To assess, plan, implement and evaluate specialist treatment and care through personalised care plans to people on an allocated caseload; promoting independence and autonomy; working within a multi-disciplinary team. Supporting the GP in improving diagnosis and screening of people with dementia within the care home, this will be by the review of all care home residents. Advance own clinical knowledge, skill and competence based on current evidence through advanced educational programmes. Completing and sharing advanced care plans Partnership working with other providers to deliver seamless joined up care.
Reviewing and making clinical decisions, including prioritisation of need. Provide highly specialist advice to others regarding the management and care of patients/service users. To demonstrate clinical effectiveness by use of evidence-based practice and outcome measures. Recognise, assess, and manage risk across the immediate and wider working environment and make appropriate decisions autonomously, ensuring statutory requirements are met.
To be responsible for patient safety through knowledge of systems, legal requirements and understanding of litigation. To communicate effectively in verbal and written form in the exchange of highly complex, sensitive or contentious information in difficult situations using de-escalation, mediation, resolution and professional Duty of Candour. To evaluate care, taking appropriate action leading to improvement in quality standards through clinical audit, root cause analysis and dealing with complaints. Provision of support to carers considering what can put in place to support that persons mental health and wellbeing, by the use of tools to identify deterioration in wellbeing and mental state.
Liaison between local organisations such as volunteering etc to provide services that can support the delivery of care within the patients own home. Referral to and attendance at MDTs involving a range of health and care professionals, from one or more organisations, working together to deliver comprehensive patient care. The benefits of such an approach can include improved health outcomes, enhanced satisfaction for the individual and a more efficient use of resources

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