Clinical Screener Transfer of Care Hub

Job description

Job summary

An exciting opportunity has arisen for a Band 7 Physio/OT or Nurse who would embrace a new challenge. Northwick Park Hospital Transfer of Care Hub are looking for a Clinical Screener within the Brent Integrated Services.

The successful post holder will be based at Northwick Park Hospital and work in partnership with colleagues in the acute sector, social services, continuing care and other community health services to ensure that appropriate patients from the acute setting are assessed and transferred safely to appropriate community-based services in a timely and seamless manner.

Main duties of the job

You will:

• Assess patients with complex and challenging needs and determine the most appropriate discharge pathway to support a safe and timely transfer of care.
• Triage referrals received by the Transfer of Care Hub, ensuring patients are directed to the appropriate services and pathways.
• Work proactively with ward multidisciplinary teams (MDTs) and the wider Integrated Discharge Team (IDT) to identify and assess patients who are ready for discharge.
• Provide an in-reach service to hospital wards, supporting teams to facilitate timely discharge and reduce unnecessary delays.
• Liaise and work collaboratively with internal and external partners, including acute services, Social Services, Continuing Healthcare and community health services.
• Act as a Trusted Assessor for intermediate care units, supporting appropriate and efficient transfers of patients.
• Identify and resolve barriers to discharge, helping to minimise delays and streamline the discharge process.
• Ensure patients are safely transferred from the acute setting into the most appropriate community-based services, providing a coordinated and seamless transition of care.
• Work in accordance with the principles of the Hospital Discharge and Community Support Guidance, supporting safe, effective and patient-centred discharge planning.
• Previous work experience in discharge hubs or complex discharge planning teams
• Experience in discharge planning from acute hospitals or community based rehab units.

About us

We are proud to be one of the largest community healthcare providers in the country, with more than 4,500 colleagues caring for over four million people across London and Hertfordshire. Every day, our teams bring their skill, compassion, and determination to the people who depend on us.

What inspires us is at the heart of who we are: when we work together, we can help people move forward in ways that truly matter. Our teams support children as they take their first steps in life, and they stand beside adults as they rebuild strength, confidence, and independence. From newborn health visiting to community nursing, stroke rehabilitation, and palliative care, we are there for people through some of life's most important moments.

Joining Central London Community Healthcare means becoming part of a community that lifts each other up. It means working in an organisation that values compassion, welcomes new ideas, and believes in the potential of every colleague. Your development matters here. Your wellbeing matters. Your voice helps shape the future of the care we provide.

We offer a competitive employment package because the work you do matters. At Central London Community Healthcare, you will join an inclusive organisation that invests in its people, supports development, and helps you thrive while delivering high-quality care.

Job description

Job responsibilities

Please refer to Job description and person specification for outline of skills, knowledge and experience required.

Successful applicants will be required to demonstrate alignment with the Trusts values - Accountability, Inclusion, Compassion, and Empowerment, alongside fulfilling the duties detailed in the attached Job Description and Person Specification

Job description
Job responsibilities

Please refer to Job description and person specification for outline of skills, knowledge and experience required.

Successful applicants will be required to demonstrate alignment with the Trusts values - Accountability, Inclusion, Compassion, and Empowerment, alongside fulfilling the duties detailed in the attached Job Description and Person Specification

Person Specification

Education/Qualification

Essential

• Registered Nurse with current NMC registration or registered AHP with current HPC registration
• Evidence of continuing personal and professional development with up-to-date CPD portfolio
• Extensive post -registration qualification in advanced nursing practice, community nursing or equivalent relevant to the post

Desirable

• Evidence of continuing professional education and training at master's Level.
• Management or Clinical leadership qualification
• Mentor or practice-based learning training Registered Nurse with current NMC registration or registered AHP with current HPC registration

Experience

Essential

• Evidence of significant recent post-registration experience in community nursing, rapid response, emergency care, unscheduled care or equivalent inpatient therapy or community rehabilitation experience.
• Experience of effectively working in collaboration, negotiating and liaising within a multi-disciplinary team and across organisational boundaries
• Experience of assessing, co-ordinating and delivering quality care to people with complex needs and long-term conditions
• Experience of urgent nursing/therapy assessments and developing and delivering care plans to meet these needs.
• Experience of leadership including coordinating and managing a team
• Experience of change management and implementing change in practice
• Experience of working in a changing and uncertain environment.
• Proven ability to prioritise and manage own workload with minimal supervision

Desirable

• Experience in working in a Transfer of Care Hub/ Discharge Hub
• Experience in presenting and service promotion
• Experience in monitoring clinical standards.
• Experience of conducting research projects and audit.
• Experience of teaching others and mentoring students

Skills and Knowledge

Essential

• Evidence of comprehensive range of clinical skills and expertise relevant to the role
• Specialist knowledge in clinical reasoning, history taking, physical examination, diagnostic skills and prescribing/treatment
• Clinical knowledge across a range of long term and enduring conditions.
• Able to work autonomously, planning and prioritising own workload and that of others
• Able to delegate work effectively and safely
• Able to deal with conflict and manage appropriately
• Ability to assess a situation and act appropriately
• Advanced communication and report writing skills, in both verbal and written format
• Basic IT skills including use of Microsoft Office package, clinical systems and email
• Knowledge of current health care policy and relevance to the delivery of healthcare services including Hospital Discharge
• Knowledge of adult protection and safeguarding children issues.
• Detailed knowledge of Community Health and Social Care Environment and collaborative working with other care providers, e.g. social care and voluntary services
• Knowledge and understanding of clinical governance and its application to clinical
• Knowledge of evidence-based practice and able to implement in practice
• Experience in monitoring clinical standards.
• Ability to thrive in a changing environment and to focus on opportunities to generate new ideas Experience of conducting research projects and audit

Desirable

• Knowledge/ Ability to use Cerner Clinical System and OPTICA Discharge Tool
• Knowledge of the audit process and able to implement in practice
• Knowledge of resource management.
• Knowledge and understanding of NICE and other relevant guidelines
• Knowledge and understanding of the role of MDT members within an integrated locality team.

Person Specification
Education/Qualification

Essential

• Registered Nurse with current NMC registration or registered AHP with current HPC registration
• Evidence of continuing personal and professional development with up-to-date CPD portfolio
• Extensive post -registration qualification in advanced nursing practice, community nursing or equivalent relevant to the post

Desirable

• Evidence of continuing professional education and training at master's Level.
• Management or Clinical leadership qualification
• Mentor or practice-based learning training Registered Nurse with current NMC registration or registered AHP with current HPC registration

Experience

Essential

• Evidence of significant recent post-registration experience in community nursing, rapid response, emergency care, unscheduled care or equivalent inpatient therapy or community rehabilitation experience.
• Experience of effectively working in collaboration, negotiating and liaising within a multi-disciplinary team and across organisational boundaries
• Experience of assessing, co-ordinating and delivering quality care to people with complex needs and long-term conditions
• Experience of urgent nursing/therapy assessments and developing and delivering care plans to meet these needs.
• Experience of leadership including coordinating and managing a team
• Experience of change management and implementing change in practice
• Experience of working in a changing and uncertain environment.
• Proven ability to prioritise and manage own workload with minimal supervision

Desirable

• Experience in working in a Transfer of Care Hub/ Discharge Hub
• Experience in presenting and service promotion
• Experience in monitoring clinical standards.
• Experience of conducting research projects and audit.
• Experience of teaching others and mentoring students

Skills and Knowledge

Essential

• Evidence of comprehensive range of clinical skills and expertise relevant to the role
• Specialist knowledge in clinical reasoning, history taking, physical examination, diagnostic skills and prescribing/treatment
• Clinical knowledge across a range of long term and enduring conditions.
• Able to work autonomously, planning and prioritising own workload and that of others
• Able to delegate work effectively and safely
• Able to deal with conflict and manage appropriately
• Ability to assess a situation and act appropriately
• Advanced communication and report writing skills, in both verbal and written format
• Basic IT skills including use of Microsoft Office package, clinical systems and email
• Knowledge of current health care policy and relevance to the delivery of healthcare services including Hospital Discharge
• Knowledge of adult protection and safeguarding children issues.
• Detailed knowledge of Community Health and Social Care Environment and collaborative working with other care providers, e.g. social care and voluntary services
• Knowledge and understanding of clinical governance and its application to clinical
• Knowledge of evidence-based practice and able to implement in practice
• Experience in monitoring clinical standards.
• Ability to thrive in a changing environment and to focus on opportunities to generate new ideas Experience of conducting research projects and audit

Desirable

• Knowledge/ Ability to use Cerner Clinical System and OPTICA Discharge Tool
• Knowledge of the audit process and able to implement in practice
• Knowledge of resource management.
• Knowledge and understanding of NICE and other relevant guidelines
• Knowledge and understanding of the role of MDT members within an integrated locality team.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.
Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the .

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. .
UK Registration

Applicants must have current UK professional registration. For further information please see

Additional information
Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.
Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the .

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. .
UK Registration

Applicants must have current UK professional registration. For further information please see

Employer details

Employer name

Central London Community Health Trust
Address

Northwick Park Hospital

Watford Road

Harrow

HA1 3UJ

United Kingdom

Employer's website