Overview
The post holder will work as part of a multi-professional team managing a GP-aligned caseload of patients in the community, ensuring the needs of the patients are identified and met. Promoting the independence of patients, assisting them to maintain or improve their own physical, psychological and social wellbeing. To ensure that the service we deliver is adaptable and resilient, commercially focused and creates innovative solutions to enhance the patient experience. Please note all candidates must have their own car with the correct insurance to be able to work.
Responsibilities
* To work as part of a community integrated service that is responsive to the needs of housebound patients within a defined caseload.
* To reduce inappropriate hospital admissions, minimise hospital lengths of stay and support vulnerable clients at home by undertaking comprehensive holistic assessment and care plans in order to facilitate and coordinate packages of care in partnership with GPs, patients, health and social care colleagues.
* Work closely with aligned GP surgery, Clinical Commissioning Group and all relevant primary and secondary care and social care professionals, voluntary agencies and The London Ambulance Service.
* Act as an autonomous practitioner, working with the support of Senior Team Members.
* Provide high quality, comprehensive holistic assessment (including physical assessment) and treatments for patients and their families referred to the service utilising a Single Assessment Process to achieve person centred care.
* Provide assessments of risk and complex situations as required, utilising knowledge and skills to interpret and make accurate analysis of patients\' and carers\' needs.
* To work closely and communicate effectively with all members of the Primary Health Care team, ensuring attendance at GSF/MDT, participating in multidisciplinary working with internal and external agencies and partners.
* Manage the assessment, risk assessment, supply, review and safety of equipment used to support nursing care in the homes of patients.
* Assist in the professional development of junior team members with the support of the Nursing Team Sister.
* Maintain clear, concise and up-to-date records of care. Undertake data collection as required by the Clinical Commissioning Groups.
* Comply with the obligation to maintain data through RiO.
* Provide patients and carers with details of health care information and how they may access services. Act as a patient advocate, if required.
* Be proactive in offering health promotion and participate in health promotion activities, including health needs assessment for the caseload and local population.
* To participate in clinical supervision, appraisal and in-service training as identified on own personal development plan.
* To respond to complaints as delegated by the locality Sister.
* Supervise pre-registration students allocated to the team, providing mentorship and leadership as and when required.
* To contribute to the development of new nursing knowledge and support the implementation of evidence based practice using audit and other tools including user and stakeholder feedback.
* To keep a personal professional profile of study in line with NMC requirements.
* To identify own training needs to maintain and develop clinical skills and practice in line with NMC Fitness to Practice.
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