Surrey Downs Health & Care
The Surrey Downs Health and Care Quality and Care Home Liaison Team, part of Home First Service works across organisational boundaries with the GP Primary Care Networks, and is responsible for providing therapeutic/MDT intervention for those who would otherwise need hospital admission, as well for as those medically stable to return to a care home from an acute hospital but requiring enhanced short term support as one stage in their on-going care pathway. The Service also supports Care Homes from a quality aspect as required.
To role is expected to work as a key member of the multidisciplinary team in the assessment (including Comprehensive Geriatric assessment) and management of a caseload within the care home setting (Residential or Nursing homes) To plan, deliver and evaluate the treatment needs of clients with a variety of complex social and health care needs. To recognise and refer onto other community services as appropriate.
· To participate as an active member of the multidisciplinary team in developing and delivering high quality and innovative services
· To promote effective teamwork delegating activities appropriately, to the benefit of the patient and service delivery.
· To liaise closely with other health and social care professionals.
· To supervise and teach less experienced Physiotherapy staff, Rehabilitation Assistants and students within this speciality as required.
· To lead on audit, implementation of best practice guidelines and contribute/participate in in-service training
Surrey Downs Health and Care deliver care closer to people’s own communities through our Primary Care Networks, Community Hospitals, Specialist Services and our innovative partnership of local NHS organisations.
Surrey Downs Health and Care has a track record of providing person centered care that goes beyond organisational boundaries to do what is best for the individual. This partnership includes:
• The three GP federations GP Health Partners, Dorking Health Care and Surrey Medical Network representing practices that operate in the Surrey Downs area
• CSH Surrey
• Epsom and St Helier’s University Hospitals NHS Trust
• Surrey Council County
Historically, there have been boundary lines between the organisations that provide care to people in their homes, in GP surgeries and in hospitals, but we have always been united in our mission to provide great care to the people who need us.
It’s on those grounds that the Surrey Downs Health and Care was formed – we want local people to receive the care that they need in the right environment. By bringing together our expertise, we can improve patient care and enable local people to access the right support, care and treatment more easily than ever before.
In bringing this partnership together, we are working to the same set of values that will translate into better care for our residents.
Clinical
• To perform advanced physiotherapeutic assessment of the patient with complex presentations using advanced clinical reasoning skills to create targeted treatment plans using SMART goals specific to the patient’s condition.
• To formulate and deliver an individual or group physiotherapy treatment programme in line with best practice guidelines.
• Support and work alongside the registered and unregistered nurses within the care home and offer clinical support, training, education, advice and guidance.
• Support effective discharge management and prevention of readmission
• To promote effective teamwork within the wider Surrey Downs Health and Care, delegating activities to the wider team to the benefit of the patient and service delivery
• To be able to make rapid decisions where required, using clinical reasoning skills, knowledge and experience, with support as appropriate
• To work with multidisciplinary teams, Adult Social Care, Continuing health care, Acute staff and other relevant agencies, sharing care appropriately ensuring patients and carers receive optimum level of therapy and holistic care within available resources
• To evaluate patient progress, reassess and alter treatment programmes as required and to advise and support more junior colleagues to this effect. To handover treatment plans to the rehabilitation assistant to support with the patient centred goals.
• Willingness and enthusiasm to work toward cross-disciplinary capabilities
• To have an awareness of local community services and be able to refer to these appropriately and in a timely manner.
• To be involved in clinical innovation, using research evidence based practice and clinical networks
• To understand clinical risk within own patient caseload and within the service and advise more junior staff, seeking guidance from fellow peers and Clinical Lead as required.
• Work within Epsom and St Helier policies and CSP clinical guidelines and participate in CPD to maintain professional registration. Monitor own and others quality of practice as appropriate.
• To keep accurate and complete records of work undertaken in line with CSP, Community Therapy Team, Surrey Downs Health and care standards. Maintaining confidentiality and information governance standards at all times.
• To understand the implications of mental capacity in relation to care and discharge decisions including legal frameworks and ensure the team is working within these frameworks
• To teach, assess and contribute to the performance assessment of Band 6/ 5’s and Rehabilitation Assistants.
• To make a significant contribution to the development of departmental policies and procedures on clinical care by attending appropriate meetings and recommending changes to clinical care or service provision.
Professional
• To maintain own clinical professional development (CPD) and incorporate them as necessary into your working practice.
• To actively participate in your Performance Development Plan and review process.
• To be an active member of the in-service training programme by attending and delivering at training sessions.
• To deliver training within care homes as required to support with quality and safety
• To train, supervise and performance manage more junior staff and students, including formal appraisals as required.
• To be responsible for teaching students, physiotherapists/Occupational therapists, rehabilitation assistants, MDT members on cross competency skills.
• Provide support / assurance to enable discharges to be made safely to the care homes that they are working with, liaise with discharge teams and Continuing Healthcare acute practitioners- including introduction of Trusted Assessor role and Trusted Pre Assessment
• To undertake organisational and local audit. Undertake research projects as appropriate.
• Maintain and develop evidence based practice in Intermediate Care / Frailty.
• To demonstrate a sound understanding of clinical governance and risk management within the work situation.
• To be professionally and legally responsible for all aspects of professional activities, working within the codes of practice, professional guidelines and Epsom and St Helier NHS Trust policies and procedures.
Organisational
• To be responsible for the safe use of equipment used in carrying out physiotherapy duties and to adhere to departmental policies and guidelines to ensure safe use of equipment by the team. To report defects as per policy.
• To share responsibility for departmental tidiness, maintenance and administration.
• To develop compassionate leadership awareness and be sensitive to team dynamics. Be able to respond appropriately when considering your own role and the role of others in the team, being sensitive to the needs of your colleagues.
• To demonstrate flexibility according to the needs of the service and the clinical demands.
• To provide updates to service leaders regarding data collection, progress of potential discharges and waiting lists.
• Utilise IT systems to improve the efficiency of the service.
• This role will collate and anaylis data including but not limited to ED attendances, Admissions to acute, Training etc
This advert closes on Sunday 29 Dec 2024