Community COPD Nurse/Physiotherapist

Oxleas NHS Foundation Trust · Greenwich · £55524.00 to £62652.00 We have an exciting opportunity for a nurse or physiotherapist with previous experience managing respiratory patients, either in acute or community setting, to join the innovative COPD team. The team comprises of a mixture of matrons, physiotherapists, a dietitian, a clinical psychologist, administrative support and healthcare/therapy assistants. Clinical leadership is provided by a Consultant Chest Physician from the Lewisham and Greenwich NHS Trust. The COPD team delivers a wide range of services including: An SOS admission avoidance and early supported discharge services Annual review service COPD diagnostic service Pulmonary rehabilitation (PR) Self management education session enabling the patients to manage their disease in a much more proactive way Home oxygen assessment and review service The successful candidate will be a registered nurse/physiotherapist with the relevant experience who will support the team to manage their own COPD patient caseload. They must be comfortable and confident to work alone and within the wider MDT. The SOS service delivers care Mon- Sun, 9-5pm and is managed by 2 clinicians per day, except the weekends where 1 person is rostered on. Computer literacy and the ability to use an iPad for remote working is essential. Main duties of the job The post holder will proactively manage a caseload of patients requiring complex case management in order to prevent hospital admissions and improve patient health outcomes. Working autonomously, the post holder will have continuing responsibility for proactively monitoring and managing, patients on the caseload. The post holder will be expected to possess skills in advanced clinical assessment, diagnostic reasoning and using these skills will assist in the recognition of early symptoms of disease exacerbation. The post holder will be expected to be a competent leader and case manager and critical thinker navigating the patient through the COPD care pathway which spans across the primary, secondary care interface. Pivotal to the care pathway is the prevention of unnecessary admissions and facilitation of early supported discharge to reduce lengths of stay. Job responsibilities To be responsible and accountable for providing expert care to COPD patients who are registered with a Greenwich GP Utilisation of advanced clinical skills and expert knowledge to plan, implement, monitor and review individualised patient-directed programmes of care to patients with COPD including health promotion interventions. To undertake goal centred interventions that are evidence-based, evaluating the effectiveness of these at regular intervals with a view to improving care continuously. Develop risk management plans that will enable individuals to remain safely within their homes Use expert knowledge and skills as a non medical prescriber to manage patient medication within own areas of competency, developing clinical management plans in partnership with GP colleagues where necessary. Anticipate individual care needs and develop appropriate care plans, involving carers and relatives To provide individuals and their carers with the necessary education that will enable them to plan for unavoidable disease progression and self manage as far as possible. To work collaboratively with members of the multi professional team to ensure that the patients needs are met, making appropriate referrals are made where necessary. Develop practices which promote patient choice and well-being To be responsible for ordering stock and other resources when asked Ensure that the needs of individuals who are vulnerable are highlighted and addressed in a timely manner To be a competent clinical leader demonstrating a willingness to work as an integral part of a multi professional team Be a highly skilled communicator, written and verbal, with a capability for communicating within a variety of professional groups, challenging attitudes whe