Community Matron

The role of the Case Manager/ Community Matron is: To provide systems leadership at a neighbourhood level for managers, specialist nurses and staff within a primary care setting. Work effectively in an integrated partnership way with primary care, secondary care, social care, the independent and voluntary sector. Through patient involvement, brokering care across partnerships, whilst leading and promoting the principles of multidisciplinary team working, to support the achievement of better health outcomes. To provide a high quality, comprehensive and accessible community nursing service to housebound patients. Undertake complex holistic assessments using advanced clinical examination and assessment skills that encompass all aspects of an individuals needs. Act as key worker, liaising and working collaboratively with other professionals to co-ordinate care, preventing duplication, fragmentation and ensuring the effective deployment of resources. Undertaken line management responsibilities of the District Nurse and Assistant Community Matron roles. Proactively manage a caseload of patients with long term conditions who have complex needs, increasing and decreasing input into a patient care as required and discharging from the caseload as appropriate in line with the Community Nursing Service Operating Framework. Undertake the keyworker role, liaising and working collaboratively with other professionals to co-ordinate care, preventing duplication, fragmentation and ensuring the effective deployment of resources. Actively case find using data bases and risk stratification tools to actively seek out patients who will benefit from clinical case management techniques to avoid unplanned hospital admissions and reduce the length of hospital stays by facilitating a timely discharge. Undertaken complex holistic assessments using advanced clinical examination and assessment skills that encompass all aspects of an individuals needs in conjunction with the individual and their family. Use self-management and joint care planning principles to care delivery that promote the resilience, enhance well-being and maintain independence. To provide evidence based care plans based on sound clinical decision making using the knowledge of the unique presentation of long term conditions, negotiated with the person. To initiate and lead medicines management reviews, independently prescribing medicines and appliances where appropriate and within scope of practice. Use expert knowledge to promote healthy lifestyles and self-management of long term conditions. Prevent unplanned hospital admissions through intensive clinical management and health and social care support at home. Reducing the length of stay of unplanned hospital admissions through communication and coordination of care with secondary and primary care. We are aware that an increasing number of applicants are using AI technology to generate responses on NHS Job application forms. Over reliance on AI-generated content in application forms is strongly discouraged and we will conduct a thorough screening process before selecting candidates to progress to the next stage. If you are using AI to enhance your application, please disclose this in your NHS Jobs application form.

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