APPLICANT REQUIREMENTS

You must have appropriate UK professional registration.
This post is subject to the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (Amendment) (England and Wales) Order 2020 and it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service.

MAIN DUTIES OF THE JOB

We are seeking a proactive and experienced clinician to join our integrated community healthcare team. In this role, you will provide same day, community-based care to adults (18+), including care home residents, who are at risk of hospital admission.
As part of a collaborative multidisciplinary team, you will work closely with GP practices, the Urgent Community Response (UCR) team, the Clinical Medical Team (CMT), District Nursing service, and Proactive Care to deliver timely, effective interventions aimed at preventing avoidable admissions and supporting patients in their own homes.
This is a senior clinical position involving same-day home visits, comprehensive assessments, diagnosis, and the development of personalised clinical plans. You will also contribute to triage as part of the “Clinician of the Day” role, applying autonomous decision-making, critical thinking, and advanced clinical judgement to incoming referrals.
The role requires close collaboration with a range of professionals across community services and will involve providing mutual aid to the District Nursing Service, UCR, and the Community Medical Team where needed.

DETAILED JOB DESCRIPTION AND MAIN RESPONSIBILITIES

Provide same-day home visits to patients at risk of hospital admission.
Conduct comprehensive assessments for patients who require admission prevention support.
Perform clinical assessments, diagnoses, and treatment plans, ensuring safe and effective care.
Work autonomously while collaborating with GP practices, Community Medical Teams (CMT), Urgent Community Response (UCR), and District Nurses to ensure joined-up care.
Identify patients who may benefit from Virtual Ward input or MDT frailty discussions to optimize their care.
Use critical thinking and clinical decision-making to provide safe, evidence-based interventions.
Provide a clinical initial triage/assessment of all inbound referrals and identify the most appropriate disposition/timeframe & to identify the most appropriate MDT clinician.
To prioritise health problems and intervene appropriately to assist the patient in complex, urgent or emergency situations, including the initiation of effective emergency care.
To work autonomously & demonstrate safe, clinical decision-making
Carry out proactive holistic assessments to create care plans to help reduce risk of future hospital admission.
To assess, diagnose, plan, implement and evaluate treatment/interventions and care for patients presenting with an undifferentiated diagnosis.
Attend Local Multi-Disciplinary meetings and present Patient cases.
Demonstrate clinical expertise and act as a professional role model to all colleagues, both internal and external on behalf of SDHC, working as part of an integrated team taking the lead and developing services in line with the needs of the patient
To ensure that accurate and complete records of care are kept and that your own practice and practice of other team members is compliant with agreed policies, procedures, guidance and legislation in order to deliver effective patient care.
To develop close links with the wider community to enhance both care for individual patients and the wider development of Surrey Downs Health and Care.
Treat all patients as individuals, respecting their privacy and dignity at all times
Involving, supporting, informing and educating family/carers.
Promote the health of patients and the provision of support and advice.
Be responsible for ensuring that policies and procedures and standards of care, are adhered to at all times
Have the ability to negotiate and work effectively across all agencies for the maximum effectiveness of care
Contribute to the development of integrated care in the community.
Be aware of and act upon when necessary, procedures that are in place to protect vulnerable individuals
Maintain own professional and clinical integrity in line with NMC/HCPC guidelines
Undertake any other such duties as may be required from time to time as are consistent with the responsibilities of the post.
Be responsible for individual timely data entry and responsible for the corporate team’s data entry
Employees are employed to work within SDHC localities and may be reasonably requested to move base temporarily or on a more permanent basis, as requested by service needs.
Ensure all Statuary and mandatory training is kept up to date.
This job description is subject to review and development from time to time in liaison with the post holder. As an employee of SDH&C you will be required to adhere to all the organisations policies and procedures