Frailty General Practitioner
hace 2 días
Godstone
Job Summary Salary: £11,500 per session; Up to 5 sessions per week. Contract Duration: 6-month rolling contract. Job Location: Practice sites across South Tandridge PCN (Oxted Medical Practice, Pond Tail Surgery and Lingfield Surgery) with regular home visiting to frailty patients. In this role the successful applicant will manage the PCN clinical frailty pathway (Hub) that all practices within this PCN can refer into. The aim is to offer care in patients’ homes to reduce unplanned admissions and improve patient care. The Frailty General Practitioner will provide clinical leadership to the frailty hub team and medical leadership to the wider community team of Community Matrons, District Nurses, Pharmacists and other professionals. As a Frailty General Practitioner you will be responsible for proactive triage and management of the PCNs frail patients who have been referred. Referrals will come from a range of sources, including those proactively identified in-house. Management of this cohort includes developing care plans for patients at risk of hospital admission and using your clinical skills to diagnose and treat patients to improve their care. You will work with a holistic multi‑disciplinary team, liaising with all sectors of healthcare, social care and local providers. • Effective triage of referred and proactively identified patients to provide highly effective medical care to the entitled population in a timely fashion, • Proactively manage the care of frail people alongside the Community Matron, • Generic prescribing in accordance with local and national guidance, • Manage long‑term conditions effectively, • Process administration promptly, including referrals, repeat prescription requests and other administrative tasks, • Undertake telephone triage and prioritise home visits accordingly, • Maintain accurate clinical records in accordance with good practice, policy and guidance, • Work collaboratively across the PCN with all practices and partner organisations and agencies, • Lead discussions about patients at both PCN‑level and practice‑level MDTs, • Adhere to best practice recommended through clinical guidelines and the audit process, • Contribute to continuous improvement and quality initiatives with the Practices and PCN, • Accept delegated responsibility, • Support development and maintenance of the PCN, including clinical governance, training, financial management and HR, • Commit to self‑learning and continuing professional development, • Support partners in achieving the strategic aims of the PCN, • Review and adhere to Practice/PCN protocols and policies at all times, • Promote a culture of continuous improvement at all times, • Proactive management of the frail population and people at the end of their life (65+ years), • Identify those most at risk of deterioration or hospital admission, • Multi‑disciplinary team (MDT) approach to provide holistic care, • Defined caseload of people who have:, • In‑depth frailty assessments, • Structured medication reviews and falls assessments, • Quality conversations about end‑of‑life care, • Planning for changes in care needs, • Personalised care plan agreed and enacted, • Key point of contact, • Proactive intervention to avoid hospital admission – linking with the reactive community service, • Adhere to DHC and GP practices policies and procedures and any other relevant legislation, • Ensure mandatory training is up to date at all times, • Participate in regular supervision sessions and appraisals with your line manager; attend training and development activities as identified and participate in meetings as required, • Maintain administration systems and workspaces in a clean and tidy fashion, • Maintain a good working knowledge of health and safety procedures, fire precautions and participate in policy development and data collection where appropriate, • Work flexibly to meet the needs of patients, • Contribute to ongoing or new projects as required, • Take on any other duties appropriate to the grade and purpose of the job as agreed by the post holder, • Work autonomously to an agreed set of KPIs, targets and objectives, • Manage own time and caseload, providing regular updates and progress reports to line manager and GP practices involved, • Participate in DHC’s appraisal and review system, • Competitive salaries, • Membership of the NHS pension scheme, • 27 days annual leave plus bank holidays, increasing with length of service, • Access to an Employee Assistance Programme, • Opportunities for training, development and career progression, • Some sites offer free on‑site parking subject to availability, • Employer conducts annual staff satisfaction surveys DHC actively encourages and promotes diversity, ensures all voices are heard and included and is committed to equal opportunities for all. The Frailty GP will report to the PCN Clinical Director and Service Manager. • Disclosure and barring service check, • Willing and able to travel to other sites & locations to attend meetings and training events, • Excellent communication skills (written and oral), including the ability to listen, • Strong and confident IT skills, including MS Office and databases, • Excellent administrative skills, working under own initiative at times, • Effective time management skills in a fast‑paced environment, • Proven problem‑solving and analytical skills, • Ability to adapt to changing situations and needs of the service, • Excellent patient care skills, • Motivated to achieve good outcomes for patients, • Able to follow policies and procedures effectively, • Able to maintain confidentiality at all times, • Knowledge of GP clinical systems EMIS and/or TPP SystmOne, • Polite & confident, remaining calm under pressure, • Caring, sensitive and empathetic; sensitive to patients’ life stages, concerns and problems, • Self‑motivated, reliable and dedicated, • Excellent interpersonal skills, • Motivated and proactive, • Ability to use initiative and judgement, • High levels of integrity and reliability, • Ability to work under pressure, • Confident, assertive and resilient, • Experience working with the general public in a similar role, • Experience working in a health care setting, • Experience working in the NHS/Primary Care General Practice setting, • Understanding of community services and personalised care, • Experience in managing a complex administrative role, • Experience of leading MDT meetings in primary care, • Good standard of education with excellent literacy and numeracy skills This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and a submission for Disclosure to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions will be necessary. Applicants must have current UK professional registration. For further information please see NHS Careers website. #J-18808-Ljbffr