Proactive Care Matron
4 weeks ago
This is an exciting opportunity to join our team as a Proactive Care Matron, working closely with community GPs, paramedics, pharmacists, district nurses, adult social care, and voluntary organisations to deliver proactive healthcare and support to individuals living with frailty, multiple long-term conditions, and complex needs. Our goal is to help them stay independent and healthy at home for as long as possible.
We are committed to your ongoing professional development and offer a structured training programme to support the requirements set out within the national Care Co-ordinator job profile.
As a Proactive Care Matron, you will take a lead role in proactively identifying vulnerable adults who have multiple and complex long-term conditions and who may be high-intensity users of primary and secondary care services. You will work across traditional organisational boundaries, challenging inequities to co-ordinate and ensure health and social care needs of the individuals are met.
Key responsibilities include:
- Providing clinical triage/assessment with inbound referrals and assigning the appropriate urgency
- Supporting annual Learning Disability or Serious Mental Illness Health checks
- Care coordination, managing patient caseloads, and offering proactive support
- Anticipatory care, liaising with primary, secondary, and community teams to reduce admission for patients with ambulatory care sensitive conditions
- Enhanced Health in Care Homes, proactive and targeted visits for specific cohorts of patients
- Supporting the co-ordination with the delivery of all housebound annual vaccinations
About Us
Surrey Downs Health and Care deliver care closer to people's own communities through our Primary Care Networks, Community Hospitals, Specialist Services, and our innovative partnership of local NHS organisations. We have a track record of providing person-centered care that goes beyond organisational boundaries to do what is best for the individual. Our partnership includes the three GP federations, CSH Surrey, Epsom and St Helier's University Hospitals NHS Trust, and Surrey Council County.
We are working to the same set of values that will translate into better care for our residents. Our goal is to improve patient care and enable local people to access the right support, care, and treatment more easily than ever before.
As a Proactive Care Matron, you will be responsible for:
- Working autonomously and collaboratively with other specialist nurses and multidisciplinary teams
- Conducting physical and social assessments and examinations and initiating appropriate diagnostics
- Developing and implementing individualised care plans with individuals who have long-term conditions and their carers
- Co-ordinating and reviewing the delivery of care plans to meet the needs of individuals with long-term conditions
- Leading and implementing the SDHC Clinical Governance Strategy within your practice area
- Leading and implementing the SDHC Risk Management Strategy within your practice area
Person Specification
We are looking for a professional with:
- Professional Registration
- Previous experience in a community setting
Desirable
We would also like to hear from candidates with an understanding of the Proactive Care Process and the ability to work in a multidisciplinary team environment.
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