Management of Care: Practice at an advanced level working as an autonomous practitioner within the multidisciplinary team. As an experienced advanced clinical practitioner take responsibility and be accountable for the clinical assessment, diagnosis, treatment and management of patients taking into account local and national guidelines. This is inclusive of those patients with undifferentiated and undiagnosed health care needs. Work in collaboration with the frailty team, senior staff and Doctors in ED/MAU to ensure elderly frail patients are offered appropriate assessment and care pathways. Ensure person centred advanced care plans are developed following a robust assessment process. Be mindful of patients needs, wishes and culture encouraging self management. Empower and educate service users, carers and relatives to enable informed choices to be made about their plan of care and record plans in appropriate and accessible format for patients and colleagues e.g. self-care exacerbation template. Refer patients, as appropriate, to secondary care and for appropriate diagnostic investigations inclusive of x-ray. Interpret these results holistically within the patient centred approach. With the information, prioritise, analyse, evaluate and review and adjust management plans whilst managing conflict of views and professional differences of opinions. Ensure that individual patients care and treatment plans facilitate the patient to reach their optimum health and independence. Proactively manage patients with long term conditions and acute exacerbations of these, working collaboratively with and be an advocate for shared care between professionals. As an Independent Prescriber, prescribe medications in accordance with NMC guidance, local and national policy guidance. As an independent prescriber review medication and optimise patient concordance and reduce polypharmacy. Champion patients rights, for example, dignity, equality, diversity choice and respect and provide high quality care based on best practice. Act as the patients and relatives advocate when necessary. Empower patients to manage disability, loss and change. Provide expert clinical leadership to other members of the health care team regarding the care required for patients. Work in partnership with the multi-disciplinary team from health, social care and the voluntary sector to promote continuity of care. To provide patients and carers with relevant and appropriate health education and promotion information to promote informed choices and to support self-care as appropriate. Adhere to record keeping standards and ensure good communication and documentation is entered within the appropriate systems. Support patients at end of life Assess risk that may affect patients and care delivery, working within ANHSFT risk management policies. To provide clinical care of a high standard, consistent with the requirements of clinical governance and the professional governing body e.g. NMC, HCPC Management of the Service: Provide expert clinical leadership in developing care pathways to advance practice and service provision in collaboration with relevant stakeholders and Line manager. Ensure that patients and carers comments, concerns and complaints are appropriately and proactively managed including investigation and feedback within the Patients Advocacy and liaison service (PALS). Contribute to the regular service meetings held by the Community Consultant Clinical Practitioner, Clinical Leads and Team Leaders. Contribute to clinical MDT meetings. Professional / Leadership: Provide Clinical Supervision within their own clinical speciality and monitor the provision of supervision for all team members. Actively promote the embedding of trust values through demonstration of those values. Encourage a culture of continued clinical improvement and the maintenance of the workplace as a learning environment where everyone can learn from each other and from good practice. Champion and facilitate multi-disciplinary/professional team working. Demonstrate and promote effective communications and relationships within community and intermediate care services sharing good practice and innovation. Participate in the development of services and strategy for older peoples service and Community and Intermediate Care services. Be available as a resource to others involved in care delivery. Develop strategies for quality improvement in collaboration with the Team Leader/Clinical Lead for Community Nursing, setting and maintaining high clinical standards. Establish systems for research, audit and evaluation of care in collaboration with the Community Consultant Clinical Practitioner. Proactively participate in the development of care pathways. Budget Management: To ensure prescribing within the context of national and local guidelines. Responsible for ensuring there are sufficient levels of equipment, which is maintained, monitored and replaced as appropriate within resources. Working within ANHSFT Standing Financial instructions at all times. Work Force Planning and Development: Contribute to the development of the knowledge and practice of others. Contribute to the education of others by guiding and developing team members in their professional and clinical practice. Facilitate learning for staff and be actively involved in training sessions to disseminate good practice. Develop and deliver educational programmes to clinical staff. Act as a mentor, preceptor, coach or clinical supervisor. Governance: As a member of the Senior Multidisciplinary Team, work collaboratively with colleagues and contribute to the development of policy, identifying how policy will impact on practice and service delivery. Within own specialty identify the need for and develop protocols and policies whilst working closely with relevant stakeholders and the Practice Development Team. Contribute to the development of new policies making recommendations as appropriate and ensure implementation and monitoring of operational policies with the service. Work with ANHSFT Clinical quality and Governance Teams in areas of clinical quality, infection control, waste disposal, to ensure care provided is based on best practice. Receive and review prescribing data and conduct audit of prescribing practice. Contribute to ANHSFT audit or research activity as required. Implement audit initiatives to monitor care quality within the unit including using tools such as key performance indicators. Undertake audits as identified in the audit program. Ensure audit information is used to make recommendations to raise standards of care, practice and service delivery. Ensure that incidents are reported appropriately and action is taken to reduce risk. Working with the team leader and risk managers contribute to critical incident investigations as necessary and actively monitor incidents reported on AEFs ensuring action is initiated and learning disseminated to staff., Encourage patient/carer involvement in the planning, delivery and monitoring of care. With the line manager undertake an annual development review which would include the reviewing of prescribing via ePACT data to ensure your specialized knowledge continues to be underpinned by theory and experience. Undertake appropriate mandatory training. Information Management: Keep accurate, contemporaneous documentation and care plans in accordance with professional body guidance, information governance and local / national guidance. Ensure service activity is monitored and recorded and is appropriate for service need / delivery. Obtain, analyse, share and use current information for decision making in collaboration with the Team leader and others. Working Conditions: The service is delivered over 24 hours a day, 365 days a year. Staff will be expected to work on a shift rota in order to cover the needs of the service. Frequent exposure to body fluids, blood and wounds. Occasional exposure to aggressive behaviour. Moving and handling patients, stores and equipment. Frequent concentration, work pattern unpredictable due to interruptions to deal with service issues. Frequent distressing or emotional circumstances dealing with patient complaints, dealing with staff problems or conveying unwelcome news.