Palliative Care Facilitator - Exeter, United Kingdom - Royal Devon University Healthcare NHS Foundation Trust

Tom O´Connor

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Description

To provide coordination and navigation for people and their carers across health and care services, working closely with primary care professionals; helping to ensure patients receive a joined-up service and the most appropriate support.


Work with people, their families and carers to improve their understanding of the patients condition and support them to develop and review personalised advance care plans to manage their needs and achieve better healthcare outcomes.


Assist care home teams to access self management education courses, peer support and other interventions that support them and increase their levels of knowledge in managing the healthcare needs of the people they care for.

Work collaboratively with care homes, residents and family members, GPs and practice teams, community services and, where appropriate, acute services.


Support care homes and Primary Care Networks in developing communication channels between GPs, people and their families and carers and other agencies.

Conduct follow-ups on communications from out of hospital and in-patient services. Maintain records of referrals and interventions to enable monitoring and evaluation of the service.


Support care homes, healthcare services and GP practices to keep care records up-to-date by identifying and updating missing or out-of-date information about the persons circumstances.

Recognising and appropriately addressing risk factors to clients and carers within their hea

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