Job summary
What matters to me, is
what matters to us.
Calling all frailty-minded General Practitioners
Are you interested in older peoples care, frailty or
palliative care? Are you frustrated at not having the time or capability to
sort out complex problems properly? Do you often get the feeling that you could
be doing more to improve quality of care for our most experienced members of
society?
If so, come and find your tribe at the One Weston Care Home
Hub in North Somerset, based at 168 Medical.
Pier Health Group are
transforming the care of older people. We have led this charge with the
development of a centralised Care Home Hub, servicing the healthcare needs of
our 65 care homes. Yes, thats a lot, isnt it? We are hungry with ambition,
and after our first year of success which saw us featured as a national
exemplar, and our second year as finalists for a prestigious HSJ Award. Join our existing team of dynamic clinicians
in a multidisciplinary environment. This is no ordinary service; we are building
a legacy for our population, and for our primary care workforce.
If you are tired of dealing with
problems on the day and not having time to address the real issues, if you
are feeling increasingly lonely working in primary or community care and
missing the sense of team camaraderie, if you find yourself increasingly hands
off rather than hands on, then this is the job for you.
Main duties of the job
Each day starts
with a whole team check-in either in person or via Microsoft Teams to check on
wellbeing, discuss problems and ideas, share updates and to distribute
workload.
Clinical lead
of the day is assigned during this meeting.
The GP may then
have a ward round in a care home, be completing comprehensive geriatric
assessments, producing care plans and ReSPECT forms, liaising with families and
other partners such as hospitals or district nurses, or dealing with requests
for acutely unwell care home residents. There is protected time for learning
activities, teaching, supervision, quality improvement work and meetings. This
work takes place via a variety of formats telephone, video, email and face to
face. Career and personal development is promoted through regular 1:1 meetings
with the team leader.
About us
The One Weston
Care Home Hub is a true multidisciplinary team, established in 2021, bringing
together a range of allied health professionals and GPs to work towards a
common goal of improving care for care home residents in Weston Super Mare.
Working alongside a friendly, dedicated team of GPs and allied health
professionals (pharmacists, community nurses, advanced nurse practitioners, a
paramedic and a mental health nurse) this innovative project is transforming
community care in some of the most deprived wards in the country. Excellent
admin support enables clinicians to focus on clinical matters.
Job description
Job responsibilities
The role of the
GP within the team is as follows:
To
provide clinical assessment of care home residents, via a mix of preventative
(proactive) and acute (reactive) medicine.
To
undertake holistic assessment of residents needs and devise creative solutions,
utilising the skills of the MDT to best effect.
To produce a dynamic personalised care plan for healthcare
professionals and care staff to follow, which includes treatment escalation
planning and a detailed, realistic ReSPECT form in keeping with the wishes of
patients and their families where appropriate.
To
provide continuity of care to resident, family and care home staff.
To
provide senior clinical support for complex decision making, when clinical lead
of the day.
To
take clinical responsibility for decisions and ongoing management of your
patients, drawing on the skills of the MDT as needed.
To
contribute to peer learning and education, via significant event analysis, case
based discussions and other formats.
To
provide support, clinical advice, supervision and feedback to students and
other members of the MDT.
To
be actively involved in promoting adult safeguarding.
To
advocate for high quality, appropriate, patient-centred care for older or
vulnerable adults.
Record data and assessments in patient records systems promptly
and accurately and to agreed standards ensuring appropriate use of read codes
and templates, with awareness of QOF targets and local DES specifications.
To compile and issue computer-generated acute and repeat
prescriptions, prescribing in accordance with BNSSG prescribing formulary
whenever this is clinically appropriate, working with our pharmacy hub.
To instigate necessary invasive and non-invasive diagnostic tests
or investigations and interpret findings/reports at a level that is appropriate
for the patients degree of frailty and their treatment escalation.
To
contribute and bring ideas for continuous improvement including developing / improving
care pathways for older people and contributing to QIP and audit.
To
review medication using a Structured Medication Review, alongside team
pharmacists.
Lead
and/or participate in specialist MDT meetings dementia/mental health,
palliative care or complex care with support of the team and our community
mental health and geriatrician colleagues
To
provide outreach input to cases in any of our care homes across the PCN
identified as in need, to support our team of ANPs working across Pier Health.
This may be complex cases, a home recognised to be in difficulty or to support
our local safeguarding processes.
Job description
Job responsibilities
The role of the
GP within the team is as follows:
To
provide clinical assessment of care home residents, via a mix of preventative
(proactive) and acute (reactive) medicine.
To
undertake holistic assessment of residents needs and devise creative solutions,
utilising the skills of the MDT to best effect.
To produce a dynamic personalised care plan for healthcare
professionals and care staff to follow, which includes treatment escalation
planning and a detailed, realistic ReSPECT form in keeping with the wishes of
patients and their families where appropriate.
To
provide continuity of care to resident, family and care home staff.
To
provide senior clinical support for complex decision making, when clinical lead
of the day.
To
take clinical responsibility for decisions and ongoing management of your
patients, drawing on the skills of the MDT as needed.
To
contribute to peer learning and education, via significant event analysis, case
based discussions and other formats.
To
provide support, clinical advice, supervision and feedback to students and
other members of the MDT.
To
be actively involved in promoting adult safeguarding.
To
advocate for high quality, appropriate, patient-centred care for older or
vulnerable adults.
Record data and assessments in patient records systems promptly
and accurately and to agreed standards ensuring appropriate use of read codes
and templates, with awareness of QOF targets and local DES specifications.
To compile and issue computer-generated acute and repeat
prescriptions, prescribing in accordance with BNSSG prescribing formulary
whenever this is clinically appropriate, working with our pharmacy hub.
To instigate necessary invasive and non-invasive diagnostic tests
or investigations and interpret findings/reports at a level that is appropriate
for the patients degree of frailty and their treatment escalation.
To
contribute and bring ideas for continuous improvement including developing / improving
care pathways for older people and contributing to QIP and audit.
To
review medication using a Structured Medication Review, alongside team
pharmacists.
Lead
and/or participate in specialist MDT meetings dementia/mental health,
palliative care or complex care with support of the team and our community
mental health and geriatrician colleagues
To
provide outreach input to cases in any of our care homes across the PCN
identified as in need, to support our team of ANPs working across Pier Health.
This may be complex cases, a home recognised to be in difficulty or to support
our local safeguarding processes.
Person Specification
Qualifications
Essential
- Medical Degree
- MRCGP (or equivalent)
- Adult Safeguarding Level 3
Desirable
- Diploma of Geriatric Medicine
- MRCP
Skills
Essential
- Experience working with Frailty
- (includes holistic assessments of patients, history taking, problem listing and management plan formation)
- Risk holding in the community, patient clinical safety awareness
- IT literate (MS Teams, EMIS,MS office)
- Good interpersonal skills
- Effective time management
- (Planning and organising, prioritisation and handover)
- Attention to detail.
- Excellent communication and interpersonal skills (including emotional intelligence to deal effectively with sensitive patient information, distressed or aggressive patients or those with impaired understanding)
- Resilience
- Influencing beyond your role; working with care home staff, owners, and managers
- Understands Mental Capacity Act and process for best interests decision- making
Desirable
- Additional experience in:
- Palliative Care
- Mental Health
- Learning Disability
- Dementia
- Enhanced use of Microsoft Office suite, EMIS data searches,
- Power BI
- Evidenced Team leadership.
- Forward thinking and planning
Personal Qualities
Essential
- Planning and Organising
- Motivated and Proactive
- High degree of integrity
- Flexible and co-operative
Desirable
- Ability to work and lead a team under pressure
Other Requirements
Essential
- Willingness to travel and work across community locations and in care homes
- Flexibility around working days and annual leave dates to ensure safe levels of clinical cover are maintained
Experience
Essential
- Experience of Multidisciplinary Working
- Knowledge of current clinical evidence-based practice
Person Specification
Qualifications
Essential
- Medical Degree
- MRCGP (or equivalent)
- Adult Safeguarding Level 3
Desirable
- Diploma of Geriatric Medicine
- MRCP
Skills
Essential
- Experience working with Frailty
- (includes holistic assessments of patients, history taking, problem listing and management plan formation)
- Risk holding in the community, patient clinical safety awareness
- IT literate (MS Teams, EMIS,MS office)
- Good interpersonal skills
- Effective time management
- (Planning and organising, prioritisation and handover)
- Attention to detail.
- Excellent communication and interpersonal skills (including emotional intelligence to deal effectively with sensitive patient information, distressed or aggressive patients or those with impaired understanding)
- Resilience
- Influencing beyond your role; working with care home staff, owners, and managers
- Understands Mental Capacity Act and process for best interests decision- making
Desirable
- Additional experience in:
- Palliative Care
- Mental Health
- Learning Disability
- Dementia
- Enhanced use of Microsoft Office suite, EMIS data searches,
- Power BI
- Evidenced Team leadership.
- Forward thinking and planning
Personal Qualities
Essential
- Planning and Organising
- Motivated and Proactive
- High degree of integrity
- Flexible and co-operative
Desirable
- Ability to work and lead a team under pressure
Other Requirements
Essential
- Willingness to travel and work across community locations and in care homes
- Flexibility around working days and annual leave dates to ensure safe levels of clinical cover are maintained
Experience
Essential
- Experience of Multidisciplinary Working
- Knowledge of current clinical evidence-based practice
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).
