected to promote and deliver high standards of care at all times, which utilises research-based evidence, and is audited and improved accordingly.
This position includes a rotation through all Band 7 roles within @home service, in addition to direct patient contact, you will be expected to complete the UPA triage role, NRSW lead nurse, Remote monitoring clinician and duty clinician role.
You will be expected to act as an advocate for patients within the department, to ensure a patient orientated approach to the delivery of care and to meet standards within the NHS Plan and other relevant guidelines. To be pivotal in encouraging and managing appropriate referrals, attending ward rounds, MDT and other meetings. Ensuring that patients receive high quality clinical care and a good patient experience, having regard for their social circumstances, customs, religious beliefs and doctrines. Supporting and enabling patients and carers to make informed decisions relating to their treatment and management.
Working for our organisation
Guy’s and St Thomas’ NHS Foundation Trust comprises five of the UK’s best known hospitals – Guy’s, St Thomas’, Evelina London Children’s Hospital, Royal Brompton and Harefield – as well as community services in Lambeth and Southwark, all with a long history of high quality care, clinical excellence, research and innovation.
We are among the UK’s busiest, most successful foundation trusts. We provide specialist care for patients including heart and lung, cancer and renal services as well as a full range of local hospital and community services for people in Lambeth and Southwark.
We have a long tradition of clinical and scientific achievement and – as part of King’s Health Partners – we are one of England’s eight academic health sciences centres, bringing together world-class clinical services, teaching and research. We have one of the National Institute for Health Research’s biomedical research centres, established with King’s College London in 2007, as well as dedicated clinical research facilities.
Detailed job description and main responsibilities
1. To work autonomously, managing patient assessments within the specialty whilst working as part of the multidisciplinary team, delivering individualised and personalised direct patient care
2. To act in accordance with the extended role of the nurse and be competent in extended clinical skills including nurse prescribing, AED, Phlebotomy, Cannulation, IV Drugs, male and suprapubic catheterisation, ECG and Fine Bore Tube. Physical manual handling of patient, patient movement and the care of mechanical aides.
3. Act as an advocate for patients within the department, to ensure a patient orientated approach to the delivery of care and to meet standards within the NHS Plan and other relevant guidelines.
4. To be pivotal in encouraging and managing appropriate referrals, attending ward rounds, MDT and other meetings.
5. Ensure that patients receive high quality clinical care and a good patient experience, having regard for their social circumstances, customs, religious beliefs and doctrines.
6. Recognise and avoid situations that may be detrimental to the health and wellbeing of the individuals.
7. Co-ordinate the provision of specialist services to patients, both within hospital and/or in the community setting, effectively liaising with multidisciplinary colleagues
8. Direct, support, encourage and advise clinical, therapy and social care teams, by the provision of specialist knowledge and advice in the care of patients.
9. Participate in the promotion of patient-centred care, and establish and maintain a supportive relationship with the patient and their family during the period of assessment, treatment and transfer of care
10. Support and enable patients and carers to make informed decisions relating to their treatment and management.
11. Promote high quality clinical care, and assist in the development of the specialist service, through the use of evidence based practice, risk assessment and clinical standards.
12. Provide professional and clinical leadership and expertise in the speciality and to act as a resource for education and clinical expertise in the hospital and community settings.
13. Demonstrate appropriate expert practice and highly specialist advice in the assessment, planning, implementation and evaluation of patient care. This includes history taking, physical examination and the requesting of agreed diagnostic procedures/clinical investigations.
14. Responsible for the correct administration of prescribed medication.
15. Promote and deliver high standards of care at all times, which utilises research-based evidence, and is audited and improved accordingly.
16. Act as a role model, demonstrating high standards of care and providing clinical leadership in the specialist areas.
17. Establish, develop and maintain effective working relationship between clinicians, practitioners and managers within the specialty, across the Trust and KHP (King’s Health Partners).
18. Actively participate in local, national and international networking to maintain and develop expert level of knowledge in the specialty.
19. Provide a seamless, high quality service from referral through to assessment, diagnosis, treatment and review.
20. Develop and evaluate assessment tools that will ensure an appropriate level of nursing intervention so that patients who present with the most complex needs receive the most appropriate specialist care.
21. Work in conjunction with the clinical consultant to lead a patient focused service.
22. Act as patient advocate when appropriate, respecting patient confidentiality and privacy with respect for diverse cultural backgrounds and requirements.
23. To be designated to take charge of an area within the @Home service in the absence of the person holding continuing responsibility.
Please see attached job Description for full details
Person specification
Qualification and education
Essential criteria
24. RN1 on the NMC register
25. BSC/1st degree (health related) or equivalent qualification/training and experience
26. Masters degree or equivalent qualification/training and experience.
27. Advanced Clinical Assessment Skills Course or willing to undertake
28. Teaching/Mentorship courses
Desirable criteria
29. Understanding of current and evolving community and primary care services
30. Non Medical Prescriber
Previous experience
Essential criteria
31. e Experience of working autonomously at an advanced level within relevant service ( rapid response/acute/emergency or urgent care) delivering effective patient focused care.
32. Experience of working autonomously assessing, diagnosing and treating patients
33. Proven evidence of advanced organisational/leadership skills and autonomous practice
34. Experience of audit, research & evidence based care
35. Experience of delivering change management both personally and as a facilitator
Desirable criteria
36. Community/primary care experience Teaching and assessing
Skills Knowledge/ Ability
Essential criteria
37. Advanced clinical assessment and leadership skills in specialty. Decisive, able to make decisions quickly and be assertive.
38. Proven listening / counselling skills with the ability to manage complex situation and appropriately deliver sensitive and difficult outcomes
39. Evidence of teaching skills including teaching patients in how to manage their conditions
40. Ability to clinically lead & influence staff
Desirable criteria
41. Ability to interpret and Analyse complex data and findings
42. Undertaken clinical & Nursing research
Values and Behaviours
Essential criteria
43. Demonstrates good understanding and adherence to Trust's Values and Behaviours
Additional Information
Essential criteria
44. Ability to do home visits and supervise complex clinical situations/attend community based meetings and MDTs
45. Ability to be decisive, hold a considered opinion and to be assertive in the interest of patients and the service
46. Creative, lateral thinker
47. Sensitivity based on knowledge
Guy’s and St Thomas’ celebrates, respects and values the diversity of its staff and patients. We review our policies, procedures and practices to ensure that all employees, patients and carers are treated equitable according to their needs. We are actively committed to ensuring that no one who applies for a job, works or study’s at the Trust, or accesses our services is discriminated against on the grounds of race, ethnicity, nationality, disability, religion or belief, age, gender identity, gender reassignment, sexual orientation, pregnancy and maternity/paternity, or marital/civil partnership.