Community Practitioner- Intensive Home Support Service

To support the Senior Practitioner to proactively case manage high risk patients with chronic long term conditions and complex health and social needs to avoid unnecessary hospital admission. Working closely with an integrated neighbourhood team, primary care services and local GP practices.

The post holder will provide clinical assessment, identification, planning, case management and co-ordination of care for people with long term conditions who have complex needs and co-morbidities. The post holder will work towards enhanced professional practice including medicines management, professional leadership, improving mental health and supporting and promoting a self-care management model.

The post-holder will promote partnership working to improve outcomes for patients with co-morbidity of long-term conditions in order to reduce unplanned hospital admissions, reduce length of stay, and facilitate seamless transition of care. The post holder will join a rotational rota covering shifts over a 24 hour period, 7 days per week, 365 days per year.

Main duties of the job

To support the Senior Practitioners to proactively case manage high risk patients with chronic long term conditions and complex health and social needs to avoid unnecessary hospital admission. Working closely with an Integrated Neighbourhood Team, Primary Care Services and local GP practices.

The post holder will provide clinical assessment, identification, planning, case management and co-ordination of care for people with long term conditions who have complex needs and co-morbidities.

The post holder will work towards enhanced professional practice including medicines management, professional leadership, improving mental health and supporting and promoting a self-care management model. The post-holder will promote partnership working to improve outcomes for patients with co-morbidity of long term conditions in order to reduce unplanned hospital admissions, reduce length of stay, and facilitate seamless transition of care.

The post holders will contribute to a rota working over 24 hours, 7 days a week on a rotational basis.,

• Provide comprehensive programmes of care, under the supervision of a Senior Practitioner that promote health gains, reduce risks to health and well-being, short term and long term and maximise independence of client and patient with co-morbidity long term conditions. This will include:-


• Health and social assessment including medical history and clinical examination.


• Diagnosis and exercising independent prescribing in accordance with appropriate legislation and ELHT protocols.


• Functional/cognitive assessment.


• Ensuring that client values, beliefs and views, are reflected in their management plan.


• Under the supervision of the Senior Practitioner co-ordinate care and treatment to avoid fragmentation, duplication and delay in the least intensive setting appropriate to the client's needs by:


• Requesting and interpreting diagnostic investigations in order to implement and review a programme of care to meet the needs of the client.


• Referring to specialist services.


• Ensuring effective communication and sharing of appropriate information amongst professionals to avoid conflicting treatments.


• Identifying deficiencies in service provision and addressing these appropriately.


• Use developing skills and knowledge to instigate therapeutic treatments consistent with best available evidence with appropriate input from multidisciplinary teams and other agencies.


• Be proactive in the rigorous monitoring and evaluation of the effectiveness of agreed care management plans, providing timely interventions and modifications as necessary in partnerships with clients/patients.


• Promote and improve the patient's "self-management" of their condition wherever possible.


• Take an active role in the promotion of health and the prevention of ill-health


• Work collaboratively across organisational boundaries e.g. Health, social Care, voluntary and Independent sector to support the effective provision of health and social care services developing a robust partnership approach.


• Create, maintain and facilitate effective multi-disciplinary team working to ensure that the care delivered to service users is quality driven.


• Ensure that care and services are delivered in line with all relevant NSFs, CQC guidance, NICE guidelines, professional requirement, ELHT policies and procedures, Standards for Better Health and current legislation.


• Identify and critically appraise contemporary evidence, develop and promote best practice, ensuring strong professional leadership.


• In liaison with the Integrated Clinical Lead and the Senior Practitioner, work within established models of practice that monitor and maintain high clinical standards for self and others within the care environment.


• Participate in and promote Clinical supervision in practice


• Be a role model for the delivery of clinical and professional practice that will enable innovative and creative practice development.


• Act as an ambassador for the ELHT ensuring that systems are in place to share knowledge, expertise and examples of good practice across the partnership arena.


• Provide leadership for the protection of children and vulnerable adults, ensuring that individuals within the care environment comprehend their responsibility.


• Promote ELHT's vision and public health priorities.


• Support the clinical managers and work with the Integrated Clinical Lead in the delivery of the clinical governance, quality improvement and performance management agenda across provider services.


• Ensure that all clinical records are maintained at the standard required by ELHT and GP practice, identifying assessments made, treatments given and course of action planned.


• Have in depth knowledge of relevant professional standards and guidance, understand implications for and be able to apply to practice e.g.:


• Code of Professional Conduct, standards for conduct, performance and ethics.


• Record Keeping.


• Standards of proficiency for nurse and midwife prescribers.


• Standards to support learning and assessment in practice.


• Be responsible for ensuring that the service is delivered in line with ELHT and other relevant policies in relation to Health & Safety and infection control.


• Maintain the confidentiality of patients and their carers in the with Caldicott requirements.
  
  An exciting opportunity has arisen for two enthusiastic, motivated and committed Community Practitioners to join the Intensive Home Support Service (IHSS)., Essential criteria



• Degree in appropriate subject or evidence of education to degree level.


• Current NMC / HCPC registration - Registered General Nurse / Physiotherapist / OT


Desirable criteria


• Non-medical prescribing V300 or working towards


• Clinical Examination and Clinical Diagnostic CPD Modules at Masters level or evidence of working to that level or currently working towards, Up-to-date evidence of continuing engagement in professional development and of reflective practice in a professional portfolio


• Evidence of supervising team members


• Evidence of experience working in partnership and collaboration


Desirable criteria


• Evidence of clinical experience at a high level in a range of clinical settings including the community/primary care setting.


• Experience of working with complex cases


• Evidence of experience in mentoring/teaching role.


• Participation in research, audit and evaluation


• Leading change and innovation, Enhanced clinical knowledge including current evidence-based practice


• Competent to assess patient's requirements to develop case management plans.


• Knowledge of Chronic Disease Management and long term conditions i.e. COPD, Heart Failure and COPD


• Sound understanding of the expectations of a case manager for long term conditions, particularly in terms of service outcomes and their relevant context.


• Good understanding of systems in health and social care that are wider than immediate role


• Able to plan proactively, manage and evaluate own learning, to negotiate learning opportunities and establish learning contracts


• Demonstrates excellent written and verbal communication skills


• Analytical and problem solving skills


• Ability to maintain records, statistical and activity data in line with trust standards


• Time management and organisational skills


• Knowledge and understanding of the principles of governance and its implications to their service area.


• Ability to work effectively as part of a team


• Good IT skills, including those of using internet based communications and literature.


Desirable criteria


• Ability to interpret data from diagnostic tests to adjust interventions appropriately


• Demonstrate an awareness/understanding of the factors that contribute to good health and the public health priorities of East Lancashire Hospitals Trust


• Ability to communicate complex information where agreement and co-operation is required with clients, carers, staff, colleagues and other professionals.


• Advanced counselling and communications


• Ability to analyse, interpret and present data


Personal Attibutes

Essential criteria


• A constructive, inquiring, flexible approach to others and to their work


• Self-confidence to challenge traditional practice and the persistence to address difficult, enduring issues.


• Self-motivated and adaptable with changes being implemented


• Demonstrates the need to maintain confidentiality and respects diversity and ethnicity.


• Flexible working- able to contribute to a 24hour rotational rota


• The post holder must be assessed as having a level of fitness to carry out duties/tasks after reasonable adjustments under the terms of disability discrimination act have been made.


• A current driving licence, You must have appropriate UK professional registration.
  
  At East Lancashire Hospitals NHS Trust our vision is to be widely recognised for providing safe, personal and effective care. We currently provide high quality services and treat over 600,000 people across East Lancashire and the surrounding area. We employ over 9,500 staff, many of whom are internationally renowned and have won awards for their work., At East Lancashire Hospitals Trust, our vision is to be widely recognised for providing safe, personal and effective care. We currently provide high quality services and treat over 600,000 people across East Lancashire and the surrounding area. We employ over 7,000 staff, many of whom are internationally renowned and have won awards for their work., The Trust is an equal opportunities employer, committed to improving the working lives of our staff and operates a 'Zero Tolerance' policy to aggression, violence, bullying and harassment. In addition, our aim is to help protect children and vulnerable adults by providing a first-class service to the recruitment of people into positions of trust.


We aim to employ a workforce that reflects the diverse communities we serve.

We welcome applications from everyone irrespective of ethnic origin, gender, age, gender identity, sexual orientation, religion, marital status, disability or social background.

We especially welcome applications from members of our black, Asian and minority ethnic (BAME) communities, as we have identified that ELHT has an under-representation of BAME employees. Appointments will be made on merit.

It is important you are made aware of the following as regards your application to East Lancashire Hospitals NHS Trust

• Please note that the salary advertised is for full time hours. If this post is less than 37.5 hours per week, the salary will be pro-rata. For posts on Agenda for Change pay-scales, new entrants to the NHS will normally commence on the first pay point of the relevant band.


• This vacancy may close before the closing date if the recruiting manager deems sufficient applications have been received. Therefore it is advised to complete your application as early as possible to avoid disappointment.


• Please ensure you check the email account from which you apply regularly as we will use this to contact you regarding your application.


• Please note that shortlisting is completed anonymously with candidates being assessed against the essential criteria for the post. Therefore only applicants, who can clearly demonstrate how they meet our person specification criteria in their application, will be short-listed.


Disclosure and Barring Scheme (DBS)

If the role you are applying for is identified as either controlled or regulated activity as defined in in the Safeguarding vulnerable Groups Act (2006) any offer of employment is provisional upon a satisfactory DBS check being obtained.

The healthcare sector is exempted from the Rehabilitation of Offenders Act 1974.

In line with other NHS organisations in the North West Region, the Trust is now passing the charge for undertaking a DBS check on to candidates in the event they are successfully appointed into the post for which they have applied. Candidates can choose whether to pay this over 1-3 months as a deduction from the monthly salary. However, if you are applying for a post as a BANK worker, the payment must be made in full at the time of employment checks. By applying for this vacancy you are agreeing to this undertaking in the event you are successfully appointed.

The cost of an Enhanced Disclosure will be £42.90 and for a Standard Disclosure £22.90 which includes a small handling fee.