Weseeka dedicated and skilled Specialist Ageing Well Practitionerto join outProactive Ageing Well Service (PAWS)until March 2027.The purpose of the service is to proactively assess thoseliving withfrailty,complete the medical and specialist nursing domain of the Comprehensive Geriatric Assessment andcreate patient centred plans of care, ensuring the person is linked into the wider community MDTin order toImprove symptoms of frailty, reduce disease burden and avoid unnecessary admissions to hospital.
Main duties of the job
The purpose of the Ageing Well Practitioner role is to deliver comprehensiveassessmentsand support to older adults within the community as part of the Proactive Ageing Well Service (PAWS). The practitioner willuse casefindingtools and pre-assessmentstoidentifythose who would benefit most from proactive Comprehensive Geriatric Assessments (CGA)toensure they receive coordinated care from the wider community multidisciplinary team (MDT). Bydeterminingpatient priorities andcommencingfuture care planning, this role aims to prevent unnecessary hospital admissions andmaintaincare in the individual's preferred environment. This position is integral to enhancing the quality of life for older adults through proactive, preventative, and patient-centredcare.
About us
Our people are our greatest asset. When we feel supported and happy at work, this positivity reaches those very people we are here for, the patients. Engaged employees perform at their best and our Equality, Diversity & Inclusion (EDI) initiatives contribute to cultivate a culture of engagement. We have four staff networks, a corporate EDI Team and a suite of programmes and events which aim to insert the 5 aspirations:
* Improving representation at senior levels of staff with disabilities, from black, Asian, and ethnic minorities background, identify as LGBTQ+ and women, through improved recruitment and leadership development
* Widening access (anchor institution) and employability
* Improving the experience of staff with disability
* Improving the EDI literacy and confidence of trust staff through training and development
* Making equalities mainstream
Job responsibilities
Expert Clinical Practice:
Identifyolder adults who wouldbenefitfrom proactive Comprehensive Geriatric Assessment (CGA) within the borough of Lewisham;
Provide a level ofenhancedand comprehensive geriatric assessment, based ona specialist body of knowledge.To appropriately assess, examine, investigate,diagnoseand treat patients, resulting in safe management andappropriate referral
Order and interpret investigations and act on resultswithappropriate supervision.
Manage patientswithin own case load andpresent care plans tothe MDT.
Carry out comprehensive medication reviewsandmake suggestions for changes in conjunction with the persons GP(if inpossession of prescribing qualification).
Take the lead in advance care planning conversations, ensuring that patients and their families understand their options, uncovertheir goals and work with the patient and family towards achieving them.
Provide education and support to patients, families, and caregivers about managing conditions associated withco-morbidities andageingutilisingcommunityresourceswhen it falls outside the scope of the PAWS scope.
To contribute to the development and improvement of systems and processes thatfacilitatespatient flow
To improve the quality of the patient experience byidentifyingand meeting the individual clinical needs of patients
To rigorously review all aspects of the patients care planandidentifyand address issues that may result in a sub-standard service
Contribute to the review and development of integrated care pathways and clinical guidelines toensure a standardised approach
Practice with confidence and competence within your professional guidelines and code of conduct (NMC/HCPC/GPhC).
Maintain own clinical development by keeping abreast of new treatments and technologies within frailty andolderpersonscare
To ensure thataccuratedocumentation and records of patient care are kept.
Ability to adapt specialist clinical knowledge and skills to different clinical settings and influence service delivery and patient care
Activelyparticipateineffective systems and processes for infection control management and relevantaudit within the clinical area
Utilise anddemonstratehighlysensitivecommunication styles, to ensure patients are fully informed and consent to treatment.
Communicate patients conditions verbally and in writing to other members of the health care team and contribute to thedecision-makingprocesses in patient management. Act as an advocate for patients and colleagues.
Ensure awareness of sources of support and guidance e.g., patient liaison service, and provide information inan accurateformat to all patients.
Be able toanticipatebarriers to effective communication andtake action to improvecommunication.
Managementand Leadership:
Participate in the development ofthePAWS teamand actandfacilitatechange with aninnovative and adaptableapproach
Tocontribute toevidence-basedpolicies and procedures specifically required by thePAWSteam
Maintain effective communication with the multidisciplinary team to ensurehigh standardsof care
To work collaboratively with representatives of other clinical areas,disciplinesand services to provide aseamless pathwayof care
To be conversant with all Trust policies and procedures torepresentthe Trustat specialist forums.
Adhere to confidentiality at all timeswith sensitive personal data
Prioritise, organiseand managefrailty workload.
Education andPracticeDevelopment:
To helpidentify,planand implement goals for clinical development of staff working within thePAWSteam
Toreflect and discuss areas of practice with seniorservice lead and Community Geriatrician.
Toparticipatein teaching programmes for nursing,medicaland allied health professional staff of all grades.
To maintainclose links withhigher educationand toparticipatein the development and delivery of new and established specialistolderadultpracticeprogrammes.
Toexhibita personal commitment to clinical education and development.
Participates in shared learning across the division and wider organisation.
Service Improvementand Performance:
In collaboration with theMDTparticipateinPAWSservice development and projects
To work with administrative and clinical staff to achieve sustained improvements, including in the following areas:clinical quality,patient satisfaction and meeting local andnational targets
Participate inservice improvement initiatives and associated work streams to support specific patient pathways.
To ensure that the services meet pathway targets
Audit and Research:
Contribute andassistin the development of multidisciplinary research and clinical audit in a frailty setting
Participate and contribute to any on-going regional and national research to evaluate the effectiveness of care strategies related to the patient experience
To share best practice; through publications and attendance/presentation opportunities at conference level
Resource Management
To apply sound financial evaluation to proposed service developments.
Maintainaccuraterecords in relation to equipment used.
To ensure that the systems are in place to manage, reduce and prevent clinical risk to self and others.
Tomonitorincidents highlighted by members of the team and communicate toappropriate areasto address risk issues.
Promote best practice in health and safety, in line with Trust policy.
Person Specification
Training & Qualifications
* Registered healthcare professional (NMC registered nurse, HCPC registered therapist or Pharmacist).
* Education to Masters level or equivalent experience.
* Evidence of continuing professional development.
* Advanced Assessment Qualification.
* Care of the older adult qualification.
Experience
* Significant Experience of working in frailty or with older adults
* Experience of completing Comprehensive Geriatric Assessment;
* Experience in Advance Care Planning with a compassionate and patient centred approach
* Experience of teaching in clinical practice
* Experience of using appropriate clinical assessment tools.
* Evidence of innovative practice.
* Understanding of current issues, policies and frameworks and how they affect clinical services.
* Experience of working in a community setting.
* Participation in Audit
Knowledge & Skills
* Excellent organisational skills and ability to prioritise and work to deadlines
* Understanding of the issues pertaining to clinical risk management.
* Engaging effectively across boundaries, while operating in partnership with stakeholders.
* Experience of community IT systems - RiO
Personal Qualities
* Commitment to ongoing lifelong learning and personal development and motivation riven by a genuine interest and concern for the quality and appropriateness of patient services.
* Demonstrate an understanding of the need to involve patients and carers in decision making, offering them informed choices, respecting their views
* Willingness to travel independently to see patients with a Lewisham GP and ability adapt to service changes and requirements
* Have access to own vehicle and car driver
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.
£49,387 to £56,515 a yearper annum pus HCA
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