Job summary
The ICCN will work closely with GP's / DNs / Rapids / Social Care / Mental Health Services and acute hospitals to proactively case find and identify patients (aged 18+) with high-risk complex needs. They will provide a proactive, holistic approach to managing patients with long-term medical conditions that is centred on primary / community care and the prevention of avoidable hospital admissions.
The focus will be on providing comprehensive assessments, individualised care plans and coordination for complex patients in their usual place of residence including care homes. The ICCN will enable the patient, carers/care home staff and families to understand their disease or condition, how to recognise early symptoms and proactively coordinate and manage their care decisions. The ICCN will work as part of a multi- disciplinary neighbourhood team and will develop care plans for the patients on the Complex Care (Multi-disciplinary Meeting (MDM) and Long term conditions ( LTC) )caseload. With support from the multi-disciplinary team (MDT), the ICCM's will attend once or twice weekly huddles with the MDT / MDMs to discuss patients on their caseload and formulate care plans. Where appropriate, referrals will be made to key stakeholders such as other community services e.g. district nurses, geriatrician, social services, mental health and third sector.
.
Main duties of the job
The ICCN will work closely with GP's / DNs / Rapids / Social Care / Mental Health Services and acute hospitals to proactively case find and identify patients (aged 18+) with high-risk complex needs. They will provide a proactive, holistic approach to managing patients with long-term medical conditions that is centred on primary / community care and the prevention of avoidable hospital admissions.
The focus will be on providing comprehensive assessments, individualised care plans and coordination for complex patients in their usual place of residence including care homes. The ICCN will enable the patient, carers/care home staff and families to understand their disease or condition, how to recognise early symptoms and proactively coordinate and manage their care decisions. The ICCN will work as part of a multi- disciplinary neighbourhood team and will develop care plans for the patients on the Complex Care (Multi-disciplinary Meeting (MDM) and Long term conditions ( LTC) )caseload. With support from the multi-disciplinary team (MDT), the ICCM's will attend once or twice weekly huddles with the MDT / MDMs to discuss patients on their caseload and formulate care plans. Where appropriate, referrals will be made to key stakeholders such as other community services e.g. district nurses, geriatrician, social services, mental health and third sector.
About us
CNWL is recognised locally, nationally and internationally for providing integrated high quality, innovative healthcare. Our track record in recruiting only the best people is well known, and our experts are frequently called upon to contribute to national health strategy and policy, and many models of our care have been adapted for use in other countries.Camden is a vibrant home to some of London's most visited tourist attractions: the markets, streets and shops that have grown around Camden Lock and its associated music venues. Camden as a Borough is diverse, containing Hampstead Heath and its famous swimming ponds, Holborn and parts of the West End, as well as a very colourful culture, ethnic makeup and a very wide socio-economic make up.
Job description
Job responsibilities
The ICCN will work closely with GPs / DNs / Rapids / Social Care / Mental Health Services and acute hospitals to proactively case find and identify patients (aged 18+) with high-risk complex needs. They will provide a proactive, holistic approach to managing patients with long-term medical conditions that is centred on primary / community care and the prevention of avoidable hospital admissions.
The focus will be on providing comprehensive assessments, individualised care plans and coordination for complex patients in their usual place of residence including care homes. The ICCN will enable the patient, carers/care home staff and families to understand their disease or condition, how to recognise early symptoms and proactively coordinate and manage their care decisions. The ICCN will work as part of a multi- disciplinary neighbourhood team and will develop care plans for the patients on the Complex Care (Multi-disciplinary Meeting (MDM) and Long term conditions ( LTC) )caseload. With support from the multi-disciplinary team (MDT), the ICCMs will attend once or twice weekly huddles with the MDT / MDMs to discuss patients on their caseload and formulate care plans. Where appropriate, referrals will be made to key stakeholders such as other community services e.g. district nurses, geriatrician, social services, mental health and third sector.
The distance nurses travel each day is considerable and the ICCN use public transport, trust pool cars or their own car to carry out home visits. The ICCN works autonomously to provide a full range of services predominantly to house bound patients including residential and nursing homes and will be skilled in carrying out Holistic assessments.
The role also involves senior clinical and some managerial leadership through attending key meetings as specialist clinicians and providing clinical/ managerial supervision for junior staff such as Community Nurses, Care Coordinators, Healthcare Assistants and Student Nurses and/or other staff working with the team.
The post holder will work in team of five ICCNs one of whom has a specialist mental health remit. Each ICCN will be aligned to working in a specific neighbourhood bringing specialist community nursing skills to the MDT The post holder will be responsible for line management and supervision of the peer support worker role, championing the service and promoting peer support and recovery as a key role within the trust. Liaising with Peer Support network across the trust and ensuring relationships are maintained alongside service development.
Job description
Job responsibilities
The ICCN will work closely with GPs / DNs / Rapids / Social Care / Mental Health Services and acute hospitals to proactively case find and identify patients (aged 18+) with high-risk complex needs. They will provide a proactive, holistic approach to managing patients with long-term medical conditions that is centred on primary / community care and the prevention of avoidable hospital admissions.
The focus will be on providing comprehensive assessments, individualised care plans and coordination for complex patients in their usual place of residence including care homes. The ICCN will enable the patient, carers/care home staff and families to understand their disease or condition, how to recognise early symptoms and proactively coordinate and manage their care decisions. The ICCN will work as part of a multi- disciplinary neighbourhood team and will develop care plans for the patients on the Complex Care (Multi-disciplinary Meeting (MDM) and Long term conditions ( LTC) )caseload. With support from the multi-disciplinary team (MDT), the ICCMs will attend once or twice weekly huddles with the MDT / MDMs to discuss patients on their caseload and formulate care plans. Where appropriate, referrals will be made to key stakeholders such as other community services e.g. district nurses, geriatrician, social services, mental health and third sector.
The distance nurses travel each day is considerable and the ICCN use public transport, trust pool cars or their own car to carry out home visits. The ICCN works autonomously to provide a full range of services predominantly to house bound patients including residential and nursing homes and will be skilled in carrying out Holistic assessments.
The role also involves senior clinical and some managerial leadership through attending key meetings as specialist clinicians and providing clinical/ managerial supervision for junior staff such as Community Nurses, Care Coordinators, Healthcare Assistants and Student Nurses and/or other staff working with the team.
The post holder will work in team of five ICCNs one of whom has a specialist mental health remit. Each ICCN will be aligned to working in a specific neighbourhood bringing specialist community nursing skills to the MDT The post holder will be responsible for line management and supervision of the peer support worker role, championing the service and promoting peer support and recovery as a key role within the trust. Liaising with Peer Support network across the trust and ensuring relationships are maintained alongside service development.
Person Specification
Education and Qualifications
Essential
- Current NMC Registration
- Holds the District Nurse Specialist Practitioner Qualification
- Mentorship/coaching qualification or equivalent
- Advanced Clinical Skills
Desirable
- An understanding of the current national and local health service guidelines & policies
- Post qualifying NMC approved teaching qualification
Previous Experience
Essential
- Significant previous community nursing experience as a District Nurse
- Experience in working with multiple professionals in an MDT and working across organisational boundaries
- Experience in clinical education e.g. assessing/ supervising students
- Experience of assessing and care planning for complex patients
- Experience of supervising professional staff effectively
Desirable
- Innovative and flexible working
- Knowledge & awareness of the various educational programs and opportunities offered & supported by CNWL
Skills and Knowledge
Essential
- Develop and maintain communication with people about difficult matters and/or in difficult situations
- Ability to identify areas of risk and escalate appropriately
- Experience of contributing towards improving quality of practice delivery
- Experience of teaching and supervising/assessing
- Support equality and diversity
- Understand clinical risk management and be able to impart this to others
- Multi-agency/integrated working
- In-depth physical assessment skills
- Knowledge of long term conditions
Desirable
- Application of theory into practice
- Audit
- Understand the importance of capturing data and data analysis
- Evidence of participation in QI projects
Person Specification
Education and Qualifications
Essential
- Current NMC Registration
- Holds the District Nurse Specialist Practitioner Qualification
- Mentorship/coaching qualification or equivalent
- Advanced Clinical Skills
Desirable
- An understanding of the current national and local health service guidelines & policies
- Post qualifying NMC approved teaching qualification
Previous Experience
Essential
- Significant previous community nursing experience as a District Nurse
- Experience in working with multiple professionals in an MDT and working across organisational boundaries
- Experience in clinical education e.g. assessing/ supervising students
- Experience of assessing and care planning for complex patients
- Experience of supervising professional staff effectively
Desirable
- Innovative and flexible working
- Knowledge & awareness of the various educational programs and opportunities offered & supported by CNWL
Skills and Knowledge
Essential
- Develop and maintain communication with people about difficult matters and/or in difficult situations
- Ability to identify areas of risk and escalate appropriately
- Experience of contributing towards improving quality of practice delivery
- Experience of teaching and supervising/assessing
- Support equality and diversity
- Understand clinical risk management and be able to impart this to others
- Multi-agency/integrated working
- In-depth physical assessment skills
- Knowledge of long term conditions
Desirable
- Application of theory into practice
- Audit
- Understand the importance of capturing data and data analysis
- Evidence of participation in QI projects
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
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.
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).
From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
