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Central London Community Healthcare NHS Trust
About
Central London Community Healthcare (CLCH) is one of the largest community healthcare organisations in London and Hertfordshire, providing our services to diverse communities/boroughs in 11 London Boroughs - Barnet, Brent, Ealing, Hammersmith & Fulham, Harrow, Hounslow, Kensington and Chelsea, Merton, Richmond, Wandsworth, Westminster - and Hertfordshire.
CLCH is both the largest community healthcare organisation in London and the first in the capital to be awarded NHS Trust status. As such, CLCH is at the forefront of changing the way healthcare services are provided to achieve the best possible outcomes for patients. Over 3,000 community health professionals and staff provide community and in-patient services to over 900,000 local people.
Community healthcare is our focus and our passion. We champion the role of community health professionals to make sure our patients get great care closer to home.
Job Overview
Mon Fri 9-5
The Case Manager will work within an integrated neighbourhood/care team (ICT/INT) to proactively undertake case finding, manage, co-ordinate and support patients with multiple complex long-term conditions using the whole systems integrated care (WSICS) dashboards, with responsibility for ensuring all health and social care needs are met for risk stratification and managing frailty patient populations registered in the Primary Care Networks (PCNs) aligned to the ICT/INT. The post holder will also support the health inequalities agenda through engagement of patients in the most deprived areas of the West London borough and work with key stakeholders on the wider determinants of health to improve outcomes, functional status and quality of life, ensuring integration of all elements of care, increase patient choice and prevent unnecessary admissions to hospital and reduce the stay of necessary hospital admissions.
Key Responsibilities
* The post holder will work as a minimum, 80% of their time in direct patient care. This will be spent supporting caseload allocation, providing practice development and education and competence support to the Case Managers and Health and Social Prescribing Coordinators.
* Work with the Primary Care Networks in the identification of those patients at high risk for acute hospital admission and ensure those identified are assessed and have care planned appropriately to reduce their risk of admission.
* Empower patients and carers through appropriate support and education, ensure care provided and service delivered are in line with National Service Framework, NICE Guidelines, Trust policies and procedures and the Clinical Governance Framework.
* Work with Community Practitioners on the promotion of patient self-management programmes within the local community.
* Have clinical responsibility for practice caseloads including aspects of care delivery and co-ordination in line with service operating procedures.
* Support safer caseloads across the ICT/INT minimising service risk in relation to workflow and productivity responding to referrals in a timely manner, acting swiftly to address waiting time portal breaches.
Person Specification
Education/Qualification
* Registered Adult/Mental Health Nurse
* Educated to Degree/Masters level or equivalent postgraduate experience
* Clinical Supervision Training
* Teaching and Mentoring
Experience
* Extensive work experience at a Band 7 or above in a community/hospital/primary care setting
* Experience of presenting cases at large multi-disciplinary teams
* Experience of Frailty Populations, Long Term Conditions, Palliative Care, Respiratory, Cardiovascular Disease, Dementia
* Experience of working with stakeholders and collaborative negotiating, advocating for patients
Skills & Knowledge
* Line management of clinical staff in line with trust HR Process.
* Goal setting with patients, coaching techniques to self-care and empowerment.
* Knowledge of CHC, Fast track EoL Assessments
Due to the high number of applications that are received for some posts we may close this vacancy before the advertised closing date. Therefore please apply for this post as soon as you can, if you are interested and you meet the requirements of the Person Specification.
Only those candidates who clearly demonstrate how they meet the person specification will be shortlisted for this job.
Interview arrangements will be communicated via email so please check your email regularly following the closing date.
At CLCH we appreciate and are proud of the diversity in the communities we serve and the workforce we employ. Applications are open and welcome to anyone, regardless of your age, sexual orientation, gender identity and expression, ethnicity, religion, and disability.
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