Care Home Hub GP

What matters to me, iswhat matters to us.

Calling all frailty-minded General Practitioners

Are you interested in older peoples care, frailty orpalliative care? Are you frustrated at not having the time or capability tosort out complex problems properly? Do you often get the feeling that you couldbe doing more to improve quality of care for our most experienced members ofsociety?

If so, come and find your tribe at the One Weston Care Home Hub in North Somerset, based at 168 Medical.

Pier Health Group are transforming the care of older people. We have led this charge with the development of a centralised Care Home Hub, servicing the healthcare needs ofour 65 care homes. Yes, thats a lot, isnt it? We are hungry with ambition,and after our first year of success which saw us featured as a nationalexemplar, and our second year as finalists for a prestigious HSJ Award.

Join our existing team of dynamic cliniciansin a multidisciplinary environment. This is no ordinary service; we are buildinga legacy for our population, and for our primary care workforce.

If you are tired of dealing with problems on the day and not having time to address the real issues, if youare feeling increasingly lonely working in primary or community care andmissing the sense of team camaraderie, if you find yourself increasingly handsoff rather than hands on, then this is the job for you.

Each day starts with a whole team check-in either in person or via Microsoft Teams to check onwellbeing, discuss problems and ideas, share updates and to distributeworkload.

Clinical leadof the day is assigned during this meeting.

The GP may thenhave a ward round in a care home, be completing comprehensive geriatricassessments, producing care plans and ReSPECT forms, liaising with families andother partners such as hospitals or district nurses, or dealing with requests for acutely unwell care home residents. There is protected time for learning activities, teaching, supervision, quality improvement work and meetings. Thiswork takes place via a variety of formats telephone, video, email and face toface.

Career and personal development is promoted through regular 1:1 meetings with the team leader.

The One Weston Care Home Hub is a true multidisciplinary team, established in 2021, bringing together a range of allied health professionals and GPs to work towards acommon goal of improving care for care home residents in Weston Super Mare.

Working alongside a friendly, dedicated team of GPs and allied health professionals (pharmacists, community nurses, advanced nurse practitioners, aparamedic and a mental health nurse) this innovative project is transformingcommunity care in some of the most deprived wards in the country. Excellentadmin support enables clinicians to focus on clinical matters.

The role of theGP within the team is as follows:

Toprovide clinical assessment of care home residents, via a mix of preventative(proactive) and acute (reactive) medicine.

To undertake holistic assessment of residents needs and devise creative solutions,utilising the skills of the MDT to best effect.

To produce a dynamic personalised care plan for healthcare professionals and care staff to follow, which includes treatment escalationplanning and a detailed, realistic ReSPECT form in keeping with the wishes of patients and their families where appropriate.

Toprovide continuity of care to resident, family and care home staff.

Toprovide senior clinical support for complex decision making, when clinical leadof the day.

Totake clinical responsibility for decisions and ongoing management of your patients, drawing on the skills of the MDT as needed.

To contribute to peer learning and education, via significant event analysis, casebased discussions and other formats.

Toprovide support, clinical advice, supervision and feedback to students andother members of the MDT.

Tobe actively involved in promoting adult safeguarding.

Toadvocate for high quality, appropriate, patient-centred care for older orvulnerable adults.

Record data and assessments in patient records systems promptly and accurately and to agreed standards ensuring appropriate use of read codesand templates, with awareness of QOF targets and local DES specifications.

To compile and issue computer-generated acute and repeat prescriptions, prescribing in accordance with BNSSG prescribing formularywhenever this is clinically appropriate, working with our pharmacy hub.

To instigate necessary invasive and non-invasive diagnostic testsor investigations and interpret findings/reports at a level that is appropriate for the patients degree of frailty and their treatment escalation.

To contribute and bring ideas for continuous improvement including developing / improvingcare pathways for older people and contributing to QIP and audit.

Toreview medication using a Structured Medication Review, alongside teampharmacists.

Leadand/or participate in specialist MDT meetings dementia/mental health,palliative care or complex care with…