GP - Frailty Virtual Ward

1 month ago

Torquay, United Kingdom Torbay and South Devon NHS Foundation Trust Full time

Job summary

This is an exciting opportunity for a GP to join the expanding Frailty Virtual Ward service being delivered across Torbay and South Devon. The service provides a positive alternative to acute inpatient care for people living with frailty, by offering timely enhanced clinical support to either keep people at home or enable earlier discharge. The service is integrated within the Healthcare of the Older People team at Torbay and is led by a Frailty GP working alongside 3 trainee Advanced Clinical Practitioners. Building on a successful start, our ambition is to expand from our current 8 beds to 22 beds across Torbay and South Devon. We are looking for experienced GP's who are interested in frailty care and comfortable with assessing, holding and communicating risk with patients in the community. You need to have an understanding of frailty and acute frailty presentations and be happy to work alongside the multidisciplinary teams in our existing community services and well-developed Intermediate Care teams. We also integrate with acute settings to support discharge, including Same Day Emergency Care pathways, EAU and HOP wards. We are looking for up to 8 sessions per week on a substantive or fixed term basis with a preference for Tuesdays and Fridays and provision of clinical cross cover for the GP Lead; salaried GP payscale up to £104,086 pro rata. It would be well suited to those seeking portfolio roles or wanting to develop a special interest in older people's care.

Main duties of the job

The post holder will, as part of the wider HOP team:

Provide senior clinical decision making and leadership to the wider multidisciplinary frailty virtual ward team deputising for the Lead GP in their absence.

Work at the interface between acute care, Acute Frailty and existing community services, accessing appropriate same-day interventions where appropriate

Work with intermediate care and the wider community MDT including Primary Care to deliver services.

Deliver high quality specialist assessment and interventions to older people living with frailty in the community, following the principles of the comprehensive geriatric assessment.

Use appropriate point of care testing, digital monitoring and support to facilitate care delivery.

Have the option to contribute to service development, quality improvement and teaching as part of the evolving frailty virtual ward delivery

About us

The Healthcare for Older People (HOP) team is a hard-working, dedicated, and accommodating team. Consultant numbers over the last 15 years have expanded from 3 WTE to WTE (excluding stroke consultants' numbers), plus a consultant nurse and a trainee Advanced Clinical Practitioner (ACP) and a Specialty Doctor. The addition of the WTE GP Lead for Virtual Ward and a further two trainee ACP's has allowed the team to begin to realise its ambitions to deliver care outside of the acute hospital setting.

Job description

Job responsibilities

Leadership & Management

Contribute to clinical & educational supervision for agreed clinical team members; this could include Advanced Clinical Practitioners or other doctors. Contribute to the design and development of processes & SOPs for the admission, discharge and management of patients on the Frailty VW Contribute to the monitoring and evaluation of the Virtual Ward model; using available systems and processes to ensure accurate data are captured. Contribute to the ongoing improvement of the VW clinical model and its associated systems which includes liaising with primary healthcare professionals (GPs, community matrons, district nurses, allied healthcare professionals and pharmacists as appropriate), hospital clinicians and Information Technology (IT) providers and to act on ones own initiative when To troubleshoot (and resolve with the assistance of clinical and management leads where necessary) any day to day problems in the delivery of the Frailty Virtual Ward, for example liaising with GPs, and secondary To keep clinical and management leads updated with progress at intervals deemed beneficial to the Deputise for the GP Lead for Virtual Ward in their absence.

Clinical Responsibilities

Hold clinical responsibility for agreed patients admitted to the Frailty Virtual Ward Triaging referrals and accepting patients to the VW and Leading the daily MDT meeting ensuring all patients have comprehensive treatment & discharge plans. Develop proactive management plans to prevent hospital admission and support earlier discharge from hospital when appropriate. Provide clinical leadership to enable appropriate hospital-level interventions in community settings including regular clinical observations, IV fluids, IV antibiotics, therapy team review, medication reviews. Providing virtual consultations where appropriate and specialist advice to community practitioners. Undertaking face to face assessments for complex patients in their own homes/current place of residence. Liaising with specialist teams within the acute setting including other members of the HOP team, Acute Frailty, MAAT and SDEC pathways. Contributing to Comprehensive Geriatric Assessments including medicine review and deprescribing. With the wider MDT undertaking proactive anticipatory care planning & ensuring patients have up to date TEPs representing their wishes re: future care. To arrange referrals where appropriate, onward referral to secondary care, community therapy services or Intermediate To ensure that clear, accurate contemporaneous records are made of all patient encounters. To deliver with the wider MDT medical management, treatment and advice to patients on the VW caseload. To work with and provide clinical support to the associated trainee Advanced Clinical Practitioners and nursing staff and AHPs supporting VW patients. To prioritise the workload as To liaise effectively and appropriately with the local GPs from whose practices the patients are being referred. To integrate effectively with the existing community services and look for creative ways of improving this integration wherever To ensure skills are up-to-date and relevant to the role including mandatory training as set out by the Trust, to follow relevant Trust policies and professional codes and to maintain registration via annual appraisal and revalidation. Person Specification

Qualifications and training

Essential

Full registration and a Licence to Practice with the GMC On the GP Performer's List and up to date with annual appraisal requirements and revalidation MRCGP or equivalent Ability to be mobile about the community

Desirable

MD or PhD Additional qualifications relating to frailty eg Diploma in Geriatric Medicine, MRCP, MSc Membership of the British Geriatrics Society (BGS)

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