Frailty Team Senior Clinical Practitioner
This job is now closed
Job summary
Job Purpose
The successful candidate will work under the clinical supervision of the Frailty Team ACPs and GPs, predominantly visiting patients in their own homes, as well as patients in the care homes to assess a variety of health conditions.
The team base is at Maple View Medical Practice and the core hours will be Monday Friday 0800 1600 hours, which aids a good work life balance. On occasion you may be required to work additional hours to suit the needs of the team.
Main duties of the job
Main duties of the job
Behave consistently with the values and beliefs of the organisation and promote these on a day-to-day basis.
Act as a role model to colleagues, always seeking to maintain the highest standards of professionalism.
Use their initiative and take responsibility for themselves and the quality of their work and the service they provide to patients.
Act as a source of nursing expertise, knowledge and skills in accordance with the NMC scope of practice.
Undertake clinical assessment of patients in their own homes, or registered Care Homes who have complex and or chronic disease presentations. This includes screening patients for disease risk factors and early signs of illness, making a differential diagnosis and prescribing treatments as an independent non-medical prescriber.
Assess those that are high risk of admission into an acute hospital setting with a view to reduce unplanned admissions and A&E attendances.
Be professionally accountable for the assessment, planning, implementation and evaluation of care which is evidence based.
Maintain records as an autonomous practitioner liaising closely with the frailty team ANPs and patients medical practitioner.
Work collaboratively and cooperatively with clinical colleagues to develop integrated care services and quality of care delivered.
About us
Kingfisher PCN
Kingfisher Primary Care Network (PCN) is a collaboration between 5 GP partnerships (across 6 sites) in Redditch Town with a shared population of 58,955. Kingfisher has an overarching ambition to innovate general practice and build a sustainable model for general practice for the future. Kingfisher PCN practices have a mature relationship and a proven track record of effectively working together.
One of the successes of Kingfisher PCN has been the introduction of the Frailty Team. Led by Frailty Team ACPs and working alongside GPs for clinical supervision and support. The initial focus for the Frailty Team is to fulfil the requirements of the National PCN Enhanced Health in Care Homes Service Specification. This has now expanded and our exciting new development within the team is offering holistic home assessments to frail people within their own homes.
Details
Date posted
06 January 2025
Pay scheme
Other
Salary
Depending on experience
Contract
Permanent
Working pattern
Full-time
Reference number
A1883-25-0000
Job locations
Churchill Centre
Tanhouse Lane
Redditch
Worcs
B98 9AA
Job description
Job responsibilities
Job responsibilities
Clinical
Participate in the clinical assessment of patients referred with complex, urgent or chronic health care needs. This involves using critical judgement and health assessment skills in providing the most appropriate care pathway.
Following clinical assessment and diagnosis, support care management plans with pharmacological and non-pharmacological treatment methods.
In collaboration with the frailty ANPs prioritise health care needs and refer for diagnostic investigations.
Develop, implement and evaluate individual plans of care with patients and their carers/relatives according to their current and changing health care needs.
Participate in MDT discussion to facilitate high quality, safe, effective care.
Independently prescribe and review medications for therapeutic effectiveness, appropriate to patient need and in accordance with evidence-based practice and national and local policy and protocols.
Work within appropriate legislation, policies and best practice evidence relevant to clinical area.
Initiate and review ReSPECT documents as required with patients and where appropriate their carers/relatives.
Demonstrate critical thinking and analytical skills incorporating critical reflection.
Administrative
Collect, collate, evaluate and report patient information, maintaining accurate and contemporaneous records.
Input data daily on EMIS patient administration systems.
Managerial
Monitor health, safety and security of self and others in the community.
Participate in root cause analysis for clinical/quality issues.
Participate in identifying innovation that culminates in service improvement.
Demonstrate the use of negotiation and influencing skills.
Demonstrate the ability to use skills aligned to digital advances in healthcare delivery
Training, Research and Development
Provide education and development opportunities for others.
Develop your own expert clinical knowledge and participate in the continuous development of yourself and others.
Demonstrate clinical knowledge through mentorship in conjunction with other health care professionals.
Ensure own compliance with regard to mandatory training and advanced continuous professional development requirements for registration with the NMC.
Be involved in audit and service evaluation.
Physical Resources
Ensure effective and efficient use of physical resources.
Safeguarding
Within their sphere of competence, all staff are responsible for promoting and safeguarding the welfare of the children, young people and/or vulnerable adults for whom they are responsible or may come into contact with in the job role.
Human Resources
Participate in the process of induction of new staff in conjunction with the rest of the frailty team.
Assist in the education, training, supervision and support of frailty team colleagues, junior staff and students.
Health and Safety
All members of staff are responsible for ensuring that they work in such a way as to ensure their own health and safety and that of other staff, clients, patients and members of the public.
All staff will be required to comply with regulations relating to the Health and Safety at Work Act and Infection control.
Control of Infection
Kingfisher PCN is firmly committed to reducing Healthcare Associated Infection. All staff must work to the Hand Hygiene Guidance, Infection Prevention and Control Policies, Procedures and Guidance relevant to their area of work and undertake the necessary training.
Physical Effort Manoeuvring of equipment, working in restricted positions / environments, moving and handling of clients, fine motor skills / dexterity in treatment techniques, driving skills. Mental Effort
Assessment and evaluation of patients including differential diagnosis and analysis of condition / situation. Use of clinical reasoning skills to decide on best options of techniques and interventions/ care planning. Requirement to provide rapid response assessment when necessary, with the ability to offer solutions and advice immediately.
Emotional Effort
Patients are often upset due to chronic pain, fear and frustration and need empathy and compassion. Emotional support needs to be given where unwelcome news regarding prognosis or recovery prospects is discussed. Relatives and carers also need emotional support and advice.
Working Environment / Conditions
Every hands-on contact with the patient has the potential for coming into contact with bodily fluids, especially blood, vomit or sputum. Poor personal hygiene on the part of the patient can make working conditions difficult, as patients are often required to at least partially undress.
Abusive or aggressive behaviour may be experienced due to patient fear, pain, frustration or cognitive functioning.
Training and personal development
All staff have a responsibility to participate in regular appraisal with their manager/team leader, where there is a joint responsibility to identify any training and development needs.
All staff have a responsibility to undertake statutory and mandatory training as deemed appropriate by Kingfisher PCN.
Every effort is made to provide statutory and mandatory training by a variety of methods and in a variety of settings and times. However, there is an expectation that as a condition of employment, staff may need to attend training sessions that may fall outside their normal working hours.
Communication and Liaison
Work with both clinical and administrative staff to ensure the smooth running of services reporting any problems encountered to the relevant person and ensuring everyone is aware of the different roles within the PCN
There is also the need to establish and maintain good liaison with all the practices in the network and agencies, including secondary care
Communicate complex patient related information effectively to ensure integrated care working across health, social, private, charitable and voluntary care sectors.
Communicate effectively with patients and carers from all cultures. This will frequently involve communicating using verbal and non- verbal methods with patients who have complex physical, emotional or psychological conditions.
Ensure high standards of patient care ensuring all patients' individuality and dignity are maintained at all times.
Facilitate open and harmonious communication amongst all staff within the team as well as with other departments with the aim of promoting multidisciplinary approaches to care.
Support others to develop knowledge and skills.
Develop and promote a learning environment.
Analysis and Judgment
Demonstrate critical thinking in the clinical decision-making process.
With the support of the frailty ANPs analyse the clinical history and interpret the presenting symptoms along with physical examination findings to reach a differential diagnosis.
Recognise the limits of your own scope of professional practice.
Planning and Organisation
Assist in any delegated duties that may be required to ensure the smooth running and efficiency of the frailty team.
Physical Skills
Fine motor skills / dexterity in treatment techniques, IT skills.
Driving skills to meet the travel requirements of the post
Policy and Service Development
Ensure compliance with policies, procedures, protocols and clinical guidelines for self and others and participate in the development of evidence-based practice.
Participate in developing clinical policies and guidelines for self and others based on evidence-based practice.
Continually monitor standards of care and participate in the improvement of care, through benchmarking, audit and research.
Work collaboratively and co-operatively with clinical colleagues to develop integrated care services and quality of care delivered.
Participate in the education, training and development of other integrated care team staff.
Promote patient and public involvement activities in integrated care working, leading to service improvements.
Promote peoples equality, diversity, rights and choice.
Personal/Professional development:
The post-holder is required to maintain membership of an appropriate professional body and will participate in any training programme implemented by the PCN as part of this employment, such training to include:
Provide education and development opportunities for others.
Develop your own expert clinical knowledge and participate in the continuous development of yourself and others.
Demonstrate clinical knowledge through mentorship in conjunction with other health care professionals.
Ensure own compliance with regard to mandatory training and advanced continuous professional development requirements for registration with the NMC.
Be involved in audit and service evaluation.
Quality:
The post-holder will strive to maintain quality within the practices that are part of the network, and will:
Alert other team members to issues of quality and risk
Assess own performance and take accountability for own actions, either directly or under supervision
Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance
Work effectively with individuals in other agencies to meet patients need
Effectively manage own time, workload, and resources
Confidentiality:
In line with the common law duty of confidence (confidentiality), staff must at all times maintain confidentiality on information gained in the course of their duties. This may well include access to personal confidential data relating to service users and Trust staff. Staff should be aware that their activity in dealing with personal confidential data can be monitored and recorded. This includes both digital access and physical access.
Job description
Job responsibilities
Job responsibilities
Clinical
Participate in the clinical assessment of patients referred with complex, urgent or chronic health care needs. This involves using critical judgement and health assessment skills in providing the most appropriate care pathway.
Following clinical assessment and diagnosis, support care management plans with pharmacological and non-pharmacological treatment methods.
In collaboration with the frailty ANPs prioritise health care needs and refer for diagnostic investigations.
Develop, implement and evaluate individual plans of care with patients and their carers/relatives according to their current and changing health care needs.
Participate in MDT discussion to facilitate high quality, safe, effective care.
Independently prescribe and review medications for therapeutic effectiveness, appropriate to patient need and in accordance with evidence-based practice and national and local policy and protocols.
Work within appropriate legislation, policies and best practice evidence relevant to clinical area.
Initiate and review ReSPECT documents as required with patients and where appropriate their carers/relatives.
Demonstrate critical thinking and analytical skills incorporating critical reflection.
Administrative
Collect, collate, evaluate and report patient information, maintaining accurate and contemporaneous records.
Input data daily on EMIS patient administration systems.
Managerial
Monitor health, safety and security of self and others in the community.
Participate in root cause analysis for clinical/quality issues.
Participate in identifying innovation that culminates in service improvement.
Demonstrate the use of negotiation and influencing skills.
Demonstrate the ability to use skills aligned to digital advances in healthcare delivery
Training, Research and Development
Provide education and development opportunities for others.
Develop your own expert clinical knowledge and participate in the continuous development of yourself and others.
Demonstrate clinical knowledge through mentorship in conjunction with other health care professionals.
Ensure own compliance with regard to mandatory training and advanced continuous professional development requirements for registration with the NMC.
Be involved in audit and service evaluation.
Physical Resources
Ensure effective and efficient use of physical resources.
Safeguarding
Within their sphere of competence, all staff are responsible for promoting and safeguarding the welfare of the children, young people and/or vulnerable adults for whom they are responsible or may come into contact with in the job role.
Human Resources
Participate in the process of induction of new staff in conjunction with the rest of the frailty team.
Assist in the education, training, supervision and support of frailty team colleagues, junior staff and students.
Health and Safety
All members of staff are responsible for ensuring that they work in such a way as to ensure their own health and safety and that of other staff, clients, patients and members of the public.
All staff will be required to comply with regulations relating to the Health and Safety at Work Act and Infection control.
Control of Infection
Kingfisher PCN is firmly committed to reducing Healthcare Associated Infection. All staff must work to the Hand Hygiene Guidance, Infection Prevention and Control Policies, Procedures and Guidance relevant to their area of work and undertake the necessary training.
Physical Effort Manoeuvring of equipment, working in restricted positions / environments, moving and handling of clients, fine motor skills / dexterity in treatment techniques, driving skills. Mental Effort
Assessment and evaluation of patients including differential diagnosis and analysis of condition / situation. Use of clinical reasoning skills to decide on best options of techniques and interventions/ care planning. Requirement to provide rapid response assessment when necessary, with the ability to offer solutions and advice immediately.
Emotional Effort
Patients are often upset due to chronic pain, fear and frustration and need empathy and compassion. Emotional support needs to be given where unwelcome news regarding prognosis or recovery prospects is discussed. Relatives and carers also need emotional support and advice.
Working Environment / Conditions
Every hands-on contact with the patient has the potential for coming into contact with bodily fluids, especially blood, vomit or sputum. Poor personal hygiene on the part of the patient can make working conditions difficult, as patients are often required to at least partially undress.
Abusive or aggressive behaviour may be experienced due to patient fear, pain, frustration or cognitive functioning.
Training and personal development
All staff have a responsibility to participate in regular appraisal with their manager/team leader, where there is a joint responsibility to identify any training and development needs.
All staff have a responsibility to undertake statutory and mandatory training as deemed appropriate by Kingfisher PCN.
Every effort is made to provide statutory and mandatory training by a variety of methods and in a variety of settings and times. However, there is an expectation that as a condition of employment, staff may need to attend training sessions that may fall outside their normal working hours.
Communication and Liaison
Work with both clinical and administrative staff to ensure the smooth running of services reporting any problems encountered to the relevant person and ensuring everyone is aware of the different roles within the PCN
There is also the need to establish and maintain good liaison with all the practices in the network and agencies, including secondary care
Communicate complex patient related information effectively to ensure integrated care working across health, social, private, charitable and voluntary care sectors.
Communicate effectively with patients and carers from all cultures. This will frequently involve communicating using verbal and non- verbal methods with patients who have complex physical, emotional or psychological conditions.
Ensure high standards of patient care ensuring all patients' individuality and dignity are maintained at all times.
Facilitate open and harmonious communication amongst all staff within the team as well as with other departments with the aim of promoting multidisciplinary approaches to care.
Support others to develop knowledge and skills.
Develop and promote a learning environment.
Analysis and Judgment
Demonstrate critical thinking in the clinical decision-making process.
With the support of the frailty ANPs analyse the clinical history and interpret the presenting symptoms along with physical examination findings to reach a differential diagnosis.
Recognise the limits of your own scope of professional practice.
Planning and Organisation
Assist in any delegated duties that may be required to ensure the smooth running and efficiency of the frailty team.
Physical Skills
Fine motor skills / dexterity in treatment techniques, IT skills.
Driving skills to meet the travel requirements of the post
Policy and Service Development
Ensure compliance with policies, procedures, protocols and clinical guidelines for self and others and participate in the development of evidence-based practice.
Participate in developing clinical policies and guidelines for self and others based on evidence-based practice.
Continually monitor standards of care and participate in the improvement of care, through benchmarking, audit and research.
Work collaboratively and co-operatively with clinical colleagues to develop integrated care services and quality of care delivered.
Participate in the education, training and development of other integrated care team staff.
Promote patient and public involvement activities in integrated care working, leading to service improvements.
Promote peoples equality, diversity, rights and choice.
Personal/Professional development:
The post-holder is required to maintain membership of an appropriate professional body and will participate in any training programme implemented by the PCN as part of this employment, such training to include:
Provide education and development opportunities for others.
Develop your own expert clinical knowledge and participate in the continuous development of yourself and others.
Demonstrate clinical knowledge through mentorship in conjunction with other health care professionals.
Ensure own compliance with regard to mandatory training and advanced continuous professional development requirements for registration with the NMC.
Be involved in audit and service evaluation.
Quality:
The post-holder will strive to maintain quality within the practices that are part of the network, and will:
Alert other team members to issues of quality and risk
Assess own performance and take accountability for own actions, either directly or under supervision
Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance
Work effectively with individuals in other agencies to meet patients need
Effectively manage own time, workload, and resources
Confidentiality:
In line with the common law duty of confidence (confidentiality), staff must at all times maintain confidentiality on information gained in the course of their duties. This may well include access to personal confidential data relating to service users and Trust staff. Staff should be aware that their activity in dealing with personal confidential data can be monitored and recorded. This includes both digital access and physical access.
Person Specification
Qualifications
Essential
- Registered Nurse Level 1
- Degree
- Non-Medical Prescribing (V300)
- Advanced Assessment Skills Module (Masters level)
- Evidence of portfolio of knowledge, skills and professional development
Desirable
- Mentorship or teaching qualification
- Qualification(s) in long term conditions
Values and Behaviours
Essential
- Put patient care at the heart of the work you do to improve health care outcomes and service delivery
- Deliver the highest standards and quality outcomes possible
- Be the best you can be, always look for ways to improve and develop to reach your potential
- Encourage others to develop themselves and the service through improvement, innovation and continuous development
- Joint working with others, e.g. patients, colleagues in the delivery of high-quality healthcare
- Build positive working relationships, respecting and valuing others, being helpful and inclusive
Skills and Abilities
Essential
- Ability to challenge poor behaviour
- Role modelling good behaviour
- A positive attitude and able to act on feedback
- Ability to communicate clearly and effectively in English in both verbal and written formats
- Advanced clinical assessment and clinical skills
- Advanced interpersonal and communication skills at multi-
- disciplinary level
- Ability to prioritise workload effectively
- Computer and keyboard skills at intermediate level or above
- Ability to work with minimal supervision
- High-level problem-solving skills Solution focused
- Teaching skills
- Able to make decisions autonomously
Experience
Essential
- Demonstrable post-graduate experience in a relevant area
- post-graduate experience in a role undertaking assessments of complex needs
- Experience of working with people with long-term illness and
- / or older people
- Clinical experience of caring for people with cognitive impairment
- Experience of working across professional boundaries
- Experience of working in the community setting
Other Qualities
Essential
- Ability to work flexibly
- Ability to influence and negotiate
- Able to meet the travel requirements of the role
Knowledge
Essential
- Advanced clinical skills and knowledge base
- Understanding of professional and current issues in elderly / community care.
- Demonstrate an understanding of clinical governance
- Understanding of the Mental Capacity Act 2005
Person Specification
Qualifications
Essential
- Registered Nurse Level 1
- Degree
- Non-Medical Prescribing (V300)
- Advanced Assessment Skills Module (Masters level)
- Evidence of portfolio of knowledge, skills and professional development
Desirable
- Mentorship or teaching qualification
- Qualification(s) in long term conditions
Values and Behaviours
Essential
- Put patient care at the heart of the work you do to improve health care outcomes and service delivery
- Deliver the highest standards and quality outcomes possible
- Be the best you can be, always look for ways to improve and develop to reach your potential
- Encourage others to develop themselves and the service through improvement, innovation and continuous development
- Joint working with others, e.g. patients, colleagues in the delivery of high-quality healthcare
- Build positive working relationships, respecting and valuing others, being helpful and inclusive
Skills and Abilities
Essential
- Ability to challenge poor behaviour
- Role modelling good behaviour
- A positive attitude and able to act on feedback
- Ability to communicate clearly and effectively in English in both verbal and written formats
- Advanced clinical assessment and clinical skills
- Advanced interpersonal and communication skills at multi-
- disciplinary level
- Ability to prioritise workload effectively
- Computer and keyboard skills at intermediate level or above
- Ability to work with minimal supervision
- High-level problem-solving skills Solution focused
- Teaching skills
- Able to make decisions autonomously
Experience
Essential
- Demonstrable post-graduate experience in a relevant area
- post-graduate experience in a role undertaking assessments of complex needs
- Experience of working with people with long-term illness and
- / or older people
- Clinical experience of caring for people with cognitive impairment
- Experience of working across professional boundaries
- Experience of working in the community setting
Other Qualities
Essential
- Ability to work flexibly
- Ability to influence and negotiate
- Able to meet the travel requirements of the role
Knowledge
Essential
- Advanced clinical skills and knowledge base
- Understanding of professional and current issues in elderly / community care.
- Demonstrate an understanding of clinical governance
- Understanding of the Mental Capacity Act 2005
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.
UK Registration
Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).
Additional information
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.
UK Registration
Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).
Employer details
Employer name
Maple View Medical Practice
Address
Churchill Centre
Tanhouse Lane
Redditch
Worcs
B98 9AA
Employer's website
Employer details
Employer name
Maple View Medical Practice
Address
Churchill Centre
Tanhouse Lane
Redditch
Worcs
B98 9AA
Employer's website
Employer contact details
For questions about the job, contact:
Helen Abdullah
Details
Date posted
06 January 2025
Pay scheme
Other
Salary
Depending on experience
Contract
Permanent
Working pattern
Full-time
Reference number
A1883-25-0000
Job locations
Churchill Centre
Tanhouse Lane
Redditch
Worcs
B98 9AA
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