Main Purpose: To be responsible for independently leading and managing practice, using an advanced level of professional accountability, autonomy and judgement for highly complex decision-making across a broad range of situations/conditions. To work autonomously, but as part of the Duty Team, using advanced knowledge and skills, underpinned by theory and experience, to holistically assess the identified patient caseload, using a range of methods across a broad range of, often complex, patient conditions. To plan and manage complete episodes of care, working in partnership with others, delegating and referring as appropriate, to optimise health outcomes and resource use, as well as providing direct support to patients and carers. To promote the proposal and implementation of service and policy development and redesign, impacting beyond own area and other disciplines, informed by current best practice and evidence-base, in accordance with values-based care. The post holder is expected to be able to: Hold sole responsibility for a range of duties, relevant to post Works unsupervised, clinically examining and assessing patients and initiating any appropriate action. Make independent, autonomous clinical decisions relating to patient condition and treatment / care. May require minimal support and will be expected to obtain support from GPs to make decisions, which may be outside their scope of clinical knowledge. Exercise significant discretion in the delivery of this role, being guided by policies and procedures and implementing appropriate action in order to achieve expected results. Proposes and implements appropriate changes to policy / service provision as consequence of interpretation of local and/or national guidance/research findings. Key Working Relationships: Working daily as part of the Duty Team, having own list of patients to assess and treat, but also assisting, where time allows, with Critical Care list and any emergencies that arise. Working with the Econsult administrators to ensure clinical and patient management is safe and time efficient. Working with the Reception team to ensure clinical and patient management is safe and time efficient. Key responsibilities (General Duties): Responsibility for patient care, communication, planning, organisation, analysis, freedom to act, research and service development Advanced clinical practice / direct patient care Takes responsibility for providing care and treatment in line with current evidence base, at an advanced clinical practice level, demonstrating the ability to make critical judgements and problem-solving, regarding patient pathways, on a daily basis, for a distinct caseload of patients. Initiates and carries out highly complex patient assessment, analyses and interprets results, using highly developed advanced knowledge and skills that includes: Comprehensive patient history and health assessment, physical examination, clinical measurements using advanced clinical skills, detailed medicines history, undertaking and interpreting range of tests / investigations. If legally authorised and in accordance with Trust regulations, independently prescribes a range of medications, as agreed with the Partners, based on efficacy, safety and cost. Discusses and agrees assessment outcomes with patients, carers and other health professionals, to enable them to make informed decisions regarding treatment and care, and initiates appropriate, timely consultation and/or referral, when more expert input is required Rapidly and continuously evaluates patients changing condition and response to therapeutic interventions and modifies plan of care for optimal patient outcome Communication and relationships Establishes and maintains excellent communication, with individuals/ groups, providing and receiving highly complex, sensitive and/or contentious information and exploring complex issues across a wide range of care options and decisions Uses highly developed communication skills to provide guidance, advice and support to the patient/carer regarding management of their health/illness condition and its impact on patients/carers life Communicates complex, very sensitive, sometimes distressing information to patient/carer using empathy and reassurance; identifies and overcome barriers to understanding as appropriate Provides verbal and written information to patient, to enable them to give informed consent for treatment and obtains written consent for specified procedures, using highly developed specialist knowledge Establishes supportive partnerships with patients/carers and communicates with them, sometimes in highly distressing or emotional circumstances, which may involve imparting bad news In all aspects of work, challenges and demonstrates an ability to work autonomously across organisational and professional boundaries Establishes and maintains local and regional network of contacts sharing good practice, innovative ideas, promotes developments. Leadership and management Acts as a visible advanced practice role model by demonstrating high standards of care having both advisory and clinical input into care and treatment. Acts in such a way as to be a credible, effective leader, demonstrating values-based clinical leadership, on a daily basis. Uses their professional judgement in leading on and managing complex and unpredictable care events and captures learning from these experiences to improve patient care and service delivery. Formulates, develops, implements, monitors and evaluates policies/guidelines, relevant to caseload of patients. Leads on, plans and manages own workload and workload of the service, in a flexible manner, ensuring service provision meets needs of patients. Assesses risks to health, safety and security using the results to take appropriate action and to promote and improve practice. Contributes to the Practice governance process, including adverse incident and complaints reporting and investigation. Supports the introduction and maintenance of quality and safety systems and processes within own area and monitors quality of own and others practice and participates in continuous quality improvement, using current evidence, making adjustments as required Education /Professional Actively engages in continuous professional development in line with advanced clinical practice role and service development, maintains a suitable CPD record and ensures adheres to revalidation requirements Develops and delivers relevant specialist teaching for all disciplines and levels of staff, patient and carer groups within Trust, in relation to own area of expertise. This will include development of links with other organisations. Uses high-level communication skills and contributes to wider development of those working in their area of practice by disseminating best practice, regionally, nationally and Internationally. Generates and applies new knowledge to own and others practice. Evaluation and research Initiates, facilitates and leads change at individual, team, Practice levels, in order to improve practice and health outcomes, consistent with national and international standards. Continually evaluates and audits practice at individual and systems levels, selecting and applying valid and reliable approaches and methods, appropriate to needs and context, and acts on findings. Frequently critically appraises and synthesises outcomes of relevant research and evaluations, and applies them to improve practice. Regularly involved in the initiation and implementation of research and clinical audit activities in own area and takes action, based on results of these activities, to ensure patient care is optimised. Responsibility for financial, HR, Information and physical resources Incorporates current technology appropriately in care delivery and uses information systems to support decision-making, to improve care Ensures that documentation is of the highest standard, adhering to local and national guidelines Contributes to discussions regarding allocation of financial resources through consultation, service redesign, participation in meetings, audit, evaluation and research activities. Ensures that accurate, essential and appropriate written and verbal information is relayed to staff, ensuring adequate facilities are in place to maintain safety in the environment, ensuring effective management of patient caseload. Mental, physical and emotional effort This post requires: Frequent concentration for long periods, undertaking tasks such as entering and verifying data, carrying out complex treatments Working on a continuous basis with identified patient caseload/carers. This can involve periods of emotional stress Frequent requirement to exert need for light to moderate physical activity during post-holders shift, including patient support and manual handling, manoeuvring equipment Working on an occasional to regular basis with exposure to patients with infectious conditions, exposure to bodily fluids and unpleasant conditions Possibility of being subject to violence and aggression from patients/carers, general public, which may or may not be related to patients illness.