Detailed job description and main responsibilities

Principal Duties & Responsibilities

The purpose of this role is to complement the existing cancer site specific team. To help them support patients through diagnosis, treatment pathways and follow up. To ensure the provision of safe, seamless, appropriate service. This helps maximise the health and quality of life of patient and carers. Improving the quality and efficiency of health care delivery by: -

 

• Being responsible and accountable for their practice and behaviour under the guidance and supervision of a registered practitioner and by working as part of the cancer management team.
• Working as part of the cancer management team, following up Holistic Needs Assessment, coordinate the care of the person living with cancers non-complex needs so they can access the right help at the right time.
• Working in conjunction with the cancer site specific teams 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 on a cancer pathway of care. To coordinate care and track, helping manage patient concerns via the helpline and generic email.
• To recognise and comply with the trust and departmental policies and procedures for incident reporting.
• To ensure confidentiality at all times in accordance with Trust policy and procedure.
• Navigating the complex health and social care system, both during and following completion of cancer treatment, by building relationships with professionals and facilitating access to these services including generating referrals on the person’s behalf where necessary.
• Alert to site specific team of early detection of problems/ actions to reduce in-patient admissions.
• Providing regular supported 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 resources and services available to meet their identified needs, liaising with the site specific clinical nurse specialist (CNS) team as appropriate.
• Documenting and monitoring all aspects of patient care coordination and service delivery.
• Track and action cancer Patient Tracking list (PTL), i.e. track surgery/histology/ radiology and OPAs and document all findings on Somerset data base.

 

Coordination of care

Under the guidance and supervision of a registered practitioner, coordinate care by providing a single point of access, including rapid re-entry into the system for those people identified as having urgent or specialist needs.

• Triage incoming calls and initiate appropriate response according to assessment tools, protocols and individual pathways, liaising with the site specific 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 site specific 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 Somerset Cancer Registry database 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 the cancer care/ MDT outcome plan.
• 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, ensuring that patients receive the patient information pack and understand its contents.
• Assist in site specific CNS team audit of patient satisfaction survey.
• 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 events in collaboration with the Living with cancer and beyond LWBC Programme Team.

 

 

Communication

• Act as a key point of contact for all patients diagnosed with cancer through the helpline.
• Inform 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, LWBC Team and site specific CNS support.
• 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 site specific cancer team is kept informed of outcomes.
• Promote patient/user involvement relating to the provision of cancer care.

 

Professional

• To participate and display a willingness to learn, develop a relevant technical competency / area of interest and keep up to date with current national and local issues and developments.
• To routinely participate in departmental audits and patient surveys as required under the supervision of the site specific CNS team and lead clinician and input data as requested.
• Participate in regular monitoring of compliance with remote surveillance pathways.
• To be responsible for own learning in knowledge base relevant to own clinical area including mandatory training.
• To be responsible for imparting information about the technical area of knowledge to other health care professionals as appropriate.
• To participate in regular formal clinical supervision.
• To be responsible for managing own daily timetable of delegated tasks including time for supervision and training.
• To maintain professional working relationships with the trust, and other relevant organisations i.e. Education.
• To access and input confidential patient information through integrated databases in accordance with the agreed policy and procedure.
• Carry out some administrative duties as required by the role.
• Demonstrate an awareness of the limits of own practice and knowledge and when to seek appropriate support /advice.

 

Other responsibilities

• To undertake any other such duties as may be required from time to time, that are consistent with the responsibilities of the grade.
• To comply with the Trusts and departments policies, guidelines and procedures.
• To attend all mandatory training as required in line with Trust employment and professional need.
• To participate in cancer site specific team meetings and the review and development of cancer services.
• To be responsible for informing line manager of any issues relating to the ability to safely carry out duties.
• To be aware of departmental duties and initiatives to ensure a safe environment, recognising patients’ requirements for privacy and dignity.
• To provide administrative support to the cancer service team and site specific CNS

 

 

Personal/Professional Development

• To take every reasonable opportunity to maintain and improve your professional knowledge and competence
• To participate in personal objective setting and review, including the creation of a personal development plan and the Trust’s appraisal process.
• There may also be a requirement to undertake other similar duties as part of this post in order to provide a quality service. These will be consistent with the level of responsibilities outlined above.
• This job description may be reviewed from time to time in light of developments and may be amended in consultation with the post holder.