Clinical Work autonomously in all clinical settings, home based and clinic, providing specialist assessment and management of the patient with heart failure. Assess clinical status: using clinical examination and history taking skills to devise an individualised, evidence based pharmacological and non-pharmacological management plans. Follow locally agreed guidelines to adjust and titrate pharmacological therapies. Order and interpret cardiac investigations and blood results and to explain results and their significance to patients. Act as patient advocate and empower patients to be actively involved in decisions regarding their management. Initiate referral to Ambulatory or admission to hospital where appropriate. To advise on treatment therapies according to agreed protocols and within the scope of professional practice to achieve optimal pharmacological and non-pharmacological treatments. To establish good communication with patients' GPs/Consultants regarding patients' management. To establish effective links with intermediate care providers to reduce unnecessary hospital admissions and maximise a co-ordinated approach to care. To refer appropriate patients to the Heart Failure rehabilitation programme. To provide home, clinic or telephone reviews/follow up to patients as required. To ensure equity of access to heart failure services for patients from ethnic minority groups and those from deprived areas. Refer to palliative care for those who have end-stage heart failure. To act as a support and accessible point of contact for patients with heart failure. To co-ordinate ongoing care and treatment for a group of heart failure patients. To establish and meet agreed standards of care for patients with heart failure as per NICE guidance. To document care, treatment and education provided to patients ensuring records are relevant, accurate and timely and to agreed standards. To contribute to the development of pathways and protocols of care implementing changes which lead to more timely patient interventions, increased quality of care and reduction of unnecessary hospital admission To provide education, advice and support regarding heart failure and its treatment to those who need it - patients, carers, and professionals. To provide education and support to patients in respect of lifestyle changes. To ensure continuing personal development through individual performance reviews, identifying education and training needs.Research, Development and Audit To attend relevant study days, conferences, seminars and workshops to maximise knowledge and disseminate best practice. To link any training or development initiatives with established educational programmes, either at a practice PCO or university levels. To participate in research and audit projects, implementing and evaluating subsequent changes. To act as a personal resource in an advisory and consultative role on all aspects of heart failure. Managerial To provide day to day management of the Heart Failure Team including appraisals, attendance reviews etc. To attend meetings as necessary representing the organisation. To play an active role in the implementation of the heart failure strategy. To contribute to relevant service developments and business plans. To manage time and resources efficiently. All roles within East Coast Community Healthcare CIC (ECCH) require staff to demonstrate our Values and Signature Behaviours in the care and service they provide to patients, service users, stakeholders and colleagues. All members of staff should consider these as an essential part of their job role. Our Values outline the core behaviours that we can all achieve and are summarised as an acronym within the word CARE. These stand for: Compassion, Action, Respect and Everyone. Underpinning our Values are our Signature Behaviours which highlight by taking the right actions we continue to build a strong culture. Our four Signature Behaviours are: Compassion - We Listen, We Learn, We Lead| Action - My Accountability, My Responsibility | Respect - Respect Our Resources: People, Time and Money | Everyone - Work Together, Achieve Together.