SERVICE DELIVERY To work autonomously to manage a defined complex patient caseload whilst working as part of a team. To contribute to the delivery of the service in a variety of defined clinical settings, which may include community clinics and the patients home. To undertake specialist clinical assessment, taking into account all relevant information and clinical reasoning to formulate evidence based individualised treatment plans in agreement with the patient. To monitor progress and review treatment plans and interventions to facilitate the achievement of goals. To provide appropriate oral and written information for patients and carers where relevant. To maintain accurate documentation in line with professional standards, and local policies and procedures. To provide accurate and timely written information and reports to referring agents and other agencies where appropriate. To ensure the safe and timely discharge of patients from the caseload, liaising with other agencies as required.