What matters to me, iswhat matters to us.
Calling all frailty-minded General Practitioners
Are you interested in older peoples care, frailty orpalliative care? Are you frustrated at not having the time or capability tosort out complex problems properly? Do you often get the feeling that you couldbe doing more to improve quality of care for our most experienced members ofsociety?
If so, come and find your tribe at the One Weston Care HomeHub in North Somerset, based at 168 Medical.
Pier Health Group aretransforming the care of older people. We have led this charge with thedevelopment of a centralised Care Home Hub, servicing the healthcare needs ofour 65 care homes. Yes, thats a lot, isnt it? We are hungry with ambition,and after our first year of success which saw us featured as a nationalexemplar, and our second year as finalists for a prestigious HSJ Award. Join our existing team of dynamic cliniciansin a multidisciplinary environment. This is no ordinary service; we are buildinga legacy for our population, and for our primary care workforce.
If you are tired of dealing withproblems on the day and not having time to address the real issues, if youare feeling increasingly lonely working in primary or community care andmissing the sense of team camaraderie, if you find yourself increasingly handsoff rather than hands on, then this is the job for you.
Main duties of the job
Each day startswith a whole team check-in either in person or via Microsoft Teams to check onwellbeing, discuss problems and ideas, share updates and to distributeworkload.
Clinical leadof the day is assigned during this meeting.
The GP may thenhave a ward round in a care home, be completing comprehensive geriatricassessments, producing care plans and ReSPECT forms, liaising with families andother partners such as hospitals or district nurses, or dealing with requestsfor acutely unwell care home residents. There is protected time for learningactivities, teaching, supervision, quality improvement work and meetings. Thiswork takes place via a variety of formats telephone, video, email and face toface. Career and personal development is promoted through regular 1:1 meetingswith the team leader.
About us
The One WestonCare Home Hub is a true multidisciplinary team, established in 2021, bringingtogether a range of allied health professionals and GPs to work towards acommon goal of improving care for care home residents in Weston Super Mare.Working alongside a friendly, dedicated team of GPs and allied healthprofessionals (pharmacists, community nurses, advanced nurse practitioners, aparamedic and a mental health nurse) this innovative project is transformingcommunity care in some of the most deprived wards in the country. Excellentadmin support enables clinicians to focus on clinical matters.
Job responsibilities
The role of theGP within the team is as follows:
Toprovide clinical assessment of care home residents, via a mix of preventative(proactive) and acute (reactive) medicine.
Toundertake holistic assessment of residents needs and devise creative solutions,utilising the skills of the MDT to best effect.
To produce a dynamic personalised care plan for healthcareprofessionals and care staff to follow, which includes treatment escalationplanning and a detailed, realistic ReSPECT form in keeping with the wishes ofpatients and their families where appropriate.
Toprovide continuity of care to resident, family and care home staff.
Toprovide senior clinical support for complex decision making, when clinical leadof the day.
Totake clinical responsibility for decisions and ongoing management of yourpatients, drawing on the skills of the MDT as needed.
Tocontribute to peer learning and education, via significant event analysis, casebased discussions and other formats.
Toprovide support, clinical advice, supervision and feedback to students andother members of the MDT.
Tobe actively involved in promoting adult safeguarding.
Toadvocate for high quality, appropriate, patient-centred care for older orvulnerable adults.
Record data and assessments in patient records systems promptlyand accurately and to agreed standards ensuring appropriate use of read codesand templates, with awareness of QOF targets and local DES specifications.
To compile and issue computer-generated acute and repeatprescriptions, prescribing in accordance with BNSSG prescribing formularywhenever this is clinically appropriate, working with our pharmacy hub.
To instigate necessary invasive and non-invasive diagnostic testsor investigations and interpret findings/reports at a level that is appropriatefor the patients degree of frailty and their treatment escalation.
Tocontribute and bring ideas for continuous improvement including developing / improvingcare pathways for older people and contributing to QIP and audit.
Toreview medication using a Structured Medication Review, alongside teampharmacists.
Leadand/or participate in specialist MDT meetings dementia/mental health,palliative care or complex care with support of the team and our communitymental health and geriatrician colleagues
Toprovide outreach input to cases in any of our care homes across the PCNidentified as in need, to support our team of ANPs working across Pier Health.This may be complex cases, a home recognised to be in difficulty or to supportour local safeguarding processes.
Person Specification
Qualifications
* Medical Degree
* MRCGP (or equivalent)
* Diploma of Geriatric Medicine
* MRCP
Skills
* Experience working with Frailty
* (includes holistic assessments of patients, history taking, problem listing and management plan formation)
* Risk holding in the community, patient clinical safety awareness
* IT literate (MS Teams, EMIS,MS office)
* Good interpersonal skills
* Effective time management
* (Planning and organising, prioritisation and handover)
* Excellent communication and interpersonal skills (including emotional intelligence to deal effectively with sensitive patient information, distressed or aggressive patients or those with impaired understanding)
* Resilience
* Influencing beyond your role; working with care home staff, owners, and managers
* Understands Mental Capacity Act and process for best interests decision- making
* Additional experience in:
* Palliative Care
* Mental Health
* Learning Disability
* Dementia
* Enhanced use of Microsoft Office suite, EMIS data searches,
* Power BI
* Evidenced Team leadership.
* Forward thinking and planning
Personal Qualities
* Planning and Organising
* Motivated and Proactive
* High degree of integrity
* Flexible and co-operative
* Ability to work and lead a team under pressure
Other Requirements
* Willingness to travel and work across community locations and in care homes
* Flexibility around working days and annual leave dates to ensure safe levels of clinical cover are maintained
Experience
* Experience of Multidisciplinary Working
* Knowledge of current clinical evidence-based practice
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.
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