Domiciliary visits and nursing and residential homes
What we do
The Advanced Community Practitioners (ACPs) and End of Life Facilitators work closely with residents, families, care home staff and GPs, to ensure each resident receives high quality care to meet their needs and to avoid unnecessary hospital admissions where possible.
The practitioners aim is to be both preventative and responsive care for those previously identified as being at high risk of deteriorating health. The services are based in local hubs.
We are a team of highly skilled nurses and paramedics with a community background and have acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice.
We use our advanced clinical assessment skills to complete a holistic assessment taking into account a patient’s psychological, physical and social needs. It may include us ordering, performing and interpreting common screening and diagnostic tests e.g. blood tests or x-rays.
Local Care Review Teams (LCRTs)
Local Care Review Teams (LCRTs) are a means whereby all professionals come together and share their knowledge and skills to co-ordinate how local people are supported to improve their own health and well-being and when they are ill or need help, they receive the best possible joined up care. The LCRT (pathway) develops a joint care plan for high risk patients in order to anticipate crisis and keep them in the community and support hospital admission avoidance. This process can be face to face or virtual.
Independent prescribers
Once we have reached diagnosis we are able to provide prescriptions directly to patients when necessary to avoid any delay in treatment. A patients GP will be consulted with and kept fully informed of any treatment we provide.
Self-care
We encourage patients to play a central role in managing their own care and helping them manage the health, emotional and social consequences of living with a long-term condition.
Personalised care plans
There is a collaborative process of shared decision making to agree goals and identify support needs, to ensure plans are in place to support a crisis and reduce the need for hospital admissions and ambulance calls.
Elderly care
We have access to an elderly care consultant physician on a weekly basis providing specialist advice and recommendations regarding specific patient management.