Job summary As a Registered Nurse you will be responsible for supporting your manager in ensuring that our service users' needs are met through the delivery of high-quality care. As a centre of excellence, you will offer a person-centred approach to their independence and well-being. o Work as part of the EDCS and wider health and social care services, providing advanced clinical practice and upskilling of the frontline EDCS staff so that they can recognise when EDCS participants are becoming unwell and respond to their changing needs.o Provide an initial triage of the identified cohort to identify the appropriate pathways based on the individuals level of needs. Individuals may require whole person integrated care planning and care co-ordination or delegation of the care planning responsibility to an EDCS partner agency, if the patient does not present with complex health needs at that point.o Provide education and support to individuals, their families and EDCS to promote self-care strategies and independence, and to develop multi-disciplinary informed personalised treatment and management plans for their health condition, including planning interventions for fluctuations in health status.o Step patients down to routine health, social care and other community services once care plans have been embedded, self-care optimised, and admission risks reduced and/or another professional has taken on the care co-ordination role. Main duties of the job You will work with patients on the caseload to remain independent within their own home environment, providing proactively support, clinical interventions/support and care planning. o Complete comprehensive holistic assessment using clinical skills and knowledge, to interpret a range of complex clinical findings to develop appropriate, treatment / care plans intervention and evaluation of the patients in the service. o Use clinical knowledge to identify changing or deteriorating health conditions and to educate patients and families to recognise these signs and refer to appropriate health services. o Liaise with relevant professionals i.e. GP, pharmacist, specialist professionals, when medication review. o Develop a personalised care plan with each patient, including their carers, relatives and health and social care professionals as appropriate, based on a full assessment of medical, nursing and social care needs. Each plan containing preventative strategies to prevent crisis occurring for known risks identified by the individual's health and or social circumstances, and where applicable identifies wishes for end-of-life care. o Involve people with dementia, their relatives and carers, EDCS and other appropriate stakeholders in the planning and delivery of services. Advocating for the patient in order to obtain optimal treatment and symptom control, thereby improving quality of life, co-ordinating solutions designed around the needs of the service user. About us Our high secure services care for patients from South of England and we provide low and medium secure services across eight London boroughs. The Trust also provides mental and physical healthcare in three London boroughs (Ealing, Hounslow and Hammersmith & Fulham). We employ over 5,000 staff, of whom 59% are BME. Our turnover for 2024-25 is over £500m. The Trust is rated as 'Good' overallby the Care Quality Commission. Forensic services are rated as 'Outstanding'. The Trust is an established partner and contributor in the development of the evolving North West London Integrated Care System and the Integrated Care Board. The Trust leads the NW London Children and Adolescent Mental Health provider collaborative. Date posted 20 January 2025 Pay scheme Agenda for change Band Band 6 Salary £42,938.70 to £50,697 a year per annum Contract Permanent Working pattern Full-time Reference number 222-HCS-543-A Job locations Heart of Hounslow Health Centre Hounslow TW3 3LN Job description Job responsibilities The Candidate Pack provides an overview of the key tasks and responsibilities of the role, and the person specification outlines the qualifications, skills, experience and knowledge required. Please view as attached The person specification below is not the full person specification, but outlines the criteria against which your application form will be assessed. Job description Job responsibilities The Candidate Pack provides an overview of the key tasks and responsibilities of the role, and the person specification outlines the qualifications, skills, experience and knowledge required. Please view as attached The person specification below is not the full person specification, but outlines the criteria against which your application form will be assessed. Person Specification Qualifications Essential To be an NMC registered General Nurse Desirable To have a teaching or mentorship qualification Knowledge, Experience & Skills Essential Specialist knowledge, skills or interest in Dementia with evidence of application in the community Transferable experience of working with adults with cognitive impairments, Dementia or Frailty Understanding of community assessment and interventions including crisis management and case management Ability and experience of working autonomously including caseload management, prioritisation and delegation Ability to adapt professional communication and model professional behaviours at all times Understand professional responsibilities including clinical record keeping and governance Personal attributes Essential Professional approach to role; willingness to learn and develop, critically reflect with a positive attitude towards change Skills and ability to use IT systems within the workplace including clinical records systems Ability to travel across the borough of Hounslow for work; visiting patient within their own homes Person Specification Qualifications Essential To be an NMC registered General Nurse Desirable To have a teaching or mentorship qualification Knowledge, Experience & Skills Essential Specialist knowledge, skills or interest in Dementia with evidence of application in the community Transferable experience of working with adults with cognitive impairments, Dementia or Frailty Understanding of community assessment and interventions including crisis management and case management Ability and experience of working autonomously including caseload management, prioritisation and delegation Ability to adapt professional communication and model professional behaviours at all times Understand professional responsibilities including clinical record keeping and governance Personal attributes Essential Professional approach to role; willingness to learn and develop, critically reflect with a positive attitude towards change Skills and ability to use IT systems within the workplace including clinical records systems Ability to travel across the borough of Hounslow for work; visiting patient within their own homes 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. UK Registration Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window). Additional information 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. UK Registration Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window). Employer details Employer name West London NHS Trust Address Heart of Hounslow Health Centre Hounslow TW3 3LN Employer's website https://www.westlondon.nhs.uk (Opens in a new tab)