Job summary
East Coast Community Healthcare CIC (ECCH) is commissioned to provide Community healthcare services to our local communitiy, this role is central in ensuring optimum patient outcomes and developing effective relationships with staff from other organisations and local health care providers.
Does this sound like something you would like to be a part of? Do you have a Can do attitude? Are you ready to shape and make real our aspirations for innovative, integrated healthcare, which will improve the health and wellbeing of our communities? Then we need you.
We are seeking an Allied Health Professional or Registered Nurse (Adult) to lead and manage the reablement element of our Primary Care Home, in order to deliver high quality community health care to the population of Gorleston & Great Yarmouth. If you are a compassionate, innovative, motivated and forward thinking clinical leader, then this could be the job for you.
Previous experience of providing health care in the community, rapid response, case management and people management would be beneficial. We will support the right candidate to transfer existing knowledge and skills as a registered AHP/Nurse working in a different care environment. We will work in partnership with you to create a personal development plan to become a PCH Integrated Care Lead.
Main duties of the job
The role requires a high level of autonomy as the Integrated Care Lead for the PCH you will be coordinating complex packages of healthcare, overseeing the delivery of reablement care by the multidisciplinary team, supporting the PCH response for Admission Avoidance, providing line management to a number of clinical employees. You will be working in close collaboration with the Lead Nurse, Lead Therapist, Community Matrons and Locality Lead to provide clinical leadership within the PCH. Confidence is needed to provide the team with support and guidance regarding patient care, staff development and delegation. Close links are developing with the acute and community hospitals to ensure care is provided in the best place for the patient and as an Integrated Care Lead you will be at the forefront of integration and development of these changes. This will include oversight of the assessment of patients suitable for discharge from the acute hospital.
The PCH is commissioned to provide a 24/7 service. The core shift is currently 08:30 to 16:30 hours. Applicants may be required to participate in working other shifts as part of the role including weekend and bank holiday working on a rotational basis.
About us
ECCH is a well established health care provider and has been successfully delivering NHS care within the community since 2011. We provide a range of NHS, community health and social care services predominantly across the easterly region of the Norfolk/Suffolk borders.
We are aligned to NHS terms and conditions, and offer many employee benefits, to find out more about us visit our website - www.ecch.org. We are a social enterprise and staff owned organisation which means staff can opt to be shareholders and have a real say in how ECCH is run and evolves to deliver healthcare for the future.
At the heart of our ambition, we work in partnership with and for the community to become the provider and employer of choice for community healthcare.
We encourage you to apply as early as possible as this job may close earlier than the advertised closing date once enough applications have been received.
The Primary Care Home (PCH) is a multidisciplinary team working closely with GP's and other community partners to provide an excellent standard of person centered care to adults in their own homes, or residential care settings, supporting patients to self manage whenever possible. The service uses SystmOne as a clinical IT system to support mobile working.
Job description
Job responsibilities
We Listen, We Learn, We Lead
- Contribute to, support and promote ECCHs strategic
direction, values and culture in relation to Reactive services.
- Discuss all treatment options with sensitivity, knowledge
and expertise and to act as a patient advocate when appropriate, respecting
patient confidentiality with privacy and respect for diverse cultural
backgrounds and requirements.
- Understand and support the achievement of ECCH business
plan objectives and performance targets for team and self, and initiate and
participate in screening and needs assessment as required.
- Identify the potential for service developments, risk and
deficits and inform line manager making recommendations based on specialist
knowledge and experience.
- Provide leadership and ensure effective management of
integrated teams, including rehabilitation support workers and paramedic teams
through identified and those providing a Reactive response.
- Plan and organise a range of complex integrated
multidisciplinary coordination in a wide range of settings to ensure best
practice is delivered across the designated area of responsibility and the
wider community.
- Provide clinical leadership within the integrated care
coordination team including Primary, Social Care, and all other provider
organisations to ensure high standards of care to patients the avoidance of
unnecessary admission to secondary care.
- Through effective leadership, planning and coordination;
be a key enabler for establishing integrated care teams both practically and
behaviourally.
- Work with the Primary Care Home leadership team (Locality
Leads) to design, implement and review pathways and guidelines to support
health care professionals in establishing patients to access evidence-based
therapies.
- Develop systems to monitor, evaluate and audit service
quality in order to meet nationally and locally set targets and report to
Locality governance groups.
- Effectively communicate at all levels of the organisation
and wider stakeholder, including a variety of health professionals, users and
carers, to provide the best health outcomes.
- Maintain high levels of performance for service area and
ensure that goals and objectives are monitored effectively to ensure quality
outcomes are developed and maintained.
- Provide leadership and manage stakeholder relationships
effectively within service area and ensure teams and individuals are supported
when faced with opposition or when working under conditions or pressure.
- Identify potential service developments, risks and
deficits and discuss with line manager, making recommendations based on expert
knowledge to enhance the capacity and quality of community care.
- Monitor and maintain standards/provide benchmarking data
within service area to allow comparison with other healthcare providers.
- Participate in teaching and clinical supervision with
primary care home team and other provider staff as required.
- Critically evaluate research findings, national
guidelines and implement changes in clinical practice as appropriate.
- Signpost patients, families, and carers to tailored
education programmes, advice and support that may precipitate symptoms of acute
exacerbation of underlying conditions or illness and include lifestyle changes
that would be advantageous to health.
- Be responsible for participating and maintaining a
learning environment and maximise opportunities for education and development
in the clinical area to enhance individual development and performance in the
delivery of high standards of care.
My Accountability, My Responsibility
- Take responsibility for own personal and professional development;
maintain competence, knowledge and skills commensurate with role.
- Using a standardised approach but with a high degree of professional
autonomy and accountability, work with Health, Social Care, Voluntary and other
health providers and agencies, to provide patients with complex needs a single
plan of care co-produced with the patient.
- Responsible for ensuring effective patient/case tracking within the local
health system; provide baseline health data for receiving teams to support
integrated, coordinated care. To include facilitation of Community Led
discharge processes.
- As Care Coordination Lead, ensure high visibility and be accessible to
patients, families and carers and be seen as being in charge of their care.
- Use assessment tools/skills that will ensure an appropriate level of
nursing or therapeutic intervention so that patients who present with highly
complex needs are timely referred to the appropriate specialist.
- Be wholly accountable for practice taking every reasonable opportunity to
sustain and improve knowledge and professional competence and, ensure that all
aspects of professional behaviour as required within professional code are
followed at all times.
- Maintain legible, accurate and contemporaneous patient records in
accordance with ECCH Policy; the Nursing and Midwifery Council and Health and
Care Professionals Council standards for record keeping.
- Assist with the investigations of complaints, participate in the risk
management process, critical incident reporting, evaluation, dissemination and
change in practice.
- Be responsible for understanding, following and implementing ECCH policies
and procedures, and influencing working practices to support this accordingly.
- Contribute to the clinical governance agenda through participation in
clinical risk assessment and management, clinical audit.
- Create an environment conducive to effective working, respecting and
supporting staff to deliver high quality clinical services.
- Ensure a high standard of record keeping is achieved in line with ECCH and
professional standards.
- Take responsibility to ensure compliancy with Health and Safety Policy,
Fire and Environmental Waste Regulations.
Respect Our Resources: People, Time and Money
- Take responsibility for the cost-effective management and safe use of
expensive and highly complex equipment, provide recommendations for effective
use of resources and contribute to the effective delivery of cost improvement
planning.
- Analyse, interpret, compare and contrast complex information, service
requirements and options ensuring the effective approaches to service delivery
and team working within service area.
- Evaluate the impact of Health Coaching programmes designed for patients
and carers, to ensure that they provide the necessary knowledge and skills to
gain independence, safely manage changing circumstances and plan for
unavoidable progression of conditions.
Work Together, Achieve Together
- Using generalist clinical skills to evaluate the delivery of care,
identifying subtle changing health care needs. Being able to discuss treatment
options with other generalists and specialists.
- Co-ordinate care across the whole patient pathway in ECCH for service
area. This includes ensuring a robust relationship and ongoing effective
interface with ECCH specialist services, primary and secondary care as
required.
- Working with partners in Primary and Social care to support a model of
care which identifies and case manages those patients needing complex chronic
disease management or palliative care supporting the needs of the local
community.
- Negotiate and agree with the patient carers and other healthcare
professionals, individual roles and responsibilities with actions to be taken
and outcomes to be achieved, referring on to other services or professionals as
appropriate.
- Work in partnership with the patients to empower them to make informed
choices about their healthcare and support choices about end of life care.
- With peers, and under the supervision of the Locality Lead, establish
local networks in partnership with other health and social
professionals/agencies and national links with other generalists in order to
develop protocols according to national and local guidelines for the safe and
effective provision of a community nursing services.
- In partnership with Primary Care colleagues provide seamless care pathway
for patients who occupy the Beds with Care.
- Work with partners in nursing and residential care to improve the health
outcomes of the residents and so prevent unnecessary hospital admissions or
extended in- patient care episodes.
- Provide professional expertise and clinical leadership within service
area, acting as a resource to other professionals internally and outside ECCH,
concerning clinical caseloads to ensure continuous service provision, high
levels of communication and effective inter-professional working.
- Work with ECCH Colleagues, and other partner agencies and stakeholders
including the acute trust to contribute to the development and delivery of new
innovative models of service delivery, ensuring a leading edge approach to
service development in-line with evidence based practice.
- All roles within East Coast Community Healthcare CIC (ECCH) require staff
to demonstrate our Values and Signature Behaviours in the care and service they
provide to patients, service users, stakeholders and colleagues. All members of
staff should consider these as an essential part of their job role.
- Our Values outline the core behaviours that we can all achieve and are
summarised as an acronym within the word CARE. These stand for: Compassion, Action, Respect and Everyone.
- Underpinning our Values are our Signature Behaviours which highlight by
taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion
- We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility |
Respect - Respect Our Resources: People, Time and Money | Everyone - Work
Together, Achieve Together.
Job description
Job responsibilities
We Listen, We Learn, We Lead
- Contribute to, support and promote ECCHs strategic
direction, values and culture in relation to Reactive services.
- Discuss all treatment options with sensitivity, knowledge
and expertise and to act as a patient advocate when appropriate, respecting
patient confidentiality with privacy and respect for diverse cultural
backgrounds and requirements.
- Understand and support the achievement of ECCH business
plan objectives and performance targets for team and self, and initiate and
participate in screening and needs assessment as required.
- Identify the potential for service developments, risk and
deficits and inform line manager making recommendations based on specialist
knowledge and experience.
- Provide leadership and ensure effective management of
integrated teams, including rehabilitation support workers and paramedic teams
through identified and those providing a Reactive response.
- Plan and organise a range of complex integrated
multidisciplinary coordination in a wide range of settings to ensure best
practice is delivered across the designated area of responsibility and the
wider community.
- Provide clinical leadership within the integrated care
coordination team including Primary, Social Care, and all other provider
organisations to ensure high standards of care to patients the avoidance of
unnecessary admission to secondary care.
- Through effective leadership, planning and coordination;
be a key enabler for establishing integrated care teams both practically and
behaviourally.
- Work with the Primary Care Home leadership team (Locality
Leads) to design, implement and review pathways and guidelines to support
health care professionals in establishing patients to access evidence-based
therapies.
- Develop systems to monitor, evaluate and audit service
quality in order to meet nationally and locally set targets and report to
Locality governance groups.
- Effectively communicate at all levels of the organisation
and wider stakeholder, including a variety of health professionals, users and
carers, to provide the best health outcomes.
- Maintain high levels of performance for service area and
ensure that goals and objectives are monitored effectively to ensure quality
outcomes are developed and maintained.
- Provide leadership and manage stakeholder relationships
effectively within service area and ensure teams and individuals are supported
when faced with opposition or when working under conditions or pressure.
- Identify potential service developments, risks and
deficits and discuss with line manager, making recommendations based on expert
knowledge to enhance the capacity and quality of community care.
- Monitor and maintain standards/provide benchmarking data
within service area to allow comparison with other healthcare providers.
- Participate in teaching and clinical supervision with
primary care home team and other provider staff as required.
- Critically evaluate research findings, national
guidelines and implement changes in clinical practice as appropriate.
- Signpost patients, families, and carers to tailored
education programmes, advice and support that may precipitate symptoms of acute
exacerbation of underlying conditions or illness and include lifestyle changes
that would be advantageous to health.
- Be responsible for participating and maintaining a
learning environment and maximise opportunities for education and development
in the clinical area to enhance individual development and performance in the
delivery of high standards of care.
My Accountability, My Responsibility
- Take responsibility for own personal and professional development;
maintain competence, knowledge and skills commensurate with role.
- Using a standardised approach but with a high degree of professional
autonomy and accountability, work with Health, Social Care, Voluntary and other
health providers and agencies, to provide patients with complex needs a single
plan of care co-produced with the patient.
- Responsible for ensuring effective patient/case tracking within the local
health system; provide baseline health data for receiving teams to support
integrated, coordinated care. To include facilitation of Community Led
discharge processes.
- As Care Coordination Lead, ensure high visibility and be accessible to
patients, families and carers and be seen as being in charge of their care.
- Use assessment tools/skills that will ensure an appropriate level of
nursing or therapeutic intervention so that patients who present with highly
complex needs are timely referred to the appropriate specialist.
- Be wholly accountable for practice taking every reasonable opportunity to
sustain and improve knowledge and professional competence and, ensure that all
aspects of professional behaviour as required within professional code are
followed at all times.
- Maintain legible, accurate and contemporaneous patient records in
accordance with ECCH Policy; the Nursing and Midwifery Council and Health and
Care Professionals Council standards for record keeping.
- Assist with the investigations of complaints, participate in the risk
management process, critical incident reporting, evaluation, dissemination and
change in practice.
- Be responsible for understanding, following and implementing ECCH policies
and procedures, and influencing working practices to support this accordingly.
- Contribute to the clinical governance agenda through participation in
clinical risk assessment and management, clinical audit.
- Create an environment conducive to effective working, respecting and
supporting staff to deliver high quality clinical services.
- Ensure a high standard of record keeping is achieved in line with ECCH and
professional standards.
- Take responsibility to ensure compliancy with Health and Safety Policy,
Fire and Environmental Waste Regulations.
Respect Our Resources: People, Time and Money
- Take responsibility for the cost-effective management and safe use of
expensive and highly complex equipment, provide recommendations for effective
use of resources and contribute to the effective delivery of cost improvement
planning.
- Analyse, interpret, compare and contrast complex information, service
requirements and options ensuring the effective approaches to service delivery
and team working within service area.
- Evaluate the impact of Health Coaching programmes designed for patients
and carers, to ensure that they provide the necessary knowledge and skills to
gain independence, safely manage changing circumstances and plan for
unavoidable progression of conditions.
Work Together, Achieve Together
- Using generalist clinical skills to evaluate the delivery of care,
identifying subtle changing health care needs. Being able to discuss treatment
options with other generalists and specialists.
- Co-ordinate care across the whole patient pathway in ECCH for service
area. This includes ensuring a robust relationship and ongoing effective
interface with ECCH specialist services, primary and secondary care as
required.
- Working with partners in Primary and Social care to support a model of
care which identifies and case manages those patients needing complex chronic
disease management or palliative care supporting the needs of the local
community.
- Negotiate and agree with the patient carers and other healthcare
professionals, individual roles and responsibilities with actions to be taken
and outcomes to be achieved, referring on to other services or professionals as
appropriate.
- Work in partnership with the patients to empower them to make informed
choices about their healthcare and support choices about end of life care.
- With peers, and under the supervision of the Locality Lead, establish
local networks in partnership with other health and social
professionals/agencies and national links with other generalists in order to
develop protocols according to national and local guidelines for the safe and
effective provision of a community nursing services.
- In partnership with Primary Care colleagues provide seamless care pathway
for patients who occupy the Beds with Care.
- Work with partners in nursing and residential care to improve the health
outcomes of the residents and so prevent unnecessary hospital admissions or
extended in- patient care episodes.
- Provide professional expertise and clinical leadership within service
area, acting as a resource to other professionals internally and outside ECCH,
concerning clinical caseloads to ensure continuous service provision, high
levels of communication and effective inter-professional working.
- Work with ECCH Colleagues, and other partner agencies and stakeholders
including the acute trust to contribute to the development and delivery of new
innovative models of service delivery, ensuring a leading edge approach to
service development in-line with evidence based practice.
- All roles within East Coast Community Healthcare CIC (ECCH) require staff
to demonstrate our Values and Signature Behaviours in the care and service they
provide to patients, service users, stakeholders and colleagues. All members of
staff should consider these as an essential part of their job role.
- Our Values outline the core behaviours that we can all achieve and are
summarised as an acronym within the word CARE. These stand for: Compassion, Action, Respect and Everyone.
- Underpinning our Values are our Signature Behaviours which highlight by
taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion
- We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility |
Respect - Respect Our Resources: People, Time and Money | Everyone - Work
Together, Achieve Together.
Person Specification
Personal Attributes
Essential
- Ability to embrace our Culture, Values and Signature Behaviours:
- (Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together)
- Willingness and ability to work across different sites and travel to alternative sites and across the community as required
- Flexible team orientated approach to work
- Passion and enthusiasm to deliver person centred care
- Self-motivated and solution focused
- Commitment to lifelong learning
Skills and Knowledge
Essential
- Competent IT skills ability to use electronic diary and electronic clinical record systems and MS Office software with proven ability to problem solve
- Evidenced high standards of leadership and people management skills
- Evidenced experience of negotiating and influencing skills
- Excellent interpersonal skills, including communication with different stakeholders
- Ability to travel throughout the locality in accordance with role requirements
- Advanced communication skills
Qualifications
Essential
- BSc in Nursing Practice or equivalent, or Allied Health Professional degree level qualification
- Professional registration with Nursing and Midwifery Council (NMC) or Health Care Professions Council (HCPC)
- Leadership/ management qualification or willing to undertake
Desirable
- Masters level study or working towards a masters level qualification in a relevant field
- Health Coaching Programme
Experience
Essential
- Evidenced and relevant experience of working in a community clinical role at a management/supervisory level.
- Evidence of partnership working with other care agencies
- e.g. Social care Services/voluntary sector/primary care
- Evidence of managing team(s) and individuals to a high standard of performance. Including absence, appraisal, performance and conduct (disciplinary) processes
Desirable
- Experience of team leadership
- Experience of Coordinating multidisciplinary integrated care for patients
- Experience of complaint investigation
- Project management experience.
- Experience of facilitating clinical supervision
- Experience of audit
Person Specification
Personal Attributes
Essential
- Ability to embrace our Culture, Values and Signature Behaviours:
- (Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together)
- Willingness and ability to work across different sites and travel to alternative sites and across the community as required
- Flexible team orientated approach to work
- Passion and enthusiasm to deliver person centred care
- Self-motivated and solution focused
- Commitment to lifelong learning
Skills and Knowledge
Essential
- Competent IT skills ability to use electronic diary and electronic clinical record systems and MS Office software with proven ability to problem solve
- Evidenced high standards of leadership and people management skills
- Evidenced experience of negotiating and influencing skills
- Excellent interpersonal skills, including communication with different stakeholders
- Ability to travel throughout the locality in accordance with role requirements
- Advanced communication skills
Qualifications
Essential
- BSc in Nursing Practice or equivalent, or Allied Health Professional degree level qualification
- Professional registration with Nursing and Midwifery Council (NMC) or Health Care Professions Council (HCPC)
- Leadership/ management qualification or willing to undertake
Desirable
- Masters level study or working towards a masters level qualification in a relevant field
- Health Coaching Programme
Experience
Essential
- Evidenced and relevant experience of working in a community clinical role at a management/supervisory level.
- Evidence of partnership working with other care agencies
- e.g. Social care Services/voluntary sector/primary care
- Evidence of managing team(s) and individuals to a high standard of performance. Including absence, appraisal, performance and conduct (disciplinary) processes
Desirable
- Experience of team leadership
- Experience of Coordinating multidisciplinary integrated care for patients
- Experience of complaint investigation
- Project management experience.
- Experience of facilitating clinical supervision
- Experience of audit
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).
