Job Description
Job summary
This role is centred on proactive and reactive care reviews, including advance care planning discussion, comprehensive geriatric assessments and, if appropriate, structured medication reviews.
The role aims to improve outcomes for frail patients, reduce avoidable hospital admissions, and support quality improvement across the network.
Main duties of the job
The role involves carrying out advance care planning discussions, comprehensive geriatric assessments and structured medication reviews (SMRs). These duties will be carried out in care homes, patients own homes or in the GP surgery.
You will:
- Conduct regular reviews for eligible patients, including patients in care homes and house bound patients
- Support QOF work relating to the patients
- Conduct In-practice frailty reviews for patients attending appointments
- Conduct remote consultation frailty reviews where appropriate
You will work closely with the Frailty & Care Home Lead GPs and be supported by a Multi-Disciplinary Team (MDT). The role includes attendance at MDT meetings, as appropriate.