Job summary
Supported Transfer of Care (STC)
We are transforming the way we support individuals stepping down from secondary care mental health services to Primary Care. The STC Practitioner will play a critical role in this transformation by providing visible clinical and professional leadership, leading on the coordination of safe supported discharge and transition into community-based holistic care, and shaping service development alongside partners.
This model supports people for up to 12 months post-discharge, using a named worker approach, with strong emphasis on:
Holistic and preventative support
Physical health and wellbeing
Meaningful social connection
Recovery-focused, person centred care
Strategic community-engagement and relationships
This is a unique opportunity for experienced mental health professionals to lead, influence and shape a new model of care that places community, autonomy and recovery at its core.
Main duties of the job
Key Aims of the Role:
Provide senior clinical leadership and role-model evidence-based practice across the pathway
Provide clinical leadership and hold a caseload of service users stepped down from CRT/CIMHS
Deliver time limited (up to 12 months), person-centred interventions that support long term recovery and integration into community and primary care systems.
Investment and Partnership - Build strong, sustainable relationships with Primary Care, VCSE partners, community organisations, and local residents.
Embed the STC pathway within the local neighbourhood model, ensuring collaboration across the Integrated Neighbourhood Teams (INTs).
Provide mental health clinical leadership for emerging Neighborhood teams in Newham, and support effective interface between these structures and CRT/CIMHS aligned teams.
Address social determinants of health, promote recovery, and reduce dependency on secondary care services.
Understand the needs and strengths of the local community, create culturally sensitive spaces and understand people in the context of their lives
Champion a culture of accountability, inclusivity and high standards, ensuring practice reflects the voices of service users and carers
About us
Our mission is to make a positive difference to people's lives by improving the quality of life for all we serve. Our values are: We Care, We Respect, We are Inclusive - so we are looking for people who live and breathe these qualities when supporting service users and carers, and in their relationships with colleagues in the Trust and our partner organisations.
Job description
Job responsibilities
Please see job description in documents
- To promote and offer a range of clinical and non-clinical interventions within CIMHS / Primary Care.
- To provide assessment and care planning expertise relevant to your profession
- To lead on the development of a new care pathway between Primary Care, CIMHS and CRT.
- To provide effective signposting to a range of health, social, voluntary sector and community-based resources and services.
- To work with service users to:
- support shared decision-making about self-management;
- provide brief psychological interventions, where qualified to do so and where appropriate;
- To, where possible, operate without the need for formal referral from GPs, including accepting some direct bookings where appropriate.
- The role will not directly line manage staff in CIMHS/CRT, but will offer support, training, supervision and matrix management of staff who are operating an STC Model or caseload where necessary. Acting as a professional lead for the Pathway
- To support the CIMHS, CRT and GP workforce on this new pathway. Including the delivery of any relevant training and induction.
- To attend relevant meetings and work collaboratively with colleagues to enhance patient care and co-produce the new care pathway.
- Engage service users and stakeholders throughout the development of the model.
Job description
Job responsibilities
Please see job description in documents
- To promote and offer a range of clinical and non-clinical interventions within CIMHS / Primary Care.
- To provide assessment and care planning expertise relevant to your profession
- To lead on the development of a new care pathway between Primary Care, CIMHS and CRT.
- To provide effective signposting to a range of health, social, voluntary sector and community-based resources and services.
- To work with service users to:
- support shared decision-making about self-management;
- provide brief psychological interventions, where qualified to do so and where appropriate;
- To, where possible, operate without the need for formal referral from GPs, including accepting some direct bookings where appropriate.
- The role will not directly line manage staff in CIMHS/CRT, but will offer support, training, supervision and matrix management of staff who are operating an STC Model or caseload where necessary. Acting as a professional lead for the Pathway
- To support the CIMHS, CRT and GP workforce on this new pathway. Including the delivery of any relevant training and induction.
- To attend relevant meetings and work collaboratively with colleagues to enhance patient care and co-produce the new care pathway.
- Engage service users and stakeholders throughout the development of the model.
Person Specification
Education and training
Essential
- Registered Professional in either Nursing (Mental Health), Social Work or Occupational Therapy, with current registration with NMC, Social Work England or HCPC.
- Evidence of post registration continued professional development, qualifications or equivalent experience
Experience
Essential
- Experience practicing as a Mental Health professional in the Community
- Previous experience of functioning as a team member
- Previous experience of Management and Clinical Supervision, including annual appraisal
- Previous experience of service development, quality improvement and of bringing innovation and new ideas to practice
- Previous experience of working within the health or care system
Desirable
- Lived-experience of accessing mental health services
- Experience of using DIALOG+ (as a service user or professional)
Knowledge and skills
Essential
- Sound knowledge of the applicable professional body code of practice
- Good knowledge and training of adult safeguarding
- Good knowledge of current and relevant local and national agendas impacting Community Mental Health, including the Community Mental Health Framework for Adults and Older Adults
- Sound knowledge and understanding of the Mental Health Act and Care Act, relevant national standards and other relevant national policies.
- Excellent knowledge & understanding of recovery principles
- Knowledge of quality improvement metrics and tools including relevant audits to
- Excellent communications skills
- Skills in using electronic clinical systems and associated Microsoft 365 applications
Desirable
- Knowledge of NICE guidance in relation to a wide range of mental disorders and the ability to ensure that evidence based practice with clear clinical outcomes is embedded into practice.
Person Specification
Education and training
Essential
- Registered Professional in either Nursing (Mental Health), Social Work or Occupational Therapy, with current registration with NMC, Social Work England or HCPC.
- Evidence of post registration continued professional development, qualifications or equivalent experience
Experience
Essential
- Experience practicing as a Mental Health professional in the Community
- Previous experience of functioning as a team member
- Previous experience of Management and Clinical Supervision, including annual appraisal
- Previous experience of service development, quality improvement and of bringing innovation and new ideas to practice
- Previous experience of working within the health or care system
Desirable
- Lived-experience of accessing mental health services
- Experience of using DIALOG+ (as a service user or professional)
Knowledge and skills
Essential
- Sound knowledge of the applicable professional body code of practice
- Good knowledge and training of adult safeguarding
- Good knowledge of current and relevant local and national agendas impacting Community Mental Health, including the Community Mental Health Framework for Adults and Older Adults
- Sound knowledge and understanding of the Mental Health Act and Care Act, relevant national standards and other relevant national policies.
- Excellent knowledge & understanding of recovery principles
- Knowledge of quality improvement metrics and tools including relevant audits to
- Excellent communications skills
- Skills in using electronic clinical systems and associated Microsoft 365 applications
Desirable
- Knowledge of NICE guidance in relation to a wide range of mental disorders and the ability to ensure that evidence based practice with clear clinical outcomes is embedded into 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.
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).
