CNWL are looking to recruit 2x Band 7 Older Adult Mental Health Liaison Practitioners into Kensington & Chelsea and Westminster Older Adult Mental Health services in Jameson Division.These posts are being advertised initially as a fixed-term/secondment opportunity for 12 months.
These new roles will be responsible for providing specialist advice, assessment & formulation and delivery of brief interventions for older adults with complex mental health conditions and dementia, who may be new or known previously to secondary care mental health services. Both roles will work at Primary Care Network level but will be employed by Kensington & Chelsea and Westminster Older Adult Community Mental Health Services.
This is an exciting development opportunity for staff to interface across primary care and secondary care and deliver more holistic and joined up care for older adults with multiple complex co-morbidities including frailty, functional mental health needs and/or dementia.
You will be expected to show demonstrable experience of working with older adults/ those with complex physical and MH needs including functional and organic illness, an ability to work flexibly and collaboratively across local environments and strong interpersonal skills. The roles are part of Kensington & Chelsea and Westminster Older Adult Mental Health services.
Main duties of the job
This role will be part of Kensington & Chelsea and Westminster Older Adult Community Mental Health Services . The post holder will provide specialist advice, assessment & formulation and delivery of brief interventions to improve communication and links across the primary and secondary care interface including supporting access to Older Adult Community Mental Health Teams, or other services such as Third Sector or IAPT where needs can be better met by these services.
The post holder will contribute to the provision of brief psychological interventions in the PCN, which will be under the direction of a qualified clinical psychologist who will retain clinical responsibility for clinical work carried out.
The post holder will be part of the PCN Frailty MDT team assisting case reviews, helping to triage those presenting with mental health needs and supporting GPs with referring clients to Older Adult Mental Health Services as appropriate. For those with SMI and where applicable to the skilled professional, the post holder will support antipsychotic medication management. The role will be embedded within a PCN working with several GP surgeries and within the Older Adult Community Mental Health Teams to ensure a good understanding of eligibility criteria, local need and to enable safe transfers of care.
About us Values
The post holder will adhere to the trust values: Compassion:
Our staff will be led by compassion and embody the values of care outlined in our Staff Charter. Respect:
We will respect and value the diversity of our patients, service users and staff, to create a respectful and inclusive environment, which recognises the uniqueness of each individual. Empowerment:
We will involve, inform and empower our patients, service users, carers and their families to take an active role in the management of their illness and adopt recovery principles.We will ensure our staff receive appropriate direction and support, to enable them to develop and grow. Partnership:
We will work closely with our many partners to ensure that our combined efforts are focused on achieving the best possible outcomes for the people we serve.
The successful applicant may have contact with patients or service users. As an NHS Trust we strongly encourage and support vaccination as this remains the best way to protect yourself, your family, your colleagues and of course patients and service users when working on our healthcare settings.
Job description Job responsibilities
It is crucial that the post holder can:
- Facilitate people with multiple long-term conditions including mental health and/or dementia needs to access the appropriate service and enable transfers of care back to the GP from Community Hub teams.
- Screen, Triage and deliver brief interventions based on clients needs and enable access to therapeutic activities working closely with voluntary, Community and third sector organisations.
- Work to the principles of recovery/ person centred care and their application to risk management, positive risk taking and strengths orientated approaches to care
- Provide an enhanced level of support to Primary Care clinicians through advice, education and training to improve skills and capacity in responding to the needs of Older Adults with mental health conditions who are exhibiting complex psychosocial needs and/or challenging behaviours
- Recognise and identify older adults that may have un-recognised mental health or cognitive needs including reviewing practice referral patterns to identify potential areas of unmet need/underserved communities
- Ensure that the Public Sector Equalities Duty is met.
As an autonomous practitioner, he/she will be responsible for their own work and interventions and for the interpretation of agreed guidelines and policies. They will have freedom to act, particularly around assessment and interventions for people not known to secondary mental health services while also working closely as part of a frailty MDT to meet individual needs including enabling timely referral into specialist services when required.Key Result Areas & Performance:
The characteristics of the core population are frail Older Adults presenting in primary care with enduring mental health needs and/or mild to moderate cognitive impairment at risk of admission to acute services. These individuals have multiple co-morbidities but dont quite fit into secondary care thresholds and are too complex for GPs and primary care based services to manage alone.
Service users seen by the post holder will include those who have experienced levels of distress and common mental health difficulties. Some service users may present with a level of risk to both themselves and sometimes to other people. Assessments and interventions will be delivered both in the PCN and via Older Adult Mental Health services where suitable.
All clinical duties will be carried out under the supervision and direction of a qualified professional in the Older Adult Community Mental Health Team. The post-holder has a responsibility to perform all tasks within the values of CNWL. Under such direction and with these conditions, the duties will be: Clinical
- Attend the PCN frailty MDT meetings and conduct specialist short-term intervention and mental state assessment for patients either as part of the transfer of care process or following request by primary care team.
- Provide advice to primary care to help prevent inappropriate referrals and provide support to patients and to find other ways of meeting their mental health needs.
- Carry out robust risk assessments and care planning in primary care environment.
- Provide access and /or deliver a broad range of psychosocial interventions for individual patients where needed
- Follow up on patients whose referrals have been rejected by secondary care services (e.g. patients with suspected cognitive impairment or delirium after 6 weeks and consider re-referral
- To be responsible for providing and receiving complex, sensitive, distressing and emotional information in relation to health issues where there are often barriers to acceptance.
- To spend sustained amounts of time with service users whose behaviour may be aggressive and hostile, who may have poor verbal communication skills and self-care and special physical and/or mental needs.
- To be mindful of the needs of individuals and families from a wide range of racial, cultural, sexual, religious and social backgrounds and, with service users and colleagues, co-produce innovative ways of communicating and working across language and cultural barriers.
- Where appropriate, provide expert advice regarding the pharmacological management of mental health patients to non-mental health professionals, seeking clinical guidance from the designated Consultant Psychiatrist/GP in relation to any specific prescribing advice.
- Be required to work in conjunction with individual members of the primary care team, patients and carers to develop personalised relapse/crisis plans
- Ability to present cases in Frailty MDT for referral to OA Services including potential differential diagnoses and rationale for referral to other services
- Work within an agreed process for safe transfer of care from Older Adult Community Mental Health Teams to GPs that will ensure good clinical outcomes, access to appropriate advice, advocacy and support networks as well as rapid re-referral, when appropriate.
- Develop systems of engagement with key 3rd sector partners to identify and promote access to mainstream activities.
- Demonstrate a high standard of record keeping and documentation with adherence to Trust policy and an understanding of professional guidelines and application of confidentiality.
- Work with colleagues to develop clinical expertise and high standards of professional practice.
- Deliver care that is evidence based, reflecting current best practice and research, demonstrating clinical excellence and high standards of professional practice to other staff.
- Demonstrate sound understanding of the legal and ethical issues in caring for people with a mental health condition. In particular, demonstrating sound understanding of the Mental Health Act (1983) and Mental Capacity Act and its use in a non-mental health setting.
- To have a working knowledge of Safeguarding Adults and Childrens procedures, including completion of referrals and participation in multi-agency safeguarding strategy meetings.
- Be required to make clear autonomous decisions, with close support and supervision from more senior clinical staff, based on an analysis of complex presenting problems and judgement about available options. This will include decisions related to the management of care with the primary care setting.
- The post holder will work with relevant Psychiatrists and GPs and key members of the primary care team to map out the caseload and define the (clinical) needs of each patient. Within this work identify the patients who could be managed in primary care. At this stage, a provisional time period for that management on a case by case basis would be determined.
- Participate in structured clinical supervision in accordance with Trust policies and procedures
- Work alongside other members of the primary care teams in the networks and attend/contribute to identified case discussions and team meetings, presenting complex cases for discussion where relevant (including ICP Meetings
The post holder will be expected to engage in their own training as follows;
Partnerships Communications and Relationships
- To undertake mandatory and statutory training as required by Trust policy.
- To undertake other training relevant for working in primary care.
- Take an active part in team supervision/reflective practice.
- To contribute and commit to undertaking an annual Personal Development Review /appraisal, as part of the process of working towards an individualised personal development plan.
- The post holder will work very closely within the PCN they are aligned to within their borough and will liaise with key clinicians from that Network to work at an operational level across the Network.
- They will identify the necessary protocols that come out of the above work, that go beyond the safe discharge protocols.
- Further and substantial development of shared care protocols
- There will be a need to develop clear interfaces with a range of services in primary care and the community as well as a range of Older Adult Mental Health services. It will be expected as part of induction that these roles participate in triage of accepted referrals by Older Adult Mental Health services to facilitate understanding of the referral and eligibility criteria.
- To provide knowledge of social support available and of the partnership suppliers whether voluntary sector or others.
- To communicate assessment results and care plans to patients, carers, GPs and other staff in Primary Care.
- Demonstrate the ability to develop and maintain good working relationships with colleagues within the team, the wider borough, and both the Mental Health and Acute Trusts.
- Take an active role in seeking carer and patient feedback.
- Maintain and provide service activity data/statistical information as required
- Demonstrate respect, empathy and understanding of all patients and colleagues within the service, in accordance with the Trust policy for promotion of equal opportunities and cultural awareness.
- Adhere to all Central and North West London NHS Foundation Trust policies e.g. Human Resources policy, Health and Safety Policy, all Clinical Policies and Procedures.
- There is an expectation to work flexibly across a range of bases throughout the working week, including Trust buildings and GP surgeries.
Person Specification Qualifications and Training Essential
- Professional qualification in mental health e.g. Occupational Therapy, Social Work or Mental Health Nursing (RMN) with current NMC/HCPC registration
- Attained at lea
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