Scope and purpose of the role To deliver a high standard of patient care as a salaried GP in nursing Homes, using advanced autono.....
Scope and purpose of the role To deliver a high standard of patient care as a salaried GP in nursing Homes, using advanced autonomous clinical skills, and a broad and in-depth theoretical knowledge base To manage a clinical caseload, dealing with patients needs in a nursing Home setting Provide advanced GP care and case management to patients with multiple complex long-term conditions Undertake medical and social care assessments to initiate interventions to improve quality of life in the nursing Home setting Reduce the fragmentation of care To provide informal training and support to the nursing home team (where applicable) and ensure the highest standards of care are provided for the patients Job Summary The post holder is an experienced GP, who acting within their professional boundaries, will provide care for the patient from initial history taking, clinical assessment, diagnosis, treatment and evaluation of their care. They will demonstrate safe, clinical decision-making and expert care for patients within the general practice. They will work collaboratively with the multi-disciplinary general practice team to meet the needs of patients, supporting the delivery of policy and procedures, and providing clinical leadership as required. Key Responsibilities Clinical role The post-holder will Make professionally autonomous decisions for which he/she is accountable Provide face to face visits via a clinical ward round during the working week. Provide a first point of contact for Nursing Homes for advice regarding medical/nursing conditions of patients, making use of skills in history taking, physical examination, problem-solving and clinical decision-making, to establish a diagnosis and management plan. This includes a comprehensive review (ensuring coding of all significant health conditions and allergies) of newly admitted patients to the Nursing Home and patients readmitted to the Nursing Home following discharge from hospital. This process would include a post-discharge reconciliation of the medication. Instigate necessary invasive and non-invasive diagnostic tests or investigations and interpret findings/reports To prescribe safe, effective and appropriate medication as defined by current legislative framework. This would include the prescription of monthly repeat medication, acute medication and the additional/cessation of medication as indicated (e.g. following discharge from hospital or from the advice of other healthcare professions including but not limited to specialist consultants). Additionally, this includes liaison with both community pharmacists (for example to ensure the continuity of supply of medication) and other pharmacists (including the medicines management pharmacists from GSTT). Provide polypharmacy/drug reviews of medications. To prescribe medication safely and in line with local CCG/national guidance including evidence based and cost-effective prescribing. Provide safe, evidence-based, cost-effective, individualised patient care. This significantly includes documentation about resuscitation and advanced care planning (onto recognised registers such as Co-ordinate My Care) of all patients newly admitted to the Nursing Home as well as a retrospective review of already admitted patients where such resuscitation and advanced care planning discussions have not yet been performed. This is likely to be performed with the patient and/or their representatives (dependent on circumstances including where which involving the patient may not be appropriate) and also be done in Best Interest meetings with other relevant healthcare professionals where a patient lacks capacity about advanced care decision making (and where an advanced directive does not exist). Offer a holistic service to patients and their families, developing where appropriate an on-going plan of care/support, with an emphasis on prevention and self-care Promote health and well-being through the use of health promotion, health education, screening and therapeutic communication skills Refer patients directly to other services/agencies as appropriate including social services and allied agencies/services. Work with nursing, medical and health care assistant colleagues to ensure that National Service Frameworks (e.g. Coronary Heart Disease/Older People/ Diabetes /Mental Health) are being delivered. This includes QoF/KPIs/Local & National schemes including enhances services in care homes schemes. Work with multi-disciplinary teams within the locality, and across the wider Health Economy, to promote integrated and seamless pathways of care. This includes playing a significant role in ensuring the delivery of effective multidisciplinary meetings (MDTs). Sustain & maintain high standards of patient care and service delivery. Participate in identification of community health needs and develop patient/family-centred strategies to address them. Help develop and set up new patient services and participate in initiatives to improve existing patient services. Be aware of and contribute to planning and delivery of practice-based commissioning. Where appropriate will perform non-nhs funded work (such as private reports). Teaching and mentoring role The post-holder will Promote a learning environment for patients, nursing & care home staff and other health professionals. Contribute to the planning and implementation of the teaching for existing staff, such as medical students, GP trainees and registrars, and Health Care Assistants, within the locality. Professional role The post-holder will: Promote evidence-based practice through the use of the latest research-based guidelines and the development of practice-based research. Monitor the effectiveness of their own clinical practice through the quality assurance strategies such as the use of audit and peer review. Maintain their professional registration. Participate in continuing professional development opportunities to ensure that up-to-date evidence-based knowledge and competence in all aspects of the role is maintained. Develop and maintain a Personal Learning Plan. Record accurate consultation data in patient records in accordance with the latest guidance and other pertinent standards. Keep up to date with pertinent health-related policy and work with the locality team to consider the impact and strategies for implementation. Work collaboratively with colleagues within and external to the locality. Encourage and develop teamwork within the locality. Participate in multi-disciplinary protocols and Patient Group Directions development. Participate in meetings, reporting progress as required. Participate in audits and inspections as appropriate.
