Job summary
We are looking for a 12-month maternity cover for a Lead Nurse Clinical Care Co-ordinator to work with the five practices that are part of PCN Wakefield South, working with our existing non-nurse Care co-ordinators.
As part of your role, you would liaise with the surgeries and wider PCN team including Social Prescriber, Care Co-ordinators, Health and Wellbeing team.
The role is to proactively:
* provide and maintain a high standard of nursing and care co-ordination for patients who are house bound or deemed hard to reach.
* reduce unplanned hospital admissions by supporting patients to be healthy, by monitoring their long-term conditions, promoting screening and health prevention.
* visit patients who would benefit from out-reach by providing a long-term condition service.
* engage with a patients family members and/or carers to ensure they are supported to access services, by promoting referrals to the care co-ordinators within the team.
* provide nurse leadership as required to the existing developed team to include training needs and support where required.
* promote and engage with vaccination campaigns including Flu and Covid
* Enage with community events and the wider teams including both secondary and voccational care.
Main duties of the job
The post holder will be required to undertake the following:
1. Act as the lead to identify and visit those who are house bound or considered hard to reach, who may have a long-term health condition.
2. Lead the roving multi-disciplinary care co-ordination team and support the team members to enable the team to be a success within our PCN.
3. Assess the needs of the patient and co-ordinate the most appropriate person to carry out the visit, such as Care Co-ordinator, nursing associate or a member of the wider PCN workforce.
4. Prioritise health problems and intervene appropriately to assist the patient in complex, urgent or emergency situations, including the initiation of effective emergency care.
5. Utilise population health intelligence to proactively work with patients to deliver personalised care, alongside the non-clinical care coordinators.
6. Support patients to utilise decision aids in preparation for a shared decision-making conversation.
7. Working with the non-clinical care coordinators, holistically bring together all of a persons identified care and support needs and explore options to meet these within a single personalised care and support plan (PCSP) in line with PCSP best practice, based on what matters to the person.
8. Support practices with Nursing care if and when required
9. Identify and work towards PCN and practice targets
About us
Wakefield Health Alliance South Ltd is predominantly situated across the eastern side of the Wakefield district, made up of five GP Surgeries, Park Green, Langthwaite, White Rose, The Grange and College Lane collectively serving a patient population of approximately 64,000.
The successful applicant will work with practices across the PCN footprint; working closely with the existing clinical teams to deliver excellent patient care. This role provides fantastic opportunity for career development alongside a competitive salary package.
The role has the potential to help manage general practice workload and significantly improve quality of care and safety for patients.
Job description
Job responsibilities
Please see the attached job description and person spec for further details of the responsibilities of this role.
Person Specification
Other Essential criteria
Essential
10. * Hold a full UK driving licence with the relevant car insurance to cover travel for business purposes or have the ability to be independently mobile and travel across the footprint of PCN South on a regular basis
11. * Ability to work autonomously, managing their own caseload.
12. * Knowledge of clinical governance and audit Knowledge of relevant Professional and Clinical legislation
13. * IT skills in Microsoft applications
14. * Demonstrates effective communication and interpersonal skills.
15. * Ability to work well as a team member.
16. * Demonstrations initiative and potential ability to work without direct supervision, problem solve and prioritise own work.
Desirable
17. Awareness/knowledge of the issues surrounding social inclusion for mental health service users.
Experience
Essential
18. * Substantial post-registration experience
19. * Practical experience of clinical procedures as per job profile/advertised requirements.
20. * Experience of working in a primary care environment
21. * Experience of working with housebound patients and hard to reach groups.
22. * Experience of wound management
23. * Experience of working in an MDT setting
24. * Experience of documenting and record keeping of clinical information
Desirable
25. Previous use of SystmOne
Qualifications
Essential
26. *Qualified Registered General Nurse or equivalent with current NMC registration
27. * Good standard of general education and good standard of spoken and written English language
28. * Evidence of continuing professional development within the last 12 months
29. * Ability to communicate informally and develop supportive relationships with clients, carers and other professionals.
30. * Ability to motivate, empower and enable others.
31. * Be adaptable and self-motivated using initiative and clinical judgements.
32. *Have enthusiasm and commitment to achieving better outcomes for patients.
Desirable
33. Masters degree in relevant subject area Diploma(s) in chronic disease management, eg Diabetes, asthma, COPD etc