Job responsibilities
Clinical assessment and care delivery
Deliver
dementia holistic health checks using agreed clinical templates within EMIS.
Undertake
physical health assessments including blood pressure, pulse, body mass index
(BMI), falls risk, Malnutrition Universal Screening Tool (MUST) nutrition
screening, pain and continence.
Carry
out Clinical Frailty Scale (CFS) reviews and accurately record findings.
Undertake
blood pressure, weight, urinalysis, non-urgent ECG and other agreed
investigations, and venepuncture where trained and assessed as competent.
Monitor
and document mental health status, including mood, behaviour and signs of
delirium, escalating concerns promptly.
Identify
risks related to medication, adherence and side effects and escalate
appropriately.
Undertake
falls and continence assessments and contribute to risk stratification,
prevention interventions and management plans.
Caseload
management and care coordination
Manage
a caseload of lower-risk frailty patients previously assessed by the PCN
frailty team, with diary and appointment support provided by that team.
Provide
follow-up visits for lower-risk frail patients as directed by the frailty team,
supporting care planning, treatment compliance and review.
Support
medication reviews by checking compliance, adherence and the patient's
understanding of medication changes.
Chase
and follow up clinical results, investigations, outstanding tasks and care
plans.
Monitor
and follow up equipment requests and orders to ensure timely provision, and
confirm that recommended equipment or adaptations are in place.
Support
patients to access services and interventions, helping to ensure appointments
are attended and not missed.
Make
appropriate onward referrals and connect patients to appropriate services,
including social prescribing and Age UK.
Safeguarding,
consent and mental capacity
Recognise
and respond to safeguarding concerns for adults at risk, escalating and
reporting in line with local safeguarding policy and the postholder's level of
safeguarding training.
Apply
the principles of the Mental Capacity Act 2005, obtaining and recording valid
consent and, where a patient lacks capacity, supporting best interests decision
making and recognising when Deprivation of Liberty Safeguards may apply.
Undertake
carer wellbeing conversations, provide signposting, and remain alert to carer
strain and safeguarding indicators.
Communication and
relationships
Document
personalised care discussions ('what matters to me') and support advance and
anticipatory care planning within scope in conjunction with the Frailty
Practitioner team.
Communicate
sensitively and effectively with vulnerable adults, families and carers,
adjusting communication to individual needs.
Participate
in multidisciplinary team (MDT) discussions and contribute to care planning.
Cope
with occasional exposure to distressing and emotional situations while
maintaining professionalism, compassion and resilience.
Information,
recording and reporting
Ensure
accurate, contemporaneous and timely data recording and reporting in line with
EMIS templates and information governance requirements.
Maintain
confidentiality and handle personal data in accordance with data protection
legislation and local policy.
Professional
responsibilities
Practise
in accordance with the NMC Code and within the NMC standards of proficiency for
nursing associates, which form the ceiling of the role.
Maintain
NMC registration, complete revalidation, and undertake preceptorship where
newly qualified.
Escalate
clinical concerns to the GP, pharmacist or frailty clinician without delay.
Undertake
mandatory and role-specific training and participate in clinical supervision
and appraisal.
Scope of Practice
Work
within clearly defined protocols, competencies and delegated tasks agreed with
the supervising registered clinician.
Do
not diagnose conditions or prescribe medication.
Identify
and escalate clinical concerns appropriately.
Work
at all times within the NMC standards of proficiency for nursing associates and
the NMC Code.
Practice Responsibilities
Contributes to the evaluation/audit and
clinical standard setting with colleagues.
Records
data in patient records systems promptly and accurately and to agreed
standards.
Ensures
appropriate use of read codes.
Participates
in the auditing of practice activity as required.
Responsible
for health and safety of themselves and others and actively co-operates with
Health and Safety Policies and procedures.
Processes
and actions incoming patient and hospital correspondence.
Attends
in-house meetings, significant event audit meetings and other meetings as
deemed necessary.
Ensures
that the practice complaints system is adhered to at all times.
Awareness
and compliance with all relevant guidelines e.g. data protection,
confidentiality and health and safety.
Maintain
current CPR and anaphylaxis certification and child/adult safeguarding training
in line with local policies.
Measures of Success
The following measures support appraisal and service
monitoring. Individual objectives will be agreed through appraisal.
Completion
of assigned health checks.
Compliance
with EMIS documentation templates.
Frailty
scoring completion.
Carer
wellbeing assessments documented.
Timely
escalation of clinical risks.
Training &
Development
Fully
participates in training and development
Engages
in a programme of ongoing support and feedback to maximise the benefit of the
training and development plan.
Travel
Ability and willingness to travel across multiple
sites is essential for this role
Confidentiality
In the course of seeking
treatment, patients entrust us with, or allow us to gather, sensitive
information in relation to their health. They do so in confidence and have the
right to expect that staff will respect their privacy and act appropriately.
Information relating to patients,
carers, colleagues, other healthcare workers or the business of the Practice
may only be divulged to authorised persons in accordance with the Alliance policies
and procedures relating to confidentiality, and the protection of personal and
sensitive data.
Health & Safety
The post-holder will assist in promoting and
maintaining their own and others health, safety and security as defined in the
Practice Health & Safety Policy to include:
Identifying the risk involved in
work activities and undertaking such activities in a way that manages those
risks.
Using appropriate infection
control procedures particularly those relating to needlestick injuries,
maintaining work areas in a tidy and safe way and free from hazards.
Ensuring that all accidents or
dangerous accidents are reported and investigated, and follow up action taken
where necessary.
Maintain training in line with
local policies.
Equality and Diversity
The post-holder will support the quality, diversity and
rights of patients, carers and colleagues to include:
Acting in a way that recognizes
the importance of peoples rights, interpreting them in a way that is
consistent with current legislation.
Respecting the privacy, dignity,
needs and beliefs of patients, carers and colleagues.
Behaving in a manner which is
welcoming to and of the individual, is non-judgemental and respects their
circumstances, feelings, priorities and rights.
Quality
The post-holder will strive to maintain quality within
the Practice, and will:
Assess
own performance and take accountability for own actions, either directly or
under supervision.
Contribute
to the effectiveness of the team by reflecting on own and team activities and
making suggestions on ways to improve and enhanced the teams performance.
Work
effectively with individuals in other agencies to meet patients needs.
Effectively
manage own time, workload and resources.
Communication
The post-holder should recognise the importance of
effective communication within the team and will strive to:
Communicate effectively with other
team members.
Communicate effectively with
patients and carers.
Recognise peoples needs for
alternative methods of communication and respond accordingly.
The employer is Sunderland GP Alliance
and the post-holder is expected to comply with the Alliances employment
policies and procedures.
