Community GP

Job responsibilities

KEY DUTIES AND RESPONSIBILITIES

1. Provide day-to-day clinical leadership to provide proactive and reactive general medical services to the housebound population, including those in are homes, in collaboration with registered practices where appropriate;

2. Promote and deliver a multi-skilled team response that includes GP Acute Home Visits, holistic assessment, care, pro-active follow up and care planning;

3. Contribute to the development of the Acute Home Visiting and Community Urgent Response Service.

4. Deliver an efficient, high quality, multi-disciplinary Acute Home Visiting and Community Urgent Response Service to people who have an urgent need that is best provided in their own home, or wherever they call home;

5. Ensure that the Acute Home Visiting and Community Rapid Response Service that supports and links well to system infrastructure provided at a bigger scale e.g. Acute Hospitals, 999, 111, Ambulance services;

6. Ensure Acute Home Visiting and Community Urgent Response Service that links well to routine and proactive services;

7. Developing expertise within the community for improving the lives of people living with frailty;

8. Promoting the use of supportive, non-statutory services to support self-care and social prescribing agendas;

9. Maximize best care in the patients own home in order to reduce the need for hospital or care home admissions;

10. Ensure that the care and support people receive is based on their wishes, preferences and aspirations, particularly towards the end of their lives;

11. Provide medical expertise in the management of older people living with frailty in the defined community. To support ACPs and wider MDT members working in the community by:

Providing Senior GP clinical triage for all Acute Home Visit requests to determine the urgency and type of response needed, according to clinical need.

• Regular debrief sessions for patients on their caseload.
• Lead and support the ACPs in their role in the MDT
• Deliver formal and informal education for the ACPs during clinical interactions
• Advising on complex clinical situations including;

Complex prescribing decisions,

Where there are difficult clinical risk decisions.

Where there is disagreement between professionals, patients or their carers.

Diagnosis is uncertain

Identification of end of life is difficult;

12. Liaison with GPs and frailty unit when needed;

13. Lead and engage in MDT and other team meetings, and quality improvement activities.

14. Contribute to the development and implementation of new care pathways, systems and processes to support the service delivery;

15. Contribute towards the development and implementation of new standards, policies and procedures;

16. Advise local GP practices within the defined population to implement effective multidisciplinary working for people with frailty;

17. Contribute to CPD programmes for the members of the ageing well team:

• Clinical Mentorship/educational supervision of the team members including GP Registrars, Trainee ACPs, First contact practitioners;

18. Ensure contemporaneous notes are recorded and clinical tasks are updated and completed within the agreed timescales;

19. To work collaboratively with other teams and services to maintain an effective and efficient service;

20. Participate in quality improvements and innovations, e.g. audits, significant events analysis and development of protocols and new services.

CONFIDENTIALITY

All staff working for AVH Ltd have both a common law duty and a statutory duty of confidentiality to protect patient information and only use it for the purposes for which it is intended. The disclosure and use of confidential patient information needs to be both lawful and ethical.

PROFESSIONAL DEVELOPMENT

Work with your line manager to undertake continual personal and professional development.

Undertake relevant training as required.Continually update own knowledge and skills within the job role.

Adhere to organisational policies and procedures, including confidentiality, safeguarding, lone working, information governance, and health and safety.

Participate in annual individual performance review.

POLICIES & PROCEDURES

All staff working for AVH Ltd are bound by the organisation's policies and procedures, a clinical handbook and access to all policies will be provided upon commencement of employment.

MISCELLANEOUS

Work as part of the team to seek feedback, continually improve the service.

Undertake any tasks consistent with the level of the post and the scope of the role, ensuring that work is delivered in a timely and effective manner.

Duties may vary from time to time, without changing the general character of the post or the level of responsibility.

Act at all times in a manner consistentwith legislation, policy and procedures in respect of Equality and Diversity, and safeguarding.

To develop and maintain effective working relationships with colleagues.

To abide by all relevant policies and procedures.

An enhanced DBS check will be carried out for all successful candidates.

The list of duties in this job description is not exhaustive and is intended to outline the main activities of the post holder. Duties and responsibilities may be subject to change taking into account the development needs for Ageing Well Service and ARCH Primary Care Network

Experience

Essential

• Experience and evidence of an interest in care of the Elderly
• Understanding of adult safeguarding and Deprivation of liberty procedures
• Experience of multidisciplinary working
• Experience of senior clinical triage for the Acute Home Visiting to determine the urgency and type of response needed, according to clinical need.

Desirable

• Knowledge and experience of carrying out Comprehensive Geriatric Assessment
• Experience of medical education/clinical supervision
• Experience of using SystmOne or another clinical device
• Experience of working in a multi-disciplinary team.

Qualifications

Essential

• A vocationally trained and accredited GP
• Current registration with GMC
• On the GP performers list

Desirable

• MRCGP
• Recognised qualification in Care of the Elderly
• Recognised qualification in medical education/clinical supervision
• Evidence of leadership development

Aptitude and Personal Qualities

Essential

• Flexible, supportive, collaborative.
• Recognise the benefits of multiagency & multidisciplinary team working.
• Ability to work as part of a multi-disciplinary team.
• Willingness to contribute to and participate in a peer support group.

Skills and Abilities

Essential

• The ability to understand the competencies of others and support them to work within and at the top of those competencies. Also, to recognise and act when others are going beyond their competency.
• Ability to work effectively and provide leadership across traditional organisational and professional boundaries.
• Ability to demonstrate leadership skills within a multidisciplinary team.
• Excellent organisational and communication skills.
• Ability to work effectively as a member of a team.
• Ability to work effectively with colleagues, patients and external organisations.
• Ability to triage patients in order of clinical need.
• Effective communication, verbally and in writing.
• Full driving license required as travelling required for the role.
• Committed to the development of integrated community teams.

Desirable

• Leadership of service delivery / change.

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).