Community frailty practitioner Virtual ward

Job overview

Are you looking to be part of an exciting model of care? If so, we have a fantastic opportunity for Frailty Specialist practitioners to bring their expertise and knowledge to assist in the ongoing delivery of clinical care as part of the integrated Virtual Ward clinical team which runs over seven days a week, covering the hours of 8am to 8pm. The role involves working closely with existing specialist teams and the acute teams and is a pivotal role ensuring all patients within the Virtual Ward receive the best possible care and service.

The Frailty practitioner will be responsible for providing the delivery of evidenced based and clinically effective practice within the community to facilitate step down from the acute hospital and step up from the community. To promote effective self-management of patients preventing unnecessary hospital admissions and improving quality of life and to actively identify patients who would benefit from an admission to the virtual ward.

The post holder should be an experienced community practitioner with diagnostic and consultation skills and preferably be a non-medical prescriber or willing to complete the course and will act within their professional boundaries, providing care for the presenting patient, from initial history taking through to treatment. They will work collaboratively across the virtual wards and with the multidisciplinary team to meet the needs of the patients.

Main duties of the job

Will be responsible for the efficient running of the Frailty virtual ward ensuring flexibility, collaboration, and integration across the CHFT footprint within Calderdale community.

• Will work in various locations across the Calderdale community footprint, with the ability to commute within the specific response times.

Will undertake comprehensive geriatric assessments for patients under the care of the Frailty virtual ward and formulate personalised management plans in collaboration with the MDT. This includes chronic, acute, and palliative care within own competencies, recognising own limitations and seeking advice when necessary.

• To work autonomously managing own clinical caseload/workload efficiently, to support patients in their own homes whilst on the virtual ward, interpreting diagnostic results and escalating where appropriate.
• Will use relevant specialist training/knowledge and using expertise to clinically assess, diagnose and deliver evidence-based practice.

Detailed job description and main responsibilities

Will use relevant specialist training/knowledge and using expertise to clinically assess, diagnose and deliver evidence-based practice.

• Monitor indicators, to analyse the possible decline and proactively managing this, to ensure optimum wellbeing and independence.
• Collaborate with team members to devise protocols, guidelines, and policies.
• Act as a focal point for support and advice offering specialist advise whilst supporting frailty patients and their carers to navigate the patient pathway.
• Provide telephone support, assessment, and advice to people with frailty on their management in accordance with national and local guidelines and practice.
• Contribute to the achievement of standards/compliance of targets through participation in local and national audits to meet best practice tariffs and improve patient care and outcomes.
• To support the delivery of education to the wider community nursing teams and primary care colleagues.
• To support the vision, purpose, and objectives of the community Frailty service
• To support the Nurse manager in the community Frailty service to ensure the service achieves the quality, performance, productivity, and financial requirements.
• To be accountable for the management of patients in your care, to ensure a high standard of evidence based, clinical care is maintained from the very start of their journey to end of life care.
• Undertake on-going service reviews which will shape the service in response to user involvement, professional opinion, and audit along with local and national guidance.
• The post holder will be expected to act as the patients advocate at all times.
• Ensure all electronic based patient records are kept up to date in line with the trusts policies