Job description

Job responsibilities

The Frailty service is a planned proactive service maintaining the health and wellbeing of people living with frailty.

The post holder will work as part of a multi-disciplinary team in a patient-facing role across the East Cornwall Primary Care Network, to help improve patient outcomes, ensure better access to healthcare and support practices to manage their most vulnerable and complex patients. The role is pivotal to improving the quality of care and operational efficiencies so requires motivation and passion to deliver excellent services within general practice.

Job Purpose:

To establish a Frailty Service for East Cornwall PCN

• To identify those living with frailty within the PCN, utilising the Rockwood scoring system or other identified method.
• To support the elderly to age healthier, reducing progression of frailty and risks associated with it where possible.
• To support them to make informed choices as to their health and welfare.
• To attend and lead MDTs and work collaboratively with neighbourhood teams to support elderly and carers.
• Reduce emergency hospital admission, readmission and try to reduce care burden.
• Support early discharge planning
• To identify those likely to be within their last year of life and support them to plan for their future needs.
• Develop shared care and support plans by involving older people living with frailty, their families and carers throughout all stages of progression.
• Early identification and treatment of Delirium.

Core Responsibilities

• Develop, implement and evaluate a seamless Frailty support service across the PCN, working with community and secondary care where appropriate, and aimed at continuously improving standards of patient care and wider multi-disciplinary team working.
• Where appropriate, support the development of discharge and contingency plans with relevant professionals to arrange on-going care in residential, care home, hospital, community settings and at home;
• Periodically review, evaluate and change rehabilitation programmes to rebuild lost skills and restore confidence;
• Advise on home, and workplace environmental alterations, such as adjustments for wheelchair access, technological needs, and ergonomic support;
• Advise patients, and their families or carers, on specialist equipment and organisations that can help with daily activities;
• Assist patients to adapt to and manage their physical and mental health long-term conditions, through the teaching of coping strategies; and assess, plan, implement, and evaluate treatment plans, with an aim to increase patients productivity and self-care;
• Ensure delivery of best practice in clinical practice, caseload management, education, research, and audit, to achieve corporate PCN and local population objectives.
• Advise practices of workflow and develop SOPs for team and practices to follow and implement, particularly Personalised Care Planning, utilising best practice.

Multi-disciplinary team working (MDT)

• Ensure MDTs adhere to the Gold Standard Framework and lead MDT development and best practice across the PCN.
• Ensure the right people are involved in MDTs from the East Cornwall Neighbourhood teams and PCN teams.
• Participate in GP huddles and any other PCN/Partnership MDT and promotes effective ways of working;
• Exercise a critical understanding of personal scope of practice and to identify when a patient requires escalation or referring on to other services.
• Develop effective working relationships with the Palliative Care Team and embed new processes and ways of working if required, to avoid duplication and to enhance the patient and family experience.

Communication

The post-holder should recognise the importance of effective communication across the PCN and within the team and will strive to:

• Work with patients through a shared-decision making approach to plan realistic, outcomes-focused goals;
• Coordinate and support the provision of Personalised Care Plans; Treatment Escalation Plans; End of Life Plans;
• Undertake both verbal and non-verbal communication methods to address the needs of patients that have communication difficulties;
• Communicate effectively with other team members;
• Communicates effectively and appropriately with patients and carers complex and sensitive information regarding diagnosis, pathology and prognosis;
• Recognise peoples needs for alternative methods of communication and responds accordingly;
• Develop relationships and a collaborative working approach across the PCN supporting the integration of pathways in primary care.

Signposting

Ensure that patients are referred to the appropriate healthcare professional for the appropriate level of care within an appropriate period of time e.g. pathology results, common/minor ailments, acute conditions, long term condition reviews etc.

Service Development

Contribute to the development and implementation of new services for the PCN.

Information Management

Analyse, interpret and present data to highlight issues and risks to support decision making.

Quality Improvement

• Undertake clinical audits of in areas directed by the PCN, feedback the results and implement changes in conjunction with the practice teams.
• Demonstrates ability to identify and resolve risk management issues according to policy/protocol;
• Follows professional and organisational policies/procedures relating to performance management;
• Represents the Frailty service on relevant committees and meetings, as a lead clinician, provide input in relation to specialist issues and clinical matters as required.

Education and Training

Provide education and training to primary healthcare teams.

Care Quality Commission

Work with the general practice teams to ensure the practice is compliant with CQC standards.

Public Health

To support public health campaigns. To provide specialist knowledge on all public health programmes available to the general public.

Confidentiality

In the course of seeking treatment, patients entrust us with, or allow us to gather, sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately.

In the performance of the duties outlined in this Job Description, the post-holder may have access to confidential information relating to patients and their carers, practice staff and other healthcare workers. They may also have access to information relating to the practices as a business organisation. All such information from any source is to be regarded as strictly confidential.

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 practice policies and procedures relating to confidentiality and the protection of personal and sensitive data.

Health and 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:

• Using personal security systems within the workplace according to practice guidelines;
• Identifying the risks involved in work activities and undertaking such activities in a way that manages those risks;
• Making effective use of training to update knowledge and skills;
• Using appropriate infection control procedures, maintaining work areas in a tidy and safe way and free from hazards;
• Reporting potential risks identified.

Equality and Diversity

The post-holder will support the equality, diversity and rights of patients, carers and colleagues, to include:

• Acting in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with practice procedures and policies, and current legislation;
• Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues.

Personal/Professional Development

The post-holder will participate in any training programme implemented by the PCN as part of this employment, such training to include:

• Participation in an annual individual performance review, including taking responsibility for maintaining a record of own personal and/or professional development.
• Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work.

Quality

The post-holder will strive to maintain quality within the PCN and will:

• Alert other team members to issues of Clinical Governance issues, quality and risk; participate in any risk reviews;
• 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 enhance the teams performance;
• Work effectively with individuals in other agencies to meet patients needs;
• Effectively manage own time, workload and resources. He/she will also contribute to the overall team-working of the PCN putting the needs of the PCN first.
• Contribution towards practices CQC compliance rating of GOOD or above.

Person Specification

Qualifications

Essential

• Registered with the Health and Care Professional Council; or Nursing and Midwifery Council;

Desirable

• Holds a masters level qualification;
• May hold or be working towards a prescribing qualification;

Experience

Essential

• Demonstrates general skills and knowledge in core areas;
• Experienced in developing and implementing Personalised Care Plans;
• Is able to plan, manage, monitor, advise and review general frailty care programmes for patients in core areas, including disease states/ long term conditions identified by local Needs Assessment;
• Demonstrates accountability for delivering professional expertise and direct service provision;
• Able to follow legal, ethical, professional and organisational policies/procedures and codes of conduct.
• Full driving licence

Education, Training and Development

Essential

• Demonstrates self-development through continuous professional development activity;
• Demonstrates an understanding of current educational policies relevant to working areas of practice and keeps up to date with relevant clinical practice;
• Ensures appropriate clinical supervision is in place to support development;
• Enrolled into review and appraisal systems within PCN.

Collaborative Working Relationships

Essential

• Operate as a full member of the primary care team, including contributing service evaluation/improvement and research activity;
• Manage and co-ordinate the care that individual patients receive, including through liaising with other members of the MDT and with patients' carers;
• Facilitate primary care activity, with a strong emphasis on prevention and early intervention, including through the delivery of public health advice (e.g. relating to physical activity, weight management and smoking cessation);
• Contribute to the use of healthcare technologies to optimise the integration of service delivery (across teams, sectors and settings) and patients access and continuity of care;
• Contribute to the development of primary care teams, including through contributing to others' learning.

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.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Kernow Health CIC

Address

Rame Group Practice

Trevol Road

Saltash

Cornwall

PL11 2TB

United Kingdom

Employer's website

https://www.kernowhealthcic.org.uk (Opens in a new tab)

Job description

Job responsibilities

Clinical responsibilities:

• In accordance with the practice rota, as agreed, the post-holder will make him/her-self available to undertake a variety of duties including surgery consultations, telephone consultations and queries, visiting patients at home, checking and signing/authorising repeat prescriptions and dealing with queries, paperwork and correspondence in a timely fashion.
• Making professional, autonomous decisions in relation to presenting problems, whether self-referred or referred from other health care workers within the organisation
• Assessing the health care needs of patients with undifferentiated and undiagnosed problems
• Screening patients for disease risk factors and early signs of illness
• In consultation with patients and in line with current practice disease management protocols, developing care plans for health
• Providing counselling and health education
• Referring to other care providers as appropriate
• Recording clear and contemporaneous consultation notes to agreed standards
• Compiling and issuing computer-generated acute and repeat prescriptions
• Prescribing in accordance with the practice prescribing formulary (or generically) whenever this is clinically appropriate
• The post-holder will be required to visit patients during surgery time in an emergency if clinically indicated.
• The post-holder will participate in the extended hours enhanced service.
• The post-holder will undertake fair share of home visiting sessions per week as allocated.
• Experience with audit and able to lead audit programmes

• Recognise and work within own competence and professional code of conduct as regulated by the GMC.
• Follow all practice/PCN policies/guidelines, including prescribing, confidentiality, data protection, security, health and safety policies.
• Demonstrate efficient and prompt delivery of administrative tasks.
• Prioritise, organise and manage own workload and resources in a manner that maintains and promotes quality.
• Assess own performance and take accountability for own actions, either directly or under supervision.
• Participate in quality improvement initiative, including Significant Event Analysis and the review of patient complaints.
• Contribute to the ongoing development of the Practice/PCN local and national standards / targets e.g. Quality and Outcomes Framework, IIF.
• Support the aims and objectives of all practice policies and procedures to ensure high quality care , service delivery and minimise risk.

• Regular communication with the health professional and managerial and administrative staff of the Practice to ensure the smooth running of the practice.
• Liaison with the members of the wide multi-disciplinary team, including ICB, hospitals, community services and other agencies (such as local authority, social services and voluntary agencies) in order to assure appropriate care is provided for the Practice population.
• Communicate effectively with patients and carers, recognising their needs for alternative methods of communication.
• Demonstrate sensitive communication styles to ensure patients are fully informed and consent to treatment.
• To communicate difficult often unpleasant or sensitive messages to patients and families.
• Participate in Practice / PCN Meetings and others as appropriate.

• Work as an effective and responsible team member, supporting partners and other members of the practice team in a flexible manner.
• Show commitment to maintain and demonstrate compliance with practice vision, values and behaviours.
• Understand own role and scope within the organisation and identify how this may develop over time.
• Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the teams performance.
• Ensure clear understanding and utilisation of referral mechanisms are in place to meet patient need.
• Participate in and support locality projects as agree with the practice/PCN management team.

Responsibility for Information Resources:

• Review and process data using accurate SNOMED coding in order to ensure easy and accurate information retrieval for monitoring and auditing purposes.
• Understand and follow the requirements of confidentiality, including the Data Protection and the Freedom of Information Act and to refer on any queries as appropriate.
• Follow Practice policy regarding the use of email and computer tasks as the main non-verbal internal method of communication and use of the intranet and the internet as the main source of internal and external information.

Other responsibilities within the Organisation:

• Contribute to the development and achievement of the PCN strategy and goals.
• Participate in and promote the practice online services to patients (eg online medical viewer), along with involvement of practice online consultation system.
• Awareness of and compliance with all relevant policies / guidelines.

Equality and Diversity:

• Act in a way that recognise the importance of peoples rights, interpreting them in a way that is consistent with Practice procedures and policies, and current legislation.
• Respect the privacy, dignity, needs and beliefs of patients, carers visitors and colleagues. They must be treated equally, irrespective of gender, ethnic origin, age, disability, sexual orientation religion etc Behaving in a manner which is welcoming to and of the individual, is non-judgmental and respects their circumstances, feelings priorities and rights.
• Be aware of the statutory procedure, local guidance and referral criteria regarding the protection of children and vulnerable adults. Follow the guidance and policies and take action in an appropriate manner.

Confidentiality:

• In the course of seeking treatment, patients entrust us with, or allow us to gather, sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately.
• In the performance of the duties outlined in this Job Description, the post-holder may have access to confidential information relating to patients and their carers, practice staff and other healthcare workers. They may also have access to information relating to the Practice as a business organisation. All such information from any source is to be regarded as strictly confidential.
• 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 Practice policies and procedures relating to confidentiality and the protection of personal and sensitive data.

Security, Health & Safety:

The post-holder will assist in promoting and maintaining their own and others health, security and safety as defined in each Practice Health & Safety Policy, to include:

• Using personal security systems within the workplace according to Practice guidelines.
• Identifying the risks involved in work activities and undertaking such activities in a way that manages those risks.
• Making effective use of training to update knowledge and skills.
• Using appropriate infection control procedures, maintaining work areas in a tidy and safe way and free from hazards.
• Reporting potential risks identified.

Personal / Professional Development:

In addition to maintaining continued education through attendance at any courses and/or study days necessary the post-holder will participate in any training programme implemented by the Practice as part of this employment, such training to include:

• Participation in an annual individual performance review, including taking responsibility for maintaining a record of own personal and/or professional development.
• Taking responsibility for own development, learning and performance and demonstrating skills and activities to others who are undertaking similar work.

Person Specification

Qualifications

Essential

• Qualified GP
• MRCGP
• Vocational Training Certificate or equivalent JCPTGP
• General Practitioner (Certificate of Completion of Training CCT)

Skills

Essential

• Excellent communication skills (written and oral)
• Clear, polite telephone manner
• Competent in the use of Office and Outlook
• EMIS user skills
• Effective time management (planning and organising)
• Ability to work as a team member and autonomously

Desirable

• Strong IT skills

Experience

Essential

• Experience of working in a primary care environment
• Experience of continued professional development
• Experience of QOF
• Eligibility now applies to any GP, provided they have not been substantively employed as a General Practitioner in a Core Network Practice of South and East Stockport PCN at any point in the previous 12 months.
• General understanding of the primary care contract
• Experience of medicines management

Desirable

• Experience of clinical audit

Eligibility

Essential

• Full GMC registration
• National Performers List registration (England), noting that confirmation on this list is adequate for DBS confirmation
• Evidence of current validation
• Evidence of last appraisal
• Eligibility to practice in the UK independently

Desirable

• Experience of ICB initiatives

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.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Marple Cottage Surgery

Address

Marple Cottage Surgery

50 Church Street

Marple

Stockport

Cheshire

SK6 6BW

United Kingdom

Employer's website

https://www.marplecottage.co.uk/ (Opens in a new tab)

Job description

Job responsibilities

Post: Receptionist / Care Navigator

Responsible to: The General Practitioners in Partnership

Under Supervision of:Reception Manager / Operations Manager

Job Summary:

Receive, assist and direct patients in accessing the appropriate service or healthcare professional in a courteous, efficient and effective way.

Offer general assistance to the practice team and project a positive and friendly image to patients and other visitors, either in person or via the telephone

Duties may be varied from time to time dependent on current and evolving practice workload and staffing levels.

Job Responsibilities

• Ensure an effective and efficient reception service is provided to patients and any other visitors to the Practice.
• Deal with all general enquiries, explain procedures and make new and follow-up appointments asking patients to confirm their address when they make an appointment and take appropriate action when informed of any change of address.
• Using your own judgment and communication skills ensure that patients with no prior appointment but who need urgent consultation are seen in a logical and non-disruptive manner.
• Registration of new patients and temporary patients following practice policy.
• Receive and make telephone calls as required. Divert calls and take messages, ensuring accuracy of detail and prompt appropriate delivery.
• Enter requests for home visits onto the duty doctor telephone list and when necessary contact the duty doctor with any late requests.
• Action repeat prescription requests in accordance with Practice guidelines and ensure that they are ready for collection or sent electronically to the pharmacy within 48 hours.
• Advise patients of relevant charges for private services, accept payment and issue receipts for same. Keep adequate records of petty cash transactions.
• Enter patient information on to the computer as required. Update name, address and telephone number changes promptly.
• Sort and distribute mail as per protocol. Photocopy as requested.
• Retrieve and re-file paper medical records as required.
• Maintain supplies of stationery available in reception area, purchase stamps and post mail.
• Make drinks for the doctors and other staff and participate in washing up rota.
• Leave working area tidy and ready for incoming colleagues. Handover/leave information regarding unsolved or urgent problems. Log off the computer at the end of each shift.
• Open up the premises at the start of the day, de-activate the alarm and make all necessary preparations to receive patients including restoring the telephone service, as required.
• When last to leave at the end of the day, ensure that the building is totally secured, internal lights are off and the alarm is activated.
• Undertake any other additional duties appropriate to the post as requested by the Partners or the Reception Manager / Operations Manager.

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, the practice Health & Safety Manual, and the practice Infection Control Policy and published procedures. This will include:

• Using personal security systems within the workplace according to practice guidelines.
• Identifying the risks involved in work activities and undertaking such activities in a way that manages those risks.
• Making effective use of training to update knowledge and skills.
• Using appropriate infection control procedures, maintaining work areas in a tidy and safe way and keeping them free from hazards.
• Actively reporting health and safety hazards and infection hazards immediately when recognised.
• Keeping own work areas and general/patient areas generally clean, assisting in the maintenance of general standards of cleanliness consistent with the scope of the job holders role.
• Reporting potential risks identified.
• Demonstrate due regard for safeguarding and promoting the welfare of children.

Production of performance and quality information

• To ensure that documentation (electronic and paper-based) exists to support performance standards across the full range of performance-based activity QOF, Enhanced Services etc.
• To assist in the production of information for clinical audit.
• To undertake ad-hoc work related to the performance of the practice under the guidance of the Practice Manager.

Equality and diversity

The post-holder will support the equality, diversity and rights of patients, carers and colleagues, to include:

• Acting in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with practice procedures and policies, and current legislation.
• Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues.
• Behaving in a manner that is welcoming to and of the individual, is non-judgmental and respects their circumstances, feelings priorities and rights.

Personal/Professional development

The post-holder will participate in any training programme implemented by the practice as part of this employment, such training to include:

• Participation in an annual individual performance review, including taking responsibility for maintaining a record of own personal and/or professional development.
• Taking responsibility for own development, learning, and performance and demonstrating skills and activities to others.

Quality

The post-holder will strive to maintain quality within the practice, and will:

• Alert other team members to issues of quality and risk.
• 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 enhance 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:

• Communicate effectively with other team members, patients and carers.
• Recognise peoples needs for alternative methods of communication and respond accordingly.

Contribution to the implementation of services

The post-holder will:

• Apply practice policies, standards and guidance.
• Discuss with other members of the team how the policies, standards and guidelines will affect own work.
• Participate in audit where appropriate.

Confidentiality

• In the course of seeking treatment, patients entrust us with, or allow us to gather, sensitive information in relation to their health and other matters. They do so in confidence and have the right to expect that staff will respect their privacy and act appropriately.
• In the performance of the duties outlined in this job description, the post-holder may have access to confidential information relating to patients, their carers, practice staff and other healthcare workers. They may also have access to information relating to the practice as a business organisation. All such information from any source is to be regarded as strictly confidential.
• 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 practice policies and procedures relating to confidentiality and the protection of personal and sensitive data.

Person Specification

Experience

Essential

• An understanding, acceptance and adherence to the need for strict confidentiality.
• Ability to self-motivate, organise and prioritise own workload without direct supervision.
• Ability to work under pressure and be able to cope with stressful situations.
• Ability to work within a team.
• Ability to work in a changing environment.
• Good keyboard and computer skills.
• Good standard of English and good numeracy skills.
• Excellent communication skills.
• Attention to detail.
• Experience of dealing with the public.
• A pleasant disposition with a sense of humour.
• To be reliable and have a flexible approach to working hours.

Desirable

• A willingness to undertake further training.
• Experience working in a hospital or Primary Care setting.

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.

Employer details

Employer name

Bridge Surgery

Address

St Peters Street

Stapenhill

Burton on Trent

Staffordshire

DE15 9AW

United Kingdom

Employer's website

https://www.bridgesurgery.net/ (Opens in a new tab)