Job summary
The primary responsibility of the Proactive Care Community Matron will be to support a team of Proactive Care Navigators, who are a vital part of Enfield Community Services.
The post holder will collaborate closely with the Care Navigator team to screen all the Enfield Proactive Care referrals and conduct further assessments and treatments as needed. The Enfield Proactive Care team focuses on fostering integrated community working, reducing health inequalities, and promoting multidisciplinary, holistic assessments along with person-centred care.
The Enfield Proactive Care initiative, which aims to implement proactive care models, embodies these principles and is designed to serve as a model for other system areas to learn from in the future.
Risk Stratification and Case FindingRisk stratification tools are designed to identify individuals at high risk of adverse events, such as hospital readmissions within 30 days or unplanned admissions.
Experience has shown that successful risk stratification for case finding requires early and continuous clinical involvement to achieve better patient outcomes.
The Community Matron will manage a caseload of patients with complex long-term conditions who are either currently high users of hospital care or at risk of becoming so. The post holder will work independently while maintaining close communication with all stakeholders involved in the patient's care, including carers and family members.
Main duties of the job
CLINICAL RESPONSIBILITIES
- Assess individual care needs and collaborate with the multidisciplinary team to develop, implement, and evaluate patient care plans.
- Deliver evidence-based nursing care to adults within the community setting.
- Perform nursing procedures to a high standard in line with local clinical practice guidelines and policies.
- Demonstrate competence in recognizing and managing life-threatening emergencies, with the ability to carry out necessary interventions in the community.
- Identify and report adult and child protection concerns to the team safeguarding lead, following correct procedures for action.
- Ensure the team complies with adult and child protection policies and guidelines.
- Maintain accurate, comprehensive nursing records using appropriate documentation and the Nursing Information System, ensuring confidentiality and secure storage in accordance with NMC and Trust standards.
- Collaborate with other Community Teams on infection control to promote optimal patient care.
- Organise workload effectively, prioritising clinical needs.
- Participate actively in monthly team meetings.
About us
NMUH North Middlesex University Hospital NHS Hospital Trust (NMUH) is one of London's busiest healthcare providers, providing hospital care and community services for the 350,000 people living in Enfield, Haringey and beyond. Our specialist services include HIV, cardiology, blood disorders, diabetes, fertility, sickle cell and thalassemia. In addition to a full range of cancer diagnosis and treatment services, the Helen Rollason Cancer Support Centre is based on-site and provides services to support cancer patients' wellbeing. We also provide community services and have a dedicated 0-19 service for children and young people in Enfield so that they can get the best possible start in life. This includes health visitors and school nurses who are delivering the national Healthy Child Programme, which provides a structured framework for the delivery of key interventions to support the health and wellbeing of children and families from 0 to 5 and school aged children from 5-19. The 0-19 service aims to improve pathways and partnerships with services in the hospital and deliver excellent care for the children and families. For more information, please access the following link: https://www.northmid.nhs.uk/
Job description
Job responsibilities
RESPONSIBILITY FOR PATIENTS
- Participate in the assessment, planning, and delivery of skilled nursing care.
- Collaborate with families and other carers, empowering them to safely support the adults care within the community.
- Communicate with patients and their carers with empathy and reassurance regarding assessments, care, and treatment.
- Support patients and their families by connecting them with relevant statutory, voluntary, and related services.
- Ensure effective coordination with other agencies as appropriate to meet individual patient needs.
- Work closely with the multidisciplinary team (MDT) in both community and hospital settings to provide comprehensive, holistic care.
- Facilitate early discharge planning by coordinating appropriate arrangements for patients leaving the hospital, including making referrals and sharing information with community services as needed.
- Act as an advocate for patients.
- Assist in the safe and effective transition of patients to adult services with guidance from the senior team.
- Promote healthy lifestyles by delivering health education and participating in relevant local initiatives
Job description
Job responsibilities
RESPONSIBILITY FOR PATIENTS
- Participate in the assessment, planning, and delivery of skilled nursing care.
- Collaborate with families and other carers, empowering them to safely support the adults care within the community.
- Communicate with patients and their carers with empathy and reassurance regarding assessments, care, and treatment.
- Support patients and their families by connecting them with relevant statutory, voluntary, and related services.
- Ensure effective coordination with other agencies as appropriate to meet individual patient needs.
- Work closely with the multidisciplinary team (MDT) in both community and hospital settings to provide comprehensive, holistic care.
- Facilitate early discharge planning by coordinating appropriate arrangements for patients leaving the hospital, including making referrals and sharing information with community services as needed.
- Act as an advocate for patients.
- Assist in the safe and effective transition of patients to adult services with guidance from the senior team.
- Promote healthy lifestyles by delivering health education and participating in relevant local initiatives
Person Specification
Experience
Essential
- Knowledge of Primary Care Trust and NHS priorities and the national long terms conditions agenda.
- Advanced Nursing Assessment Skills Excellent interpersonal skills good presentation skills
- Significant experience in community nursing and multiple long term condition case management.
Desirable
- Ability to work unsupervised and manage own caseload
- Ability to work under pressure and manage competing priorities
- Ability to manage staff, including understanding of the process for appraisal and development
- Full UK driving licence and use of care for business purposes
Education and professional qulification
Essential
- 1st level degree or equivalent Registered Nurse with current NMC registration and post registration in qualification in community nursing or advance nurse practice
- Nurse prescriber - V300
Skills and aptitude
Essential
- Evidence of advanced Nursing Assessment Skills
- Excellent interpersonal skills and presentation skills
- Ability to work unsupervised and manage own caseload
Face to face interview
Essential
- Demonstrate a significant experience in case management of patients with Long Term Conditions
- Demonstrate knowledge of Primary Care Trust and NHS priorities and the national long terms conditions agenda
- Demonstrate knowledge of advanced nursing assessment skills, treatment plan and monitoring
Desirable
- Understanding of current legislation and its implications of this role, including performance indicators and targets
Person Specification
Experience
Essential
- Knowledge of Primary Care Trust and NHS priorities and the national long terms conditions agenda.
- Advanced Nursing Assessment Skills Excellent interpersonal skills good presentation skills
- Significant experience in community nursing and multiple long term condition case management.
Desirable
- Ability to work unsupervised and manage own caseload
- Ability to work under pressure and manage competing priorities
- Ability to manage staff, including understanding of the process for appraisal and development
- Full UK driving licence and use of care for business purposes
Education and professional qulification
Essential
- 1st level degree or equivalent Registered Nurse with current NMC registration and post registration in qualification in community nursing or advance nurse practice
- Nurse prescriber - V300
Skills and aptitude
Essential
- Evidence of advanced Nursing Assessment Skills
- Excellent interpersonal skills and presentation skills
- Ability to work unsupervised and manage own caseload
Face to face interview
Essential
- Demonstrate a significant experience in case management of patients with Long Term Conditions
- Demonstrate knowledge of Primary Care Trust and NHS priorities and the national long terms conditions agenda
- Demonstrate knowledge of advanced nursing assessment skills, treatment plan and monitoring
Desirable
- Understanding of current legislation and its implications of this role, including performance indicators and targets
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).
