NHS Greater Glasgow and Clyde (NHSGGC) is one of the largest healthcare systems in the United Kingdom, employing approximately 40,000 staff across a wide range of clinical and non-clinical professions and roles. We deliver acute hospital, primary, community and mental health services to a population of over 1.15 million people, and to a wider population of 2.2 million when regional and national services are included.
The role:
Renfrewshire HSCP has a diverse population of approximately 180,000 people and employs around 2000 WTE staff. Services managed include, Health Visitors, District Nurses, Allied Health Professionals, Addiction, Learning Disability Services, Palliative Care, Local Adult and Older Mental Health Services, Frailty Services.
The Hospital at Home Service is a short-term, targeted intervention that provides a level of acute hospital care in an individual’s own home that is equivalent to that provided within a hospital. This is to support acute hospital admission avoidance and early supported discharges aligned with the frailty pathway. The Renfrewshire model is based on the Scottish Government and HIS principles and Frailty Pathway
The broad aims of the service will be:-
1. Professional assessment and support decision making around optimum place of care
2. Service provision to address all levels of need, complexity and vulnerability
3. Shift in service delivery towards local community provision.
4. Development of patient centred pathways.
The role of health and community services within the HSCP is to:
5. Manage Council and NHS Health and Social Care services
6. Improve the health of the population and close the inequalities gap;
7. Keep people safe from harm
8. Deliver integrated health and social care services;
9. Achieve better specialist care through joint working with Acute services;
10. Achieve strong local accountability through involvement of the community, service users, community organisations and elected members;
11. Contribute to wider planning processes;
12. Work with 3rd sector and independent partners to deliver positive outcomes for service users;
13. Deliver agreed Single Outcome Agreement priorities and the national Strategic Priorities for Health & Social Care Integration
14. Contribute to ongoing work around the primary care framework.
There will also be a focus on prevention of admission from GP practice to Acute Services
The Frailty at the front Door service will exist to:
15. Provide a rapid-response using community MDTs to facilitate diversion away from GPs, Out of Hours services (OOH) and the Scottish Ambulance Service (SAS) and consequently maintain patients in the community
16. Provision of enhanced assessment capability within acute to identify and coordinate care for those patients living with frailty
17. Enhance the MDT acute/community interface;
18. Reduce length of stay for people living with frailty and provide support to enable them to live well and safely within the community.
19. Develop the use of digital solutions to support the MDT virtual hub and peer to peer advanced practitioner triage. This will support appropriate turnaround of presentations at the acute hospital and prevent unnecessary admissions.
Duration, Location, and Working Pattern:
Permanent, Full time
Shift Pattern - 8.30am to 4.30pm, Monday to Friday
Royal Alexandra Hospital
Key responsibilities:
Clinical
20. Undertake a comprehensive assessment of frailty positive patients (including screening and multi-professional baseline assessments) with a complex presentation using investigative skills, analysing clinical and non clinical information (i.e. social information, environmental) and to provide a functional diagnosis for individual patients to determine their need for Physiotherapy intervention, using formal assessment tools as appropriate.
21. Following assessment, act autonomously to assess, develop, implement and evaluate Physiotherapy interventions for a range of patients. This will include patients who have highly complex presentations and those with multi-factorial health and social needs, requiring multi-service/multi-agency input. Incorporate risk assessment to maximise functional independence and rehabilitation potential within a specialist area.
22. Provide specialist interventions based on a problem solving and advanced clinical reasoning approach. Deliver specialist interventions using a wide range of treatment techniques. Monitor, evaluate and modify treatment in order to measure progress and ensure effectiveness of intervention.i.e. frailty specific interventions, therapeutic handling techniques, functional rehabilitation, adaptation, specialist equipment provision and use, education and health improvement. Monitor, evaluate and modify treatment in order to measure progress and ensure effectiveness of intervention
23. Undertake a case coordination role taking responsibility for coordinating the interdisciplinary goal planning and discharge planning process. Liaise and work collaboratively with other agencies e.g. initiating referrals, sharing of information, recommending appropriate service delivery, attendance at case conferences and discharge planning. Balance the needs of a clinical caseload alongside case coordination duties in the management of service waiting times.
24. Assess for a range of equipment, e.g. orthotics and walking aids, providing appropriate equipment and referral onto other specialist services when required, e.g. Orthotics, Community OT, Equipu, Westmarc and Housing Dept. To be responsible for the care, advice regarding maintenance and issue and stock control of equipment.
25. Autonomously manage a professional caseload within the interdisciplinary service through efficient workload management and adjustment of service provision to meet changing priorities and ensure individual patients receive intervention timeously and appropriately.
26. Be professionally and legally accountable and responsible for all aspects of own work including direct and indirect patient care, complying with CSP and HCPC guidelines, national and local policies.
27. Maintain patient documentation records and accurate statistical information (including computerised systems) to reflect care provided and ensure this meets HCPC professional and service standards.
28. Apply a high level of understanding of the effect of frailty and disability and provide advice and support to both patients and their families/carers on lifestyle changes and adaptations to the patients’ social and physical environment taking into consideration the lifestyle, gender and cultural background.
29. Provide specialist advice and teaching to other members of the multidisciplinary team, external agencies e.g. social work, clients, carers and families regarding client management to ensure consistent approach to client care.
Managerial/Supervision
30. Take a coordinating role and be responsible for the day to day management and delivery of the Physiotherapy services in conjunction with the interdisciplinary service, as agreed with the Operational Team Leader. Undertake delegated managerial tasks on an infrequent basis as directed.
31. Delegate appropriate caseload, tasks and supervise Physiotherapists and less experienced staff, Rehabilitation Support Workers and students to achieve successful management of their assigned caseload. Participate in, and implement the AHP Clinical Supervision Policy, TURAS and Personal Development Plan to promote personal and service developments. Participate in the induction of new staff and students.
32. Contribute to identifying gaps and pressures within the service e.g staffing levels, and other resources available and discuss remedial action with the Operational Team Leader. Complete accurate activity information to reflect care provided. Contribute to the ongoing development of a robust framework to monitor and evaluate standards of care and clinical outcomes.
33. Actively lead identified areas within clinical effectiveness (such as audits, journal clubs, peer review and projects) to support the Physiotherapy health care governance agenda. Assist / cooperate in all matters necessary for the efficient management and development of the Frailty Service in accordance with Service Policy.
34. Induct rotational Physiotherapy staff and students and participate in the induction of new team members.
35. Assist the Operational Team Lead in recruitment and selection processes ensuring appropriate appointments to the service and retention of staff.
36. Ensure the Health & Safety Policy is adhered to, to maintain a safe working environment for patients and staff.
Educational and Research
37. Contribute to appropriate in-service training and provide specialist input to the Service in-service programme to promote continued personal and professional development of self and other staff.
38. Provide specialist advice, teaching or training to other members of the multi-disciplinary service, patients, carers and other agencies, (e.g. other health staff across GG&C, voluntary sector, social work, employment and educational establishments). Provide formal and