Exeter City PCN (ECPCN) has developed a same day service to support our patients and GPs in providing care for medium to low risk patients who present to the practice for on-the-day support and advice.
This role will support patients who currently use alternative services and pathways for care to consider using the same day service team, community services, and secondary care services appropriately.
The postholder will work as part of a multi-disciplinary team and within their own competencies to provide expertise in using their skills to coach and support patients by text and over the telephone to consider alternative services to support their care needs.
Main Duties of the Job
KEY RESPONSIBILITIES:
1. Daily review of ED attendances and 111 contacts to gather a list of patients accessing these services.
2. Developing patient messaging and education to support navigation to other services such as primary care and the voluntary sector.
3. Identifying trends and frequent attenders and suggesting interventions to support patients making appropriate decisions.
4. Proactively manage patients who frequently attend services, suggesting care plans and check-ins to change behaviour.
5. Work with Devon ICB to understand shared data and provide suggestions, delivering campaigns to guide patients to access appropriate services across primary and secondary care as well as voluntary services.
About Us
Exeter City PCN provides services to 38,000 patients across 6 GP practices in Exeter. The PCN enables patients to access specialisms in primary care such as Physiotherapy, Mental Health, Pharmacy Services, and Wellbeing Services. Part of the offer is to provide same day access to services and support patients to choose the right clinician for their care.
The PCN is running a pilot for the next 6 months to support patients to navigate Primary, Secondary, and Voluntary Care Services. This role will be pivotal in helping to understand trends and themes of patients accessing care, providing timely interventions to support effective choices and help navigate patients through services.
The successful candidate will be working with the existing team either remotely or in person at our Exeter office.
Job Responsibilities
Dependent on Experience
WORKING HOURS: 30 hours
Summary:
This role will support patients who currently use alternative services and pathways for care to consider using the same day service team, community services, and secondary care services appropriately.
This role is pivotal to improving the quality of continuity of care for patients.
You will also be able to support and signpost or refer patients to other appropriate services or colleagues within the well-established same day service team. The team comprises of a physio, pharmacists, pharmacy technicians, 2 Health Coaches, a Social Prescriber, Assessment and Brief Intervention Worker (ABI), and Mental Health Nurses.
Part of the role will involve reviewing data and providing lists to practices about patient behaviour and attendance patterns.
The postholder role is temporary for 6 months as part of DEVON ICB and Exeter City PCN joint pilot to evaluate the role of non-GP interventions in increasing capacity in general practice. The post holder will be asked to contribute to data collections and support the review of the service.
Scope and Purpose of the Role:
Supporting patients to make best use of alternative services such as community-based voluntary services as well as formal NHS support pathways.
Our offer to patients is to ensure they are helped to access timely care and able to navigate primary care, secondary care, and voluntary services effectively.
This role will be integral in understanding the number of patients choosing to use inappropriate services outside and support them to access services more local to them, which better meet their needs.
KEY RESPONSIBILITIES:
1. Daily review of ED attendances and 111 contacts to gather a list of patients accessing these services.
2. Developing patient messaging and education to support navigation to other services such as primary care and the voluntary sector.
3. Identifying trends and frequent attenders and suggesting interventions to support patients making appropriate decisions.
4. Proactively manage patients who frequently attend services, suggesting care plans and check-ins to change behaviour.
5. Work with Devon ICB to understand shared data and provide suggestions, delivering campaigns to guide patients to access appropriate services across primary and secondary care as well as voluntary services.
Managerial:
1. Support the Clinical Lead in ensuring the effective provision of care and service developments of the Same Day Service Team.
2. Manage own workload and ensure interventions happen in a timely, flexible, and responsive manner.
3. Participate in team meetings, initiating and discussing new methods and contributing to the Devon ICB and Exeter City PCN joint pilot.
4. Participate in the multi-disciplinary and multi-agency decision-making process through team meetings and team building when required.
5. Undertake duties as assigned by senior staff to ensure that all agreed patient quality, safety, and operational performance outcomes are delivered within the area of responsibility.
6. Provide specialist advice, support, and consultation to staff within the team, outside teams, and other agencies on managing patient behaviours.
7. Support the introduction of outcome measures, to measure patient experience and behaviour.
8. Contribute towards team education and development providing opportunities for exchange of ideas, experience, techniques, and interventions.
9. A holistic approach to care is required that encompasses physical health, mental health, and social care.
10. Take part in service development and review.
Responsibility for Patient/Client Care:
1. Develop and maintain effective individualised care by ensuring the following areas are proactively undertaken at all times:
2. Review relevant data and consider mental, physical, and social care needs of patients frequently accessing services.
3. Planning, implementation, and evaluation of interventions.
4. Clear, accurate, and concise documentation of individualised patient care and recording both qualitative and quantitative measures, as agreed with PCN director and PCN lead.
5. Signposting patients and promoting self-care as appropriate.
Supervision and Training:
An Induction programme will be provided.
Monthly meetings with the PCN Lead Manager will be provided for more formal supervision.
Quality:
The post-holder will:
1. Alert other team members to issues of quality and risk, reporting Significant Events as they arise and participating in the review and learning of incidents.
2. Assess own performance and take accountability for own actions, either directly or under supervision.
3. Contribute to the effectiveness of the team by reflecting on own and team activities and making suggestions on ways to improve and enhance the team's performance.
4. Work effectively with individuals in other agencies to meet patients' needs.
5. Effectively manage own time, workload, and resources.
6. Participate in audit, where appropriate.
Person Specification
Experience
* Recognises priorities when problem-solving and identifies deviations from the normal pattern and is able to refer when appropriate.
* Able to work under pressure and to meet deadlines.
* Produces timely and informative reports.
* Demonstrable ability to show kindness and compassion.
* Able to manage data and reporting across clinical systems after guidance.
* Evidence of ability to support collation and analysis of data.
* Excellent interpersonal, influencing, and negotiating skills.
* Excellent written and verbal communication skills.
* An appreciation of the nature of GPs and general practices, including the breadth of acute and long-term conditions that are likely to be seen in general practice.
* Experience of working in primary care or attached to a primary care team through secondment or training.
* Experience of local services in the Devon area.
* Ability to use SystmOne and medical software packages.
* Ability to use Microsoft Office packages, including Microsoft Teams.
* Understanding of the development of Primary Care Networks and the Network Direct Enhanced Services.
Qualifications
* GCSE in English and Mathematics.
* Qualified to NVQ Level 3 in Health and Social Care or equivalent.
* Counselling Qualifications.
* Experience in Patient Navigation.
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.
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