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Detailed job description and main responsibilities

Role Summary

Being responsible and accountable for their practice and behaviour under the guidance and with the support of a registered practitioner and by working as part of the speciality cancer multidisciplinary team.

Working with primary care colleagues and understand cancer pathways in order to support newly referred patients to attend for appointments and investigations providing a point of contact and promoting relevant and timely communication.

Working in conjunction with the speciality cancer team to provide coordination of high-quality patient care through on-going telephone/ face to face assessment and proactive identification of needs using basic knowledge, approved tools and procedures.

Be the single point of contact for all patients under the care of the speciality cancer team including those patients on person centred follow-up. Coordinate care, track and update on the results for non-complex cases, managing patient concerns via the helpline and generic email, facilitate rapid re-entry into the system if required.

Work with the clinical team to coordinate any necessary assessments, appointments, investigations and organisation of MDTs, virtual MDTS and outcomes in order to fast track people and provide a seamless patient pathway.

Navigating the complex health and social care system to support patients at all points in the cancer pathway. Building relationships with professionals and facilitating access to a variety of services including generating referrals on the person’s behalf where necessary.

Working as part of the speciality cancer team to facilitate Holistic Needs Assessments and coordinate care for patients living with cancer who have non-complex needs so they can access the right help at the right time, providing a seamless experience of care.

Recognise when there is a potential deterioration in condition or an emergency situation and escalate these concerns to a registered practitioner in a timely manner. Early detection of problems/ actions to reduce in-patient admissions.

Providing regular supportive conversations with the person living with cancer with non-complex needs, assessing their holistic needs, and supporting them to self-manage by providing relevant information and advice, and signposting to other Macmillan resources and services available to meet their identified needs, liaising with the speciality cancer team as appropriate.

Awareness of Cancer Waiting Time Targets and systems to ensure all mandatory cancer data is accurate and timely. Documenting and monitoring all aspects of patient care coordination and service delivery.

Professional Values

To ensure Trust standards and values are maintained and monitored to improve the quality of care to all who come into contact with the services provided by South Warwickshire Foundation Trust.

Ensure records and documentation are maintained, kept confidential, and meets appropriate Trust standards, and in line with the Data Protection Act.

Demonstrates a positive and enthusiastic approach to their work in order to maintain high morale and motivation within the department. Promoting a professional and positive working environment.

To report any accidents or incidents via the DATIX incident reporting system and/or to an appropriate registered professional, ensuring an open and transparent culture.

To adhere to the Trust’s IT policies regarding e-mail and internet usage.

To ensure children and adults and protected from abuse and avoidable harm and report any safeguarding concerns in accordance with Trust policies and procedures.

Clinical Practice

Triage incoming calls and initiate appropriate response according to assessment tools, protocols and individual pathways, liaising with the CNS as appropriate.

Highlight need for practical and emotional support for the person living with cancer and their families. Recognise information needs may change over time and work with the person to ensure they have all the information and support they need at all stages of the cancer journey.

Make pre planned outbound telephone calls to patients to assess needs and monitor progress, liaising with the CNS and other members of the healthcare team as appropriate in order to initiate a proactive prevention approach.

For patients on the self-managed pathway ensure that test results, clinic letters and any notes are available and communicated to the clinical team at the earliest opportunity to inform the next steps of the pathway.

Maintain the Remote Monitoring System and Somerset Cancer Registry databases for open access follow up, monitoring alerts, organising relevant tests and ensuring results are flagged to the relevant MDT member.

Coordinate the necessary assessments, appointments or investigations as identified in self-managed patients care plan.

For patients on the self-managed pathway, work closely with the MDT coordinators to ensure good preparation of the cases for the MDT discussion and ensure that MDT outcomes are followed up in a timely manner.

Support the delivery of patient information to ensure all patients/carers receive appropriate verbal/written communications on a timely manner – this may include referring to the Macmillan Cancer Support and Information Service, ensuring that patients receive the patient information pack and understand its contents.

Assist in CNS team’s audit of patient satisfaction survey and clinical audits.

Coordinate the care for patients assessed by a registered practitioner as having non-complex needs and support self-management programmes.

Contribute to holistic needs assessment and the development of a care plan for patients with non-complex needs and monitor and review care plan with the patient and carer.

Evaluate outcomes of care delivery with the registered practitioner.

Assist people to access appropriate information and support by sign posting to a range of support services and encourage self-management where appropriate.

Participate in the development and support the planning, delivery and evaluation of Health and wellbeing sessions in collaboration with the LWBC Programme lead.

Take responsibility for care and welfare of a defined caseload of patients/clients within your area of work.

Continuously assess, implement and evaluate treatment, using appropriate tools and algorithm as agreed by a registered professional.

To report to the registered professional any patient who gives cause for concern.

Never undertake anything beyond your own level of competency.

To ensure delivery of high-quality care in accordance with Trust policies, procedures and guidelines.

To accurately document all care delivered to patients, maintaining confidentiality at all times.

Participate in activities to improve the quality, productivity and effectiveness of care in response to local and national policies and initiatives.

To adhere to Infection Prevention and Control policies relevant to the area of work, demonstrating an understanding of cross infection.

To support relatives as required demonstrating compassion and empathy.

Provide supervision and support to junior support and care staff as required.

Communications and Interpersonal Relationships

Welcome patients, relatives and visitors to the clinical area, providing assistance, support and information where required, identifying individual needs and utilising a range of agreed communication mediums.

Always introduce yourself in line with the Trust privacy and dignity promises and the principles of good customer service.

Communicate effectively and professionally with the multi-disciplinary team to ensure that patient care is well planned, coordinated and communicated.

Contribute to the reporting, handover and documentation of patient care maintaining confidentiality at all times.

Use the Trust information support systems and other computer systems as required by the clinical area.

Act as a key point of contact for all patients diagnosed with cancer and patients on the self-managed pathway through the helpline. Informing patients and carers on how to make contact when they feel their condition or needs have changed, including what to do out of hours.

Ensure that patients and carers are aware of the full range of resources and services available through appropriate referral e.g. Macmillan Cancer Support and Information Service.

Effectively utilise a computer and various software applications in order to enter and maintain patient data, communicate with the multidisciplinary team and complete other IT tasks as required by the post.

Discuss support options with patients and carers with sensitivity and ensure that the cancer team is kept informed of outcomes.

Promote patient/user involvement relating to the provision of cancer care.

Team Working

To act in a professional manner, and as a role model, at all times, leading by example to junior members of the team.

Support and cooperate with the multidisciplinary team to ensure that all statutory and Trust regulations are complied with.

Participate in research and audit as required by the multidisciplinary team to ensure standards of patient care are monitored and improved.