The Community Matron is a pivotal member of the Integrated Care Coordination team, working in close partnership with our PCN services to provide assessment, care and support for those patients identified with the population health model as having moderate to severe frailty with complex long term conditions. The Community Matron will support the Senior Community Matron in clinically leading services and supporting patients with Long Term Conditions and complex needs with a case management approach to prevent unnecessary hospital admissions. The Community Matron will support the Senior Community Matron and Community Nursing in working in partnership within neighbourhoods. Able to effectively communicate at all levels in the organisation, to a variety of health and social care professionals, users and carers, to provide the best outcomes for patients and their carers with Long Term Conditions. The Community Matron will deliver high quality care and support patients to develop their own personalised care plan. Responsibilities Anticipate care needs and collaborate with key stakeholders to develop appropriate care plans, referring on to other services or professionals as appropriate, while supporting the neighbourhood model of care by providing care pathways for the case management. Work within the multi-disciplinary team to plan and implement high quality care, coordinating care across all settings within the patients care pathway. Wirral Community Health and Care NHS Foundation Trust has been rated as Good by CQC (Dec 2023) with some outstanding areas. As an aspiring outstanding Trust we have numerous policies and procedures in place which provide standard organisational ways of working, in line with organisational objectives, relevant legislation and requirements. Policies allow for continuity and consistency within the Trust. Employees must abide by and adhere to all Wirral Community NHS Trust’s policies, at all times. The Community Matron works independently exploring all avenues to support patients with complex needs and chronic disease including forming effective communication networks across organisations to achieve patient focused goals. The Community Matron will support the Senior Community Matron and Community Nursing in working in partnership within neighbourhoods, with the CCG and with senior management within WCHC.