Care Home Team Senior Clinician (Nurse)

Operating at an

advanced level, you will manage complex caseloads advancing frailty,

multi-morbidities, and palliative care. You will lead on service improvement,

support clinical governance, staff training and mentor junior staff, fully

aligning with the NHS Leadership Academy Framework

and Band 7 competencies.

The post holder will

work collaboratively with GP practices, community teams, secondary care

providers and care home staff to improve outcomes for residents, reduce

avoidable hospital admissions and facilitate care closer to home.

The applicant will require at least 3-5 years

post registration experience, experience of implementing change in clinical

practice and experience of clinical assessment and care planning.

Advanced Clinical

Practice & Acute Response

Main aspect of the role will be to support the practices and visit

patients in Care Homes following agreed pathways with the GP Practices.

Provide rapid, autonomous assessment of

acutely unwell care home residents, utilising advanced physical assessment

and clinical history-taking skills as directed by the patients GP practice.

Autonomous Decision Making: Diagnose,

formulate, and execute immediate treatment plans for patients presenting

with complex, undifferentiated, or unstable conditions.

Prescribing & Medicine Management: Safely

prescribe medications within individual scope of practice as an

Independent Prescriber or work under Patient Group Directions (PGDs) where

applicable, ensuring rigorous adherence to safety standards.

Admission Avoidance: Utilise expert clinical

judgment to safely manage high-risk patients in their place of residence,

coordinating with community assets to minimize unnecessary hospital

admissions.

Work across boundaries and in partnership with primary and

secondary care clinicians and social services, coordinating care promoting

a multi-disciplinary approach.

To act as a point of contact, where appropriate for

the care home staff when there is a request to see, treat or refer any patient

whose health status has deteriorated.

To refer patients to the GP practice where

appropriate.

Assess

patient needs through effective planning, implement and evaluate care according

to individualised patient needs. Ensure

that all patient computer records are maintained correctly.

Recognise when patient presentation requires

referral onto other health professional or specialist teams and take

appropriate actions.

Act as a specialist

clinical resource for care home staff regarding assessment, escalation and

management of deteriorating residents.

Maintain accurate, timely and legally

compliant clinical records using PCN and practice clinical systems.

Proactive Care

& Care Home Team Integration

Proactive Holistic

Reviews: The role will predominantly work on the acute

response but will be expected to also provide pro-active care as part of the

function such as participate in scheduled Multi-Disciplinary Team (MDT) reviews

as required for care home residents to optimise health, manage frailty, and

prevent future health deterioration. The postholder will be required to work

closely with practices to manage patients care.

Personalised Care

Planning: To develop individualised care management plans (PCSP for the patients

in close discussion with them and their careers, care home staff and GPs.

Anticipatory Care & DNACPR: Initiate and

facilitate sensitive, expert discussions regarding Advance Care Planning

(ACP) forms with residents, families, and staff.

Workforce Flexibility: Dynamically pivot daily

priorities between urgent acute requests and scheduled proactive reviews

based on the immediate clinical demand of the PCN care home population.

The

post holder will provide support for patients to remain in their own care

setting, improving their health outcomes and quality of life. The role

will provide clinical skills to patients and provide expert knowledge.

The

role will support patients with end-of-life support, enabling them to die in

their own care home if that is their wish.

Supporting the management of residents with

multiple long-term conditions, dementia and complex health needs.

Leadership,

Governance, & Service Development

Clinical Leadership: Act as a clinical role

model and expert resource for care home staff, PCN colleagues, and the

wider multidisciplinary team.

Quality Improvement (QI): Identify, design,

and implement clinical audits and QI projects to enhance the quality,

safety, and efficiency of care home services across the PCN.

Risk Management: Take a lead role in the

investigation of clinical incidents, near-misses, and safeguarding

concerns within care homes, ensuring lessons are learned and embedded into

local practice.

Communicate sensitive/contentious and

occasionally highly complex medicine related information and advice to

patients, carers, GPs and other members of the health care team.

Communicate on a variety of different

levels depending on whether you are dealing with health professionals or

patients. Information may be complex and require translation into a more

patient friendly format.

To be

aware of the Data Protection Act to ensure appropriate action is taken to

ensure patient confidentiality and protection of patient information.

Education &

Training

Workforce Upskilling: Design and deliver

evidence-based training sessions for care home staff on topics such as

early signs of deterioration (e.g. RESTORE2), hydration, and falls

prevention.

Mentorship: Supervise, mentor, and complete

workplace-based assessments for junior clinical staff, students, or PCN

colleagues.

The Lytham St Annes Primary Care Network covers

5 GP Practices, Holland House, Fernbank, Parcliffe, Poplar, and Ansdell,

serving a population of approximately 53,000 registered patients. The PCN

serves a diverse population with relatively low deprivation with a complexity

from an above average elderly

population and above average residents in care homes.

The PCN has a large population that reside in

Care/ Nursing Homes with approximately 36 homes across the footprint and 900+

residents.

Experience

Qualifications

Skills and Knowledge