The practitioner will utilise the national assessment tools and adhere to the required timescales, co-ordinate, participate and support the assessment process with the multidisciplinary team. To co-ordinate and undertake assessments. To collate information and assessments, gathered from other Health and Social Care professionals, patients and carers and make judgements using this information. Taking into account opinions from medical staff, consultants and specialist practitioners.
This may involve complex and sensitive health and social care issues, patients diagnosis and prognosis. To maintain appropriate written records and communicate information to all relevant parties whilst maintaining appropriate confidentiality of the patient record. To restore and maintain independence, promote individual choice and self determination, enabling clients to live in the community and supporting their preferences, whenever feasible. The use of Personal Health Budgets will assist in supporting this objective and will be delivered by the practitioner.
Maintaining a caseload of patients eligible for Funded Nursing Care and Fully Funded Continuing Healthcare, including the assessment and reviewing of all care provision. To educate, inform and involve clients carers and professionals on the National Framework for Continuing Health Care and NHS Funded Nursing Care and matters of local service provision. To be actively involved in complaint investigations assisting the Lead Nurse and Head of Service as required. Contribute in the response to appeals supporting the Lead Nurse in completing needs portraits and attending both local and regional appeal panels.
Ensure the Head of Department, Lead Nurse and the Commissioning team are kept fully aware of any cause for concern in any care environment; liaising as required with the ICB Quality Team. Be aware of the safeguarding vulnerable adults policy and procedure and attend multidisciplinary meeting as required. To maintain registration, skills and knowledge including an awareness of policies, procedures, legislation laid out by the relevant professional bodies. Work within the clinical guidelines and policy guidelines relevant to practice.
Participate in research, audit, clinical and peer supervision on a regular basis to develop appropriate personal objectives and a lifelong learning plan To develop and maintain multi professional/agency networks representing the ICB. Responsible for the teaching and dissemination of information to students, social care staff, health professionals, and independent sector about NHS Continuing Care and Funded Nursing Care Contributions, on an individual and group basis. To prioritise and manage caseloads, under the direction of the Lead Nurse. To contribute to the effective running of the department, deputising for colleagues and Lead Nurse.
To call, attend or lead team meetings, continuing care meetings and multi-disciplinary meetings, including case conferences and discharge meetings to ensure continuity of care across agencies; thus, improving patient and family experience. To promote effective working arrangements with care homeowners, social services, community nursing and acute sector staff. To undertake and comply with all mandatory training. To undertake any other duties commensurate with the grade and responsibilities of the post.