Role Overview

The post holder will work as a member of a multidisciplinary CMHT, the post will be for those patients that have already been assessed and given a formal diagnosis of Dementia by the team.

The model for the post diagnostic care is a tiered step up and step-down model of care in partnership with the Alzheimer’s society led by RDaSH. This post is for the moderate level of patient need that requires clinical advice and interventions with multiple complexity of need to prevent break down in the community.

Key Responsibilities

• Be the lead professional for the review and coordination of care needs, planning and implementation of evidence-based care to this defined patient group and their carers as part of a multidisciplinary approach.
• Provide professional advice and support to other agencies and members of the multidisciplinary team. To act as a role model and resource for junior/less experienced staff.
• Be responsible for the further assessment, planning implementation and evaluation of the evidence-based care required, including health promotion for an identified group of patients, who have already been diagnosed as having Dementia.
• Responsible for the appropriate clinical risk assessment of patients contacting the team as appropriate.
• Provide an effective advice, guidance and decision-making process culminating in the coordination of any reviewed plan of care, within MDT support.
• Responsible for the promotion of carer and patient involvement within the service and for its provision.
• Responsible for working alongside a Dementia advisor from the Alzheimer’s society in a tiered model of care whilst been part of the larger MDT within the CHMT.
• Responsible for ensuring that carer’s assessments, education and support is delivered in accordance with the requirements of the NICE guidance and the clinical pathways.
• Responsible for providing appropriate support and caseload coverage for colleagues in the other localities when the need arises in their absence or if appropriate where skills mix is need for patient care.
• Responsible for liaison with staff working within therapies provision for post diagnostic after care and support lead by Age UK
• To maintain and enhance a close professional working relationship with all agencies, statutory and voluntary, which provide Dementia support.