Job summary
*Secondment opportunity also available* Are you a motivated, critical thinking Senior clinician working at ACP level with an interest in frailty? Do you have a passion for innovation and networking?
South Havering PCN is looking to appoint three senior clinical Practitioners who have an interest in working with older housebound individuals living with frailty or complex needs to live longer and healthier lives. The post holders will be part of a brand new team of ECPs and care-coordinators within the PCN who will be pioneering a new approach to neighbourhood integration, reaching out to, and working with, existing teams in a coordinated and purposeful way the South Havering PCN-Aligned Community Team (PACT).
The PACT service is a collaboration with the Havering Place based Partnership aligning with its priorities of Age Well and Die Well. The service has been coproduced with service users, their loved ones, and staff. The PACT aims to support older housebound individuals living with frailty or complex needs by:
- providing a single point of contact for individuals and their carers
- proactively undertaking comprehensive geriatric assessment to identify holistic needs and develop high quality, personalised, anticipatory care to promote rehabilitation and prevent deterioration.
Main duties of the job
The post holder will use advanced assessment and diagnostic skills to assess and treat patients, will be an autonomous practitioner, collaborating with colleagues from primary care, community and secondary care, as appropriate, will be based at a primary care site and will routinely visit patients in their own homes; they may at times be expected to work in other settings, e.g. local hospital.
The post holder will:
- be a qualified Emergency Clinical Practitioner (or equivalent clinical level) with experience of working in a relevant field, e.g. frailty or community elderly care
- alongside other ECP colleagues, be clinically and operationally responsible for the team, supporting and delegating work to the care coordinators as appropriate
- be responsible for undertaking comprehensive health assessments, physical examination and ordering tests for patients
- use advanced clinical decision making and assessment skills, coordinate care planning and initiate referrals to diagnostics for appropriate tests for this population
- be involved in establishing, delivering and leading a comprehensive service within the community
- play a leadership role within the team and work with external stakeholders such as
- acute frailty team
- specialist community services
- voluntary sector organisations
- social services & local authority, to develop new ways of working
- use networking skills to bring diverse stakeholders together to develop a single, integrated, community team around each individual
About us
We are a collaborative healthcare
network of 16 General Practices serving the population of South Havering with
an extended multi-disciplinary team seeking to provide accessible,
patient-centred, and high-quality primary care services that promote the health
and well-being of our community and our workforce.
The PCN supports numerous innovative
projects, looking to improve the health and well-being of our community,
including:
Working with NELFT, Care Providers and the Age Well Team to deliver targeted
falls prevention intervention to residents who have not fallen, but are
identified as 'at risk of falls'
Completing a pilot with Havering Access
Team and the reablement provider ECL on avoidance admission for the population
of South Havering. PCN Care Coordinators in association
with the Place lead for Learning Difficulties and BHR CEPN to complete training
to support others to deliver the 'Gold Standard' of LD Health Checks within the
PCN. Delivering the outcome from an earlier
Health Inequalities Workshop to deliver Group Consultations to the PCN
population on obesity South Havering PCN is led by two Clinical Directors and the PCN Manager
working with the GP Leads for each of the three integrated neighbourhood PCN
Practice Clusters.
The PCN works closely with and is supported by
its GP Federation, Havering Health Ltd, who are the employing body for the workforce
of the PCN. The Federation support the provision of high-quality and responsible health care service.
Job description
Job responsibilities
Aim of the role:
The post holder will be expected to support their team to achieve the PCNs Values in their day to day work.
Patient centred care and health equity
Sustainability and efficiency
Collaboration and team working
Quality and excellence
Inclusivity and respect
Accountability and integrity
The post holder will work with other ECPs and key partners to lead the development of a PCN aligned community team (PACT) in South Havering.
In line with the Havering Place based Partnerships priorities of Age Well and Die Well, the PACT team aims to support older housebound individuals living with frailty or complex needs to live longer and healthier lives. PACT aims to achieve this by:
- providing a single point of contact for individuals and their carers
- proactively undertaking comprehensive geriatric assessment to identify holistic needs and develop high quality, personalised, anticipatory care
- coordinating the provision of holistic, integrated care, through collaboration with other services/professionals, e.g. specialist community teams, social prescribers, voluntary sector organisations, GPs
- supporting the transition from hospital to home through consultation and collaboration with acute care partners
Key Responsibilities:
The post holder will use advanced assessment and diagnostic skills to assess and treat patients. The post holder will be an autonomous practitioner, collaborating with colleagues from primary care, community and secondary care, as appropriate. The post holder will be based at a primary care site and will routinely visit patients in their own homes; they may at times be expected to work in other settings, e.g. local hospital.
The post holder will:
- be a qualified Emergency Clinical Practitioner (or equivalent) with experience of working in a relevant field, e.g. frailty or community elderly care
- alongside other ECP colleagues, be clinically and operationally responsible for the team, supporting and delegating work to the care coordinators as appropriate
- act as a role model
- be responsible for undertaking comprehensive health assessments, physical examination and ordering tests for patients
- use advanced clinical decision making and assessment skills, coordinate care planning and initiate referrals to diagnostics for appropriate tests for this population
- be involved in establishing, delivering and leading a comprehensive service within the community
- play a leadership role within the team and work with external stakeholders such as
- acute frailty team
- specialist community services
- voluntary sector organisations
- social services & local authority, to develop new ways of working
- use networking skills to bring diverse stakeholders together to develop a single, integrated, community team around each individual
- use QI skills to lead on service development and develop approaches to measure outcomes and highlight further areas for improvement
Clinical Practice:
- Be professionally and legally accountable for all work undertaken and to practice at an advanced level of professional autonomy and accountability that is within national guidelines and your professional registration bodys (e.g. NMC, HCPC etc) Code of Conduct.
- Provide clinical leadership and maintain credibility through practice and professional update.
- Act as a role model
- Ensure high quality care through provision of evidence based practice.
- Act as an expert clinician and resource for patients, families, and staff.
- Admit, discharge or transfer patients to and from the service as their needs require.
- Undertake advanced clinical assessments of patients referred to the service to enable prompt assessment, diagnosis and treatment according to agreed policies, protocols and guidelines.
- Clinically examine and assess patient needs from a physiological, psychological and social perspective and plan clinical care accordingly.
- Order and interpret blood tests and initiate appropriate action as required.
- Provide and request appropriate diagnostic and/or therapeutic interventions in order to provide a holistic assessment of the client group.
- Maintain and develop own repertoire of advanced clinical assessment skills including physical examination, comprehensive geriatric assessment, assessment of continence, mental health screening, memory assessment, nutritional status, falls assessment, tissue viability screening, mental capacity assessment.
- Prescribe medication within own level of knowledge and competence and within the scope of the PCNs Policy for Non-Medical Prescribing qualification, or request support from ACP or GP colleagues, to ensure patients have timely access to appropriate medication
- Facilitate the further development of clinical skills for all staff caring for patients.
- Ensure self and staff are provided with adequate protection if exposed to body fluids, odours and infections. Be aware of needs and ensure that staff, patients and relatives use personal protection equipment provided and adhere to local policies in relation to health and safety and infection, prevention and control.
- Support staff as required in the management of challenging situations.
- Complete documentation relating to patient care and ensure that staff maintain and update documentation as changes occur according to local policy.
- Encourage staff through role modelling to apply critical thinking through the process of clinical assessment of patients or problem solving.
- Follow this process through the planning and evaluation stages of patient care and to effectively document this process in the patient records.
- Liaise and work closely with relevant multi-disciplinary team members, including General Practitioners, social prescribers, ARRS therapists, volunteers, social workers, community specialists and acute partners in the provision of a professional service
- Provide support for anxious patients and/or relatives demonstrating empathy and understanding in a professional manner. Provide empathetic support when involved in the process of giving patients and/or relatives bad news; for example, informing patients/relatives of changes of condition.
- To lead on proactive Advance Care Planning as necessary in an empathetic and collaborative manner, attending to the priorities and preferences of patients and their loved ones.
- To identify when people are approaching the end of life, undertake palliative care assessment and develop urgent care plans (UCP).
- Prioritise, organise and manage own workload in a manner that maintains and promotes quality.
- Assist in further development of the service and wider organisational strategies.
- Take responsibility for own learning and performance including participating in clinical supervision and acting as a role model, as well as continuous preparation for annual personal appraisal and development review.
- Contribute to the development of local guidelines, protocols and standards.
Job description
Job responsibilities
Aim of the role:
The post holder will be expected to support their team to achieve the PCNs Values in their day to day work.
Patient centred care and health equity
Sustainability and efficiency
Collaboration and team working
Quality and excellence
Inclusivity and respect
Accountability and integrity
The post holder will work with other ECPs and key partners to lead the development of a PCN aligned community team (PACT) in South Havering.
In line with the Havering Place based Partnerships priorities of Age Well and Die Well, the PACT team aims to support older housebound individuals living with frailty or complex needs to live longer and healthier lives. PACT aims to achieve this by:
- providing a single point of contact for individuals and their carers
- proactively undertaking comprehensive geriatric assessment to identify holistic needs and develop high quality, personalised, anticipatory care
- coordinating the provision of holistic, integrated care, through collaboration with other services/professionals, e.g. specialist community teams, social prescribers, voluntary sector organisations, GPs
- supporting the transition from hospital to home through consultation and collaboration with acute care partners
Key Responsibilities:
The post holder will use advanced assessment and diagnostic skills to assess and treat patients. The post holder will be an autonomous practitioner, collaborating with colleagues from primary care, community and secondary care, as appropriate. The post holder will be based at a primary care site and will routinely visit patients in their own homes; they may at times be expected to work in other settings, e.g. local hospital.
The post holder will:
- be a qualified Emergency Clinical Practitioner (or equivalent) with experience of working in a relevant field, e.g. frailty or community elderly care
- alongside other ECP colleagues, be clinically and operationally responsible for the team, supporting and delegating work to the care coordinators as appropriate
- act as a role model
- be responsible for undertaking comprehensive health assessments, physical examination and ordering tests for patients
- use advanced clinical decision making and assessment skills, coordinate care planning and initiate referrals to diagnostics for appropriate tests for this population
- be involved in establishing, delivering and leading a comprehensive service within the community
- play a leadership role within the team and work with external stakeholders such as
- acute frailty team
- specialist community services
- voluntary sector organisations
- social services & local authority, to develop new ways of working
- use networking skills to bring diverse stakeholders together to develop a single, integrated, community team around each individual
- use QI skills to lead on service development and develop approaches to measure outcomes and highlight further areas for improvement
Clinical Practice:
- Be professionally and legally accountable for all work undertaken and to practice at an advanced level of professional autonomy and accountability that is within national guidelines and your professional registration bodys (e.g. NMC, HCPC etc) Code of Conduct.
- Provide clinical leadership and maintain credibility through practice and professional update.
- Act as a role model
- Ensure high quality care through provision of evidence based practice.
- Act as an expert clinician and resource for patients, families, and staff.
- Admit, discharge or transfer patients to and from the service as their needs require.
- Undertake advanced clinical assessments of patients referred to the service to enable prompt assessment, diagnosis and treatment according to agreed policies, protocols and guidelines.
- Clinically examine and assess patient needs from a physiological, psychological and social perspective and plan clinical care accordingly.
- Order and interpret blood tests and initiate appropriate action as required.
- Provide and request appropriate diagnostic and/or therapeutic interventions in order to provide a holistic assessment of the client group.
- Maintain and develop own repertoire of advanced clinical assessment skills including physical examination, comprehensive geriatric assessment, assessment of continence, mental health screening, memory assessment, nutritional status, falls assessment, tissue viability screening, mental capacity assessment.
- Prescribe medication within own level of knowledge and competence and within the scope of the PCNs Policy for Non-Medical Prescribing qualification, or request support from ACP or GP colleagues, to ensure patients have timely access to appropriate medication
- Facilitate the further development of clinical skills for all staff caring for patients.
- Ensure self and staff are provided with adequate protection if exposed to body fluids, odours and infections. Be aware of needs and ensure that staff, patients and relatives use personal protection equipment provided and adhere to local policies in relation to health and safety and infection, prevention and control.
- Support staff as required in the management of challenging situations.
- Complete documentation relating to patient care and ensure that staff maintain and update documentation as changes occur according to local policy.
- Encourage staff through role modelling to apply critical thinking through the process of clinical assessment of patients or problem solving.
- Follow this process through the planning and evaluation stages of patient care and to effectively document this process in the patient records.
- Liaise and work closely with relevant multi-disciplinary team members, including General Practitioners, social prescribers, ARRS therapists, volunteers, social workers, community specialists and acute partners in the provision of a professional service
- Provide support for anxious patients and/or relatives demonstrating empathy and understanding in a professional manner. Provide empathetic support when involved in the process of giving patients and/or relatives bad news; for example, informing patients/relatives of changes of condition.
- To lead on proactive Advance Care Planning as necessary in an empathetic and collaborative manner, attending to the priorities and preferences of patients and their loved ones.
- To identify when people are approaching the end of life, undertake palliative care assessment and develop urgent care plans (UCP).
- Prioritise, organise and manage own workload in a manner that maintains and promotes quality.
- Assist in further development of the service and wider organisational strategies.
- Take responsibility for own learning and performance including participating in clinical supervision and acting as a role model, as well as continuous preparation for annual personal appraisal and development review.
- Contribute to the development of local guidelines, protocols and standards.
Person Specification
Qualifications
Essential
- Recognised Masters qualification in Advanced Clinical Practice (or equivalent clinical level) relevant to the clinical caseload (e.g. frailty, older adults, primary care)
- Registration with an appropriate healthcare governing body and current licence to practice (e.g. NMC, HCPC etc)
Desirable
- Mentor/teaching qualifications
- Extended/independent prescribing qualification (where relevant to background profession)
Experience
Essential
- Significant relevant experience at post registration level
- Recent primary care, community or acute experience
- ACP led management of minor illness, minor ailments and minor injuries
- Good Management/project management Skills
- Experience showing Clinical leadership skills
- ACP led triage
- Interpretation of blood results and acting appropriately with abnormal findings
- Working collaboratively with carers and other professionals
- Experience of working in a multi-agency and/or multi-disciplinary team
- Planning and delivery of training to other professionals
Desirable
- Developing protocols and clinical guidelines
Person Specification
Qualifications
Essential
- Recognised Masters qualification in Advanced Clinical Practice (or equivalent clinical level) relevant to the clinical caseload (e.g. frailty, older adults, primary care)
- Registration with an appropriate healthcare governing body and current licence to practice (e.g. NMC, HCPC etc)
Desirable
- Mentor/teaching qualifications
- Extended/independent prescribing qualification (where relevant to background profession)
Experience
Essential
- Significant relevant experience at post registration level
- Recent primary care, community or acute experience
- ACP led management of minor illness, minor ailments and minor injuries
- Good Management/project management Skills
- Experience showing Clinical leadership skills
- ACP led triage
- Interpretation of blood results and acting appropriately with abnormal findings
- Working collaboratively with carers and other professionals
- Experience of working in a multi-agency and/or multi-disciplinary team
- Planning and delivery of training to other professionals
Desirable
- Developing protocols and clinical guidelines
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).
