Job overview
Community Matrons team support patients with long term conditions and/or complex needs within their home. The team provide and coordinate clinical support for patients with long term conditions through holistic assessments and create treatment plans based on their assessment findings. The Community Matrons provide education to the patient, their family/carer relating to the patient’s specific condition(s) so that they may recognise times of exacerbation and be able to manage this in a more-timely safe manner. The main aims of the service are to avoid unnecessary hospital admissions or to facilitate a safe earlier discharge from hospital and to maintain patients as independently as possible in their home for as long as possible.
Main duties of the job
The suitable candidate to have continual responsibility for a caseload of patients which will encompass: admissions, assessments, prescription and evaluation of nursing care to a defined group of patients. This group of patients will include a caseload of patients with complex long term chronic conditions that will require
advanced specialist nursing skills and assessments. The post holder will be expected, in collaboration
with the patient, and/or carer, to produce an individualised ongoing patient management plan that may
require periodic adjustments. Community Matrons will be expected to case find their patients with chronic diseases, and proactively case manage these high-risk patients with complex needs, multiple co-morbidities and long-term conditions, to prevent unnecessary hospital admissions and to facilitate hospital discharge. The post holder will have the autonomy to act on behalf of the long-term condition patients, making differential diagnosis, prescribing treatments/investigations and/or referrals. Delegate work to team members as appropriate. Possess a high level of communication and interpersonal skills at inter-professional and inter agency levels to ensure that high standards of care pathways are maintained. Participate in decision making using the analytical skills required to be influential at all levels with regards to developments and changes within the service, and of care delivery on an individual basis.
Working for our organisation
The Humber Health Partnership is one of the largest acute and community Partnership arrangements in the NHS, seeing well over one million patients every year and managing a budget of over £1.3 billion.
Made up of two Trusts - Northern Lincolnshire and Goole NHS Foundation Trust (NLAG) and Hull University Teaching Hospitals NHS Trust (HUTH) - our Partnership has significant ambitions and is committed to delivering world-class hospital and community services for the 1.65 million people we serve.
Together we employ nearly 20,000 staff. Our five main hospital sites are Diana, Princess of Wales Hospital, Scunthorpe General Hospital and Goole and District Hospital, for NLAG and Hull Royal Infirmary and Castle Hill Hospital for HUTH.
As Teaching Hospitals working with the Hull York Medical School, we both lead and contribute to research in many areas - biomedical research, primary care, palliative medicine, cardiovascular and respiratory medicine, vascular surgery, cancer surgery and oncology.
We believe that by developing a diverse, inclusive, innovative, skilled and caring workforce, we can deliver excellent care to our patients and a great future for our employees, our Partnership and our community.
Detailed job description and main responsibilities
For more detailed information, please read the job description linked below.
As a Trust we are keen to offer and encourage flexible working opportunities to address health and wellbeing and work-life balance for our employees, this will have a positive impact on the care we provide.
Flexible working is part of a wider commitment to improve the quality and experience of working life and we recognise that it is a key contributor for the recruitment and retention of our employees.
We therefore support and encourage open conversations around a specific working pattern to suit your work-life balance or a multi-role career, if it works for you and works for the role, we'll do our best to make it happen.
Local flexible working arrangements are developed in partnership between the line manager and employee in order to ensure equality of access to flexible working, as far as practicable, regardless of role, shift pattern, team or pay, based on: patient/service user and staff experience, service delivery and work-life balance of colleagues.
We are committed to creating and maintaining a fair and supportive working environment and culture, where contributions are fully recognised and valued by all and staff feel empowered to carry out their duties to the best of their abilities. As employers we are committed to promoting and protecting the physical and mental health and well-being of all our staff. This underpins our values as set out in the NHS Constitution, supports us to be an Employer of Choice and ultimately enables our employees to support the effective care of our patients.
We strongly value the different perspectives and ideas a diverse workforce brings to deliver better outcomes for our patients. We welcome applications irrespective of people’s age, disability, sex, gender identity and gender expression, race or ethnicity, religion or belief, sexual orientation, or other personal circumstances.
In line with the General Data Protection Regulation (GDPR), the Recruitment & Workforce team will use and hold your personal data for the intended purpose and in line with the Recruitment & Workforce Privacy Statement.
“We are committed to safeguarding the welfare of children/vulnerable adults and expect the same commitment from all staff and volunteers”.
Please be aware that all new employees starting work with us will be charged for the cost of their DBS check, if it is required for their role. .
Person specification
Education/Qualification
Essential criteria
1. Adult NMC registered nurse
2. Diploma/ Degree in Community Health Studies/Chronic Disease/Long Term conditions management or equivalent, as determined by professional background.
Desirable criteria
3. Nurse Prescribing
Occupational experience
Essential criteria
4. Minimum of 5 years post registration experience in the relevant area
5. Caseload management experience
Desirable criteria
6. NHS Community experience
7. Service improvement / leading change experience
Employer certification / accreditation badges