ANP - Frailty Team

Job responsibilities

Please refer to attached job descriptionfor full range of roles and responsibilities.

Clinical Practice

1. Work as an autonomous clinician across all areas to develop and provide expert clinical advice, support and care

2. Develop and use advanced clinical skills to analyse and interpret history of illness, presenting symptoms and physical findings to enable diagnosis, planning and treatments of patients.

3. Recognise the early symptoms of disease exacerbation and acute illness based on an understanding of disease, the disease process, and current evidence and practice standards.

4. Interpret history of illness, presenting symptoms and physical findings to enable diagnosis, planning and treatment of patients.

5. Act as lead specialist and a resource to all staff in the delivery of clinical care to patients.

6. Evaluate the outcomes of interventions.

7. Prioritise and co-ordinate the multiple health care needs of the patient, co-ordinating and facilitating timely referrals to other team members within acute and primary care settings.

8. Facilitate the integration of patient goals for health and social care into care plans and plan for future health needs.

9. Undertake diagnostic assessments, health screening and therapeutic interventions and will recommend further investigations and refer to other agencies as appropriate.

10. Advocate high quality care for people, act as a champion for people by representing/supporting the persons interests at team meetings, during hospital care, home care and when interfacing with statutory and non-statutory service providers.

11. Empower patients and their families through appropriate support and education.

12. Influence, support and take an active role in Public Health/ Self-care of the individual and community.

13. Collect, collate, evaluate and report clinical information, maintain accurate patient records related to assessment and care planning.

14. Develop clinical protocols and guidelines within own area of practice to ensure quality of care at all times.

15. Review medication/act as a resource to other colleagues for medication advice and support. Discuss side effects and where appropriate prescribe within own NMP formulary and competencies relevant medication and liaise with pharmacy and medical staff. Any changes to NMP formulary to be put forward via the NMP steering group.

16. To regularly evaluate practice to ensure continuous improvement.

17. Act as an advocate for the patient negotiating and consulting with other clinicians and associated staff to ensure high quality care.

18. Work with clinicians and management in examining episodes of care delivery, critical incidents and individual care plans to improve and develop services.

19. Work across professional boundaries providing expert clinical knowledge whilst developing new and transferable skills.

20. To support best practice end of life planning (last twelve months) including advance care planning for patients identified according to best practice end of life care.

21. To work with patients and carers to develop care plans which encourage self-care and reduce avoidable hospital admissions.

22. They should be responsible for implementation, monitoring and training of infection control policies and procedures.

23. Initiate and contribute to the audit processes as required by the organisations

24. Responsible for monitoring clinical equipment register, and ensuring own equipment fit for purpose and, calibration is up to date

25. All staff whom come into contact with children, young people and adults who may be parents or carers have a responsibility to ensure they are trained and competent to be alert to potential indicators of abuse or neglect in children and know how to act on their concerns in line with PCN Safeguarding and Children Board procedures.

26. Work within the Advanced Practice Competency framework as agreed by the MLCO board to ensure a predetermined level of practice is achieved. They will be required to work with their clinical supervisor to produce a portfolio of skills knowledge and extended practice as outlined which will be reviewed annually during the appraisal process.

Leadership and operational duties

1. Contribute to the leadership and management of a multi-professional team of staff within the PCN.

2. Negotiate with/influence clinicians and managers across various commissioning agencies.

3. Effectively communicates complex and sensitive information at all levels of the organisation to a variety of health care professionals and patients across organisations using the highest level of interpersonal and communication skills to maximise understanding.

4. Provide highly specialist, expert, clinical knowledge to clinical colleagues and professional, community and policy-making organisations.

5. Present specialist, expert, clinical knowledge at large national gatherings on progress and service improvement initiatives.

6. Provide leadership and co-ordination across professional boundaries working closely with other clinicians within the same area of practice.

7. Provide effective clinical leadership within the Primary Care Network to empower and inspire the multi-disciplinary staff to develop their potential and ensure the delivery of a quality service to patients/clients in line with Service objectives and vision.

8. Act as an ambassador and role model supporting the aims and vision of the Trust.

9. Act as a resource to all staff in delivery of clinical care to patients.

10. work across multiple practices to manage the needs of patients in care homes, supported accommodation, or trying to remain at home, taking into consideration all aspects of those needs and including NHS national care homes direct enhanced service specification (Enhanced Health in Care homes)

11. Lead/support MDT in the care home and the GP home ward round, ensuring the agreed proactive strategy is put into place.

12. Work with practices to identify patients at home/extra care home who would benefit from a CGA assessment and the ACP.

13. Assessment using the Emis frailty template identifying areas where they could be better supported and facilitates the necessary intervention, create care and support plans and TEP/ACPs.

Qualifications

Essential

• MSC in Advanced Practice/clinical practice
• Relevant professional health degree
• Evidence of recent CPD
• Independent non-medical prescriber (V300)
• Current registration with NMC, HPC and or other statutory body
• Mentor

Desirable

• Communication/counselling skills training

Qualifications

Essential

• MSC in Advanced Practice/clinical practice
• Relevant professional health degree
• Evidence of recent CPD
• Independent non-medical prescriber (V300)
• Current registration with NMC, HPC and or other statutory body
• Mentor

Desirable

• Communication/counselling skills training

Experience

Essential

• Substantial post registration experience. Leadership. experience at Band 7 or above
• Proven experience of working as an independent practitioner
• In-depth knowledge of recent NHS legislation, relevant to community.
• Experience of leading, planning and completing audit/research.
• Experience of teaching and mentoring of staff across the multi-disciplinary team.
• Experience of identification, assessment and management of frailty.
• Experience of palliative care and end of life care
• Experience of working with older adults living with frailty.

Desirable

• Evidence of applying research in practice.
• Post Graduate
• Leadership
• Qualification
• Change management experience

Skills & Knowledge

Essential

• Advanced clinical skills
• Able to work as an autonomous practitioner.
• Able to demonstrate care which reflects evidence based practice.
• Can demonstrate experience of acute disease management and crisis care
• Communication skills including presentation skills
• Leadership skills with ability to engage and deliver change through negotiation and partnership working
• Management skills with team building abilities
• IT skills
• Ability to manage complexity and develop and sustain partnership working with both individuals and across organisations
• Ability to manage complexity and develop and sustain partnership working with both individuals and across organisations
• Ability to manage high pressured situations
• Able to prioritise workload, achieving a balance between clinical and other aspects of role
• Demonstrate knowledge of symptom control and managine the psychological and emotional needs of frail older people and their families.
• To work inclusively with the care home staff.

Desirable

• Evidence of recognised knowledge/skills in service improvement.
• Caseload management

Personal Qualities

Essential

• Self-motivated and innovative
• Assertive and Confident
• Enthusiastic
• Empathetic and Supportive
• Flexible to meet the needs of the 5 day service.
• Access to a car for business use on a daily basis
• Able to deal with occasional unpleasant working conditions
• Ability to manage and diffuse stressful situations
• A commitment to improving care for frail older people and those in marginalised groups

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).