Clinical 1. Coordinate the care for a defined group of patients assessed by a registered practitioner as having care needs suitab.....
Clinical 1. Coordinate the care for a defined group of patients assessed by a registered practitioner as having care needs suitable for supported self-management 2. Coordinate any necessary assessments, investigations and appointments to: a) Coordinate the monitoring process and facilitate feedback of results for non-complex cases b) Coordinate the timely escalation of processes / the pathway for those with complex results from remote surveillance and monitoring investigations 3. Be able to refer and sign post to the clinical team as appropriate for complex decisions 4. Provide basic telephone advice where appropriate and sign post to other sources of support 5. Support and advise people in accessing appropriate information, by sign-posting to a variety of resources. Promote and educate towards a self-management approach, where appropriate. 6. Deliver patient-centred, self-management support and education as necessary, to non-complex patients 7. Document and monitor all aspects of input, care coordination and service delivery, supporting data collection for audit 8. Contribute to Holistic Needs Assessments and development of an individual Care Plan in line with practitioner guidance, protocols and procedures 9. Implement, monitor and review the Care Plan with the patient and carer, in line with standard operating procedures and protocols and modify as appropriate 10. Organise and prioritise the designated workload in relation to identified needs 11. Evaluate outcomes of care delivery with the registered practitioner 12. Coordinate and support, with a team approach, the Skin PTL patients 13. Coordinate handover with other teams, to facilitate safe and effective transition of care between services in order to provide seamless support for people 14. Support the role of the registered practitioner/clinical team to ensure high quality patient centred care delivered 15. Communicate and work collaboratively with all healthcare professionals both in the Hospital and Primary Care setting, including support agencies 16. Communicate directly with patients and carers demonstrating empathy, understanding, diplomacy, honesty and integrity 17. Support the planning, delivery and evaluation of a variety of self-management initiatives in collaboration with the relevant clinical teams and wider stakeholders. This may include participation in assessments, clinical workshops or health and well-being education-based events 18. Carry out general administration duties as required by the role 19. Act as an advocate and facilitator to resolve issues that may be perceived as barriers to care 20. Support and contribute to audit processes, governance, research and service development as deemed appropriate Administrative 1. Provide administrative support to the Skin Cancer Service 2. Ensure Holistic Needs Assessments are entered onto the relevant IT system and patient Care Plans are created and given to the patient 3. Support the implementation of Stratified Pathways for invasive skin cancer patients and once implemented, maintain data input for navigating patients on this pathway 4. Provide support to the skin Clinical nursing for gathering of audit data and patient experience feedback 5. Collaborate and work closely with local providers of care and resources, including information resources; signposting and referring patients, as and when necessary, to relevant support services 6. Evaluate the range of channels used to provide information/ resources and review with all stakeholders, the need for further developments 7. Be responsible for ordering any relevant supplies and equipment 8. Input/record accurate data to enable reports to be produced on the outcomes of self-management interventions and resources Professional 1. Communicate effectively with relevant MDTs and clinical teams to ensure that all appropriate cancer patients are identified for co-ordinated support, as assessed by health professionals 2. To work within agreed policies of East Kent Hospitals University NHS Foundation Trust 3. Work wtih the Trust wide Skin Cancer team in gaining patient experience feedback, communicating effectively with patients /care givers to aim to develop the service. 4. To be accountable for his/her practice and takes every reasonable opportunity to sustain and improve his/her knowledge and professional competence to include mandatory training as specified by East Kent Hospitals University NHS Foundation Trust 5. To be responsible for maintaining a personal portfolio to demonstrate professional development and training 6. To actively participate in any regional specialist meetings/groups to facilitate collaborative developments relevant to the role Education and Development 1. Contribute to clinical/IT teams reviews of implementation issues of the remote surveillance systems and support and contribute to solution identification and resolution 2. To be confident with use of IT software to support patients in using this to access Holistic Needs Assessments and stratified pathways 3. Demonstrate an awareness of limits of practice and seek appropriate support and guidance 4. Identify personal education needs and skills development with registered practitioner 5. Demonstrate self-directed learning, actively seeking role development opportunities to enhance practice, knowledge and role progression