Job summary Are you a nurse or therapist looking for a community job in a developing service? Are you passionate about supporting people to return to their own homes following acute illness or injury? UHBW have launched two new Transfer of Care Hubs to support our patients with discharge planning from admission through leaving hospital and into the community at the Bristol Royal Infirmary and one at Weston General Hospital. The Transfer of Care Hub will bring together the acute trust, community partners (Sirona), Local Authorities and Voluntary Sector colleagues across BNSSG to create a new team from multidisciplinary backgrounds. The aim is to work collaboratively to support patients to get Home First by collocating a team of professionals from different organisations to streamline complex discharges. You will need to have experience working in the community setting and an understanding of the levels of clinical acuity that can be supported in peoples own homes. Alongside this you will have an understanding of rehabilitation pathways, discharge planning and mental capacity issues, excellent interpersonal and negotiation skills. In return, we will provide you with regular training and supervision and enable you to become involved in future service developments We have two roles available; one based in South Bristol Community Hospital and one in Castlewood. Please advise your preference in your supporting statement. Main duties of the job Be a key member of the multi-disciplinary team, responsible for providing person-centred, holistic assessment to facilitate discharge from the acute hospitals to the right discharge pathway. Responsible for triaging referrals received by CToCH. This may include liaising with the patient, family/carers and ward staff to identify the most appropriate discharge pathway. Support the CToCH to discuss complex cases with all partners in the Transfer of Care Hub to agree a joint action and discharge plan. To utilise multi-disciplinary assessment skills, supported by sound clinical reasoning to facilitate timely hospital discharge to the most appropriate environment To be able to effectively triage and prioritise a large caseload and be able to adjust daily work plan in response to system-wide pressures and escalation. Pro-actively optimising the usage of community capacity on a daily basis. High level of problem-solving required, gathering information from a range of sources, using professional experience and clinical knowledge to inform decision making. This includes being able to complete mental capacity assessments and make best interest decisions where appropriate. About us Ever dreamt about a career that sparks excitement and fosters your professional growth? Picture yourself waking up eager to make a real difference in our community, surrounded by teams who value your unique ideas. It's time to turn your dream into reality We are Sirona care & health - England's largest provider of Adult's and Children's Community Services and we'd love for you to join us in Bristol, North Somerset or South Gloucestershire. Agenda for Change Salary, full NHS benefits, 27 days' annual leave, and participation in the NHS Pension Scheme - just a glimpse of the benefits we offer. Whether you're starting your journey in healthcare, looking for a fresh challenge within the NHS, or contemplating a career change, don't be daunted by the prospect of something different - we create development opportunities for all our colleagues and apprentices. Interested? View our benefits leaflet which you can find as an attachment on this vacancy. Date posted 05 February 2025 Pay scheme Agenda for change Band Band 6 Salary £37,338 to £44,962 a year per annum, pro rata Contract Permanent Working pattern Full-time, Part-time, Flexible working Reference number 083-6402534-MP-E Job locations South Bristol Community Hospital Hengrove Bristol BS14 0DE Castlewood Tickenham Rd Clevedon BS21 6FW Job description Job responsibilities Please see the job description and person specification attached for further information on the role. We are unable to provide sponsorship for this role and can only accept applications from UK based applicants. If you are currently require a visa to work in the UK, there must be a minimum of 12 months from your start date until the expiry date. Job description Job responsibilities Please see the job description and person specification attached for further information on the role. We are unable to provide sponsorship for this role and can only accept applications from UK based applicants. If you are currently require a visa to work in the UK, there must be a minimum of 12 months from your start date until the expiry date. Person Specification Qualifications Essential Professional Qualification in Nursing, Occupational Therapy or Physiotherapy. Registered with NMC, HCPC or RCN Skills, knowledge and experience Essential Able to work across professional and organisational boundaries recognising when there are barriers to partnership working and able to implement solutions to overcome these The ability to interpret clinical information, use analytical and problem-solving skills to inform decision making Able to demonstrate innovative practice Ability to coordinate and manage a caseload including prioritising the workload, appropriate use of escalation plan, time management and delegation. When required to be able to present information to the CCG to support the requirement of additional funding (e.g., 1-1 support) to enable a hospital discharge Ability to complete mental capacity assessments when required and if the patient lacks capacity act as the lead for making a best interest decision as part of a multi-disciplinary team Desirable Ability to present self and service in a professional manner promoting the service at all times Experience of working within hospital and community settings Ability to build, and maintain, effective working relationships at all levels Person Specification Qualifications Essential Professional Qualification in Nursing, Occupational Therapy or Physiotherapy. Registered with NMC, HCPC or RCN Skills, knowledge and experience Essential Able to work across professional and organisational boundaries recognising when there are barriers to partnership working and able to implement solutions to overcome these The ability to interpret clinical information, use analytical and problem-solving skills to inform decision making Able to demonstrate innovative practice Ability to coordinate and manage a caseload including prioritising the workload, appropriate use of escalation plan, time management and delegation. When required to be able to present information to the CCG to support the requirement of additional funding (e.g., 1-1 support) to enable a hospital discharge Ability to complete mental capacity assessments when required and if the patient lacks capacity act as the lead for making a best interest decision as part of a multi-disciplinary team Desirable Ability to present self and service in a professional manner promoting the service at all times Experience of working within hospital and community settings Ability to build, and maintain, effective working relationships at all levels 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 Sirona care & health CIC Address South Bristol Community Hospital Hengrove Bristol BS14 0DE Employer's website https://www.sirona-cic.org.uk/ (Opens in a new tab)