Care Transfer Hub Practitioner

Derbyshire Community Health Services NHS Foundation Trust; Danesmoor; On-site; GBP 28,000 - 38,000; Full time

Job summary

Derbyshire Community Health Services NHS Foundation Trust is seeking a Care Transfer Hub Practitioner to navigate and coordinate flow across Joined Up Care Derbyshire by managing referrals through the Care Transfer Hub.

The post holder will assess needs, triage referrals and use professional judgement to coordinate support, ensuring safe transfers between care settings and timely onward referrals to community health, social care or voluntary sector services.

Qualifications

• Degree/diploma in a relevant health discipline and professional registration.
• Current driving licence/access to vehicle.
• Experience working with adults in community settings.

Responsibilities

• Triage and navigate future ongoing needs for patients in intermediate care pathways.
• Develop timely, person-centred plans with home-first principles.
• Lead multidisciplinary meetings and contribute to discharge planning.
• Support decisions around CHC, reablement and domiciliary care packages.

Skills

Assessment & decision-making

Communication skills

Teamwork

IT skills

Education

Degree/diploma in Physiotherapy/occupational therapy/nursing

Job description

The Trust is currently under-represented in terms of individuals from BME backgrounds and welcomes applicants from these communities. DCHS is also an LGBT inclusive employer. Selection will be on a basis of merit. The Trust has achieved the status of a Disability Confident Leader and guarantees to invite to assessment applicants who meet the criteria for the job vacancy. To ensure the diversity of the workforce and understand the differing needs of our communities, the Trust is committed to the principles of Positive Action.

Be outstanding - join an outstanding team!

Job overview

The Care Transfer Hub Practitioner is responsible for navigating and coordinating flow across Joined Up Care Derbyshire services by managing referrals through the system Care Transfer Hub.

The post holder will take a lead role in assessing an individual's need, triaging referrals and using professional judgement to navigate and coordinate the support needs.

The role is pivotal in ensuring people are safely and appropriately transferred between care settings.

Working within a multi-agency Care Transfer Hub, the postholder ensures timely and appropriate onward referrals to community health, social care, or voluntary sector services.

This role involves clinical triage, multidisciplinary collaboration, and effective communication to avoid delays in hospital discharge and ensure continuity of care.

There may be the opportunity to work alongside colleagues within the acute hospital setting as part of the role.

THIS POST IS ONLY OPEN TO CURRENT JUCD EMPLOYEES - PLEASE ONLY APPLY IF YOU WORK FOR ONE OF THE FOLLOWING:

• NHS Derby & Derbyshire ICB
• Chesterfield Royal Hospital NHSFT
• University Hospitals Derby and Burton NHSFT
• Derbyshire Healthcare NHSFT
• Derbyshire Community Health Services NHSFT
• East Midlands Ambulance Service
• Derby City social care or Derbyshire County social care (employees of DHU Healthcare will be considered).

Main duties of the job

Use experience and knowledge to triage and navigate the future ongoing needs for patients accessing intermediate care pathways from acute or community settings.

Work in both a multi-disciplinary and interdisciplinary way to develop timely and person-centred plans based on the home first principles.

Promote a strength-based approach to maintain independence and positive risk taking, ensuring adequate support is in place from statutory or voluntary services where required.

Liaise with health and social care professionals, including district nurses, social workers, therapists and care providers. Participate in, and lead, multidisciplinary meetings (MDTs) and contribute to discharge planning processes.

Support decision-making around Continuing Healthcare (CHC), reablement, and domiciliary care packages.

Act as a point of contact for professionals and patients/families regarding transfer of care.

Working for our organisation

Our purpose is to provide community health services to a patient population of over one million people in Derbyshire and Derby, as part of Joined Up Care Derbyshire.

We employ around 4,200 substantive staff, caring for patients in 11 community hospitals and more than 30 health centres, as well as in clinics, GP practices, schools, care homes and, increasingly, in people's own homes and via virtual consultations.

It is an exciting time to join primary care and community services as the national Ageing Well programme gathers pace.

DCHS is working closely with the Primary Care Networks to transform the care of housebound and vulnerable people across Derbyshire through our Team-Up approach.

Detailed job description and main responsibilities

Person specification

Qualifications/education

Essential criteria

• Degree/diploma in Physiotherapy/occupational therapy/nursing
• car driver/valid driving licence/access to vehicle
• registration with a professional Body

Experience

Essential criteria

• Current/recent experience clinical senior Band 5 level
• knowledge of community services
• Experience of working with adults in a variety of settings
• knowledge of dealing with and managing complex situations and ability to make decisions

Desirable criteria

• Knowledge of admission and discharge agenda
• Experience of working across organisational boundaries
• Band 6 experience

Skills and Attributes

Essential criteria

• Strong assessment and decision-making skills; ability to work under pressure; excellent communication and IT skills
• Excellent communication skills both written and verbal
• Able to work effectively in the team
• Willingness to undergo further training and development as the job develops

Derbyshire Community Health Services NHS Foundation Trust (DCHS) is one of the largest providers of specialist community healthcare in England and we currently employ around 4,500 staff. We deliver a variety of services across Derbyshire, caring for nearly 1.8 million patients each year.

We deliver patient care through 11 community hospitals, 4 minor injury units, 29 health centres and a learning disability centre. Another key part of our service is out in the community where we care for people in their own homes via therapists, health visitors and district nurses, and promoting public health in the wider community. As a Trust we care for patients of all ages with a special focus on the needs of elderly people and the very young.

DCHS has been recognised as a top 10 NHS organisation to work for in the UK by the Health Service Journal and NHS Employers in their Best Places to Work 2015 campaign. The Trust is also the runner-up in the category for the best NHS community trust employer.

TWITTER/FACEBOOK - DCHS has its own Social Media accounts for recruitment. Follow us/like us via @dchsjobs

Our vision is to see the health of local communities improve through partnership working, putting people at the centre and looking to the future.

Our values:

1) To get the basics right - For each other, local people and communities

2) To act with compassion and respect - For each other, local people and communities

3) To make a positive difference - For each other, local people and communities

4) To value and develop teamwork - With our partners and within DCHS

5) To value diversity and inclusivity - Of each other, local people and communities.

The majority of our locations offer free parking facilities for staff.

We will communicate with you regarding your application via email so please check your email account on a regular basis. If using hotmail, MSN or yahoo email accounts please check your 'junk/spam' mail regularly.

Please note - if we receive a high number of applications for this position we reserve the right to withdraw the post before the closing date, therefore it is advisable that you apply as early as possible to avoid disappointment.

As a flexible working friendly organisation, we want to be sure that you can work in a way that is best for our service and for you. Speak to us about how we might be able to accommodate a flexible working arrangement whether that's job share, part time or another flexible pattern.

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