1. Working with partners in Primary and Social care further develop a virtual ward model/Urgent communityresponse which identifies, and case manages those patients needing complex chronic diseasemanagement or palliative care supporting the needs of the local community.2. Maintain accountability for practice following the Nursing and Midwifery Council Code of ProfessionalConduct/Health and Care professions Council Standards of conduct Performance and ethics and compliancewith Great Western Hospitals NHS Foundation Trust Policies and Procedures.3. Maintain legible, accurate and up to date records that are dated and signed in accordance with Trust Policiesand the Nursing and Midwifery Council / Health and Care Professions Council standards onrecord keeping.4. Work autonomously with patients, their families and carers managing referrals according to need andpriority.5. Negotiate and agree with the patient, carers and other care professionals, individual roles, and responsibilitieswith actions to be taken and outcomes to be achieved, referring on to other services orprofessionals as appropriate.6. Establish local networks in partnership with other health and social professionals/agencies and national linkswith other generalists to develop protocols according to national and local guidelines for the safeand effective provision of a community nursing service.7. To work with partners in nursing and residential care to ensure optimum health outcomes for theirresidents.8. Critically analyse complex clinical data and information to inform diagnosis and, where appropriate, order investigationsand/or instigate therapeutic treatments to inform clinical decision making and improvehealth outcomes.