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Overview of the role

Planning and commissioning care for people with complex health and social care needs.

Associate continuing healthcare practitioner

Details of standard

Occupation summary

This occupation is found in a wide variety of organisations that oversee health and social care services such as Clinical Commissioning Groups, social services and community healthcare services. Continuing Healthcare services provide care for over 60,000 people over the age of 18 annually across England. It is estimated that 70% are in nursing homes, and 30% have care in their own homes.

The broad purpose of the occupation is to work as part of a Continuing Healthcare team which provide packages of on-going care that are arranged and funded solely by the NHS. The Associate Continuing Healthcare Practitioner plays a key role in the assessment of individual’s complex health and social care needs that have arisen as a result of disability, accident or illness, and the planning and commissioning of the services for these individuals. They also act as the first point of contact for individuals and their carers offering support, care and advice about the service and for young adults and their family who are transitioning from children’s continuing care into this adult continuing healthcare service. The Associate Continuing Healthcare Practitioner may be required to work shifts including evenings and weekends.

In their daily work, an employee in this occupation interacts with the individuals and their family, friends and carers, that have been referred into the continuing healthcare service, are being assessed or are receiving packages of care. They work with nurses, social workers, doctors and other health and social care colleagues involved in planning, reviewing and delivering services provided to the individual guiding them with expert knowledge of the specialist continuing healthcare regulations. They also regularly work with finance and procurement colleagues and the service providers to ensure contracts are being delivered as agreed. They may also have contact with legal and claims companies who are representing individuals who do not agree with the outcome of the assessment process. The Associate Continuing Healthcare Practitioner will need to have good communication skills to advocate for individuals and guide them through the emotionally stressful assessment process and any dispute process. They will also be required to have a detailed knowledge of the health and social care services available for these individuals who have complex and varying needs. The Associate Continuing Healthcare Practitioner will be primarily office-based but will also visit the individual in their home, and in health and social care settings.

An employee in this occupation will be responsible for screening and assessing individuals for eligibility to continuing healthcare packages in line with the National Framework for Continuing Healthcare, related legislation and policy. To support this assessment work, they undertake analysis, interpretation and evaluation of evidence from multiple health and social care professionals caring for the individual. The Associate Continuing Healthcare Practitioner will also be responsible for managing a caseload of individuals who have been found eligible. This involves the planning and reviewing of the complex health and social care packages ensuring they continue to meet their needs. They will work autonomously, exercising judgement and work in partnership with other health and social care professionals to undertake non-routine assessments and reviews on individuals in line with the law.In most instances their work will be overseen by a registered health or social care professional such as a nurse, social worker or occupational therapist. The Associate Continuing Healthcare Practitioner will also have line management or supervisory responsibility for junior members of the team, acting as a role model, planning and managing their work.

Entry requirements

Whilst any entry requirements will be a matter for individual employers, typically an apprentice might be expected to have already had 2 years experience in a carer capacity for a health or social care provider organisation, or have worked within a Continuing Healthcare team


Occupation duties

Duty

Criteria for measuring performance

KSBs

Duty 1 Undertake management and review of individual’s care packages, ensuring it continues to meet their agreed health and social care needs

Delivered in line with current National Framework and additional relevant legal frameworks

K1 K2 K3 K4 K5 K6 K7 K8 K9 K12 K13 K17 K19 K21 K22 K25 K27 K29

S2 S3 S5 S6 S8 S14 S17 S23 S25 S27 S28

B1 B2 B3 B4 B5 B6 B7 B8

Duty 2 Contribute to planning an individual’s care plan ensuring it meets their agreed health and social care needs

The plan developed meets the health and social care needs of the individual and is in line with current legislation and local procedures

K1 K2 K3 K5 K6 K7 K8 K12 K14 K17 K21 K22 K23 K25 K27 K30

S2 S3 S4 S6 S9 S12 S14 S15 S17 S18 S19 S23 S25 S27 S28

B1 B2 B3 B4 B5 B6 B7 B8

Duty 3 Contribute to continuing healthcare assessment of individuals health and social care needs using the mandated tools as outlined in the "National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care"

Complete the nationally mandated "Checklist" and "Decision Support Tool" in line with the National Framework identifying all health and social care needs

K1 K2 K3 K4 K7 K8 K12 K17 K19 K20 K22 K25 K27 K29 K31

S1 S2 S3 S5 S6 S7 S8 S14 S17 S19 S23 S25 S27 S28

B1 B2 B3 B4 B5 B6 B7 B8

Duty 4 Supervise staff assigned according to organisational policies and procedures.

Acting as a role model, demonstrates robust performance management and appropriate professional development of the team in line with relevant legislation, governance and policy requirements

K8 K12 K17 K18 K23 K24 K25 K26 K27 K31

S8 S12 S14 S17 S20 S21 S22 S23 S26 S27

B1 B2 B3 B4 B5 B6 B8

Duty 5 Manage the continuing healthcare referral process ensuring referrals into the service are in line with the "National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care"

In compliance with the current National Framework, relevant legal regulations and local policy and processes

K8 K9 K18 K20 K25 K28 K29 K31

S1 S4 S6 S10 S13 S17 S23 S24 S26 S27 S28

B1 B2 B3 B4 B5 B6 B7 B8

Duty 6 Collate and analyse evidence and assessment documentation from health and social care teams involved in caring for the needs of the individuals to enable a lawful eligibility decision to be made

Completed evidence pack to support full multidisciplinary team assessment of eligibility as required by the National Framework

K2 K3 K8 K9 K12 K22 K23 K24 K25 K27 K29 K30

S6 S8 S14 S19 S23 S25 S26 S27 S28

B1 B3 B4 B5 B6 B7 B8

Duty 7 Co-ordinate and guide the multidisciplinary, multiagency team undertaking assessments using specialist policy knowledge to advise on appropriate process to deliver a policy-compliant recommendation regarding continuing healthcare eligibility

The multidisciplinary assessment process is completed fairly, consistently and lawfully in line with relevant legal regulations and policy

K2 K8 K17 K18 K19 K20 K22 K23 K25 K26 K28 K29 K31

S6 S7 S8 S14 S16 S17 S18 S19 S20 S21 S23 S24 S25 S26 S27 S28

B1 B2 B3 B4 B5 B6 B7 B8

Duty 8 Contribute to resolution of disputed eligibility funding decisions fairly, consistently and lawfully

Correctly follows legal frameworks and local processes

K2 K8 K12 K17 K18 K19 K20 K22 K24 K25 K26 K27 K28

S6 S8 S14 S16 S17 S19 S23 S24 S25 S26 S27

B1 B2 B3 B4 B5 B6 B7 B8

Duty 9 Contribute to commissioning services required to meet individual's health and social care needs as prescribed by the multidisciplinary team in partnership with the individual

Commission the full range of services required to meet individuals’ health and social care needs

K9 K10 K11 K12 K14 K15 K21 K22 K25 K27 K30

S4 S6 S8 S11 S14 S15 S16 S23 S25 S27

B1 B3 B5 B6 B7 B8

Duty 10 Monitor continuing healthcare provider service and personal health budget (PHB) contracts in accordance with procurement law, national policy and local agreements

Contracts are managed in accordance with procurement law and local policy and agreements

K8 K9 K10 K12 K13 K14 K15 K16 K21 K25 K27 K28 K30

S8 S9 S11 S12 S14 S17 S18 S23 S26 S27

B1 B3 B4 B6 B8


KSBs

Knowledge

K1: Understands the structures and functions of the human body Back to Duty

K2: Understand how to support people going through the Continuing Healthcare process Back to Duty

K3: Understand commonly encountered mental, physical, behavioural and cognitive health conditions, medication usage and treatments and and how ill health impacts on the individual and their family Back to Duty

K4: The principles of infection control Back to Duty

K5: Understand the principles of Funded-nursing care and Joint packages of care and how the Associate Continuing Healthcare Practitioner can support the planning and assessment of these Back to Duty

K6: Knows how and when to plan and facilitate referal, discharge or transition of care between professionals, settings or services and what makes up an appropriate care package Back to Duty

K7: Understands the principles of a primary health need and the difference between health and social care needs Back to Duty

K8: Understand the importance and how to use a range of communication methods and media available to assist with communication Back to Duty

K9: The range of health and social care contract types used, including Personal Health Budgets and services commissioned to treat and support individuals with ill health, disabilities and social care needs Back to Duty

K10: Knows the principles of healthcare business and financial planning, commissioning and procurement and how this impacts on continuing healthcare services and the numeracy to undertake basic budgetary analysis. Back to Duty

K11: Understand the impact of co-morbidities and the demands of meeting people’s complex health and social care needs when commissioning services Back to Duty

K12: How to undertake risk assessment, using a range of commonly used tools, and know when to seek advice to avoid compromising quality and safety of others Back to Duty

K13: Understands the factors which affect vulnerable people and how this can impact on the health and social care needs and the role of safeguarding policy in oversight of their care Back to Duty

K14: Understand the differences between risk aversion and risk management and how to avoid compromising quality of care commissioned but work towards the choices of the individual where safe to do so Back to Duty

K15: Understand the role and function of the Care Quality Commission for care home, supportive living and home care providers Back to Duty

K16: Understand the importance of Contractual Management in maintaining the quality, sustainability and effectiveness of services and what contractual levers can be used if concerns are identified Back to Duty

K17: Knows how discriminatory behaviour is exhibited and the impact this can have on individuals and the commissioning function Back to Duty

K18: Techniques to manage differences of opinion, conflict and difficult conversations between professionals Back to Duty

K19: Understand the principles of accountability and how this applies to the role of Associate Continuing Healthcare Practitioner Back to Duty

K20: Understands the principles of courage, transparency and the professional duty of candour Back to Duty

K21: Knows how care navigation/social prescribing can be used to address the individual’s needs and support them to move from dependence to more independence Back to Duty

K22: Understand roles, responsibilities and models of care of all members of the health and social care multidisciplinary team in providing and commissioning care and how the MDT contribute to a lawful assessment for eligibility of Continuing Healthcare Back to Duty

K23: Understand the principles of effective leadership and supervisory opportunities and roles for a associate continuing healthcare practitioner Back to Duty

K24: Understand the demands of multidisciplinary practice and strategies to develop resilience in self and know how to seek support to help deal with uncertain situations Back to Duty

K25: Understand relevant legal, regulatory and governance requirements, policies, and frameworks, including any mandatory reporting duties, to all areas of practice Back to Duty

K26: Knows the financial implications that eligibility has and how this can influence demand on the service, behaviours and decisions made Back to Duty

K27: Knows how to critically appraise and reflect upon knowledge, research and practice and understand how this can be used in practice improve the quality of care and service delivered and commissioned Back to Duty

K28: The importance of accurate and timely data collection processes and how this has an impact on local and national assurance mechanisms Back to Duty

K29: Know how to review individual’s health and social care needs related to breathing, nutrition, bladder and bowel health, skin integrity, mobility, communication, psychological and emotional, cognition, behaviour, symptom control and consciousness Back to Duty

K30: Understand the challenges of providing safe care for people with complex co-morbidities and complex care needs Back to Duty

K31: Understands methods for dealing with potential conflict situations Back to Duty

K32: Recognises the impact of claims companies and solicitors on the appeals process Back to Duty

K33: Understands the roles, responsibilities and functions of the Health and Social care professionals that form a MDT Back to Duty

Skills

S1: To make appropriate referrals of an individual into the continuing healthcare service via a standard or fast-track referral pathway, using the mandated screening tools as per national policy, rejecting and redirecting any inappropriate referrals Back to Duty

S2: To formulate, monitor and reassess person-centred, evidence based health and social care plan, delegated by registered practitioner, ensuring commissioned services maintain optimal independence and health and social care outcomes where possible and continues to meet the needs of the individual Back to Duty

S3: Take appropriate action where change in health or social care need requires screening, referral or further MDT assessment to establish ongoing Continuing Healthcare eligibility Back to Duty

S4: Co-ordinate routine planning and management of referral, discharge or transition of care between professionals, settings or services Back to Duty

S5: Protect health through applying the principles of infection prevention and control Back to Duty

S6: Communicate and provide information in an accessible way that is sensitive and appropriate, using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural challenges recognising common barriers to communication Back to Duty

S7: Utilise report writing skills to formulate clear and evidence based multidisciplinary team recommendations Back to Duty

S8: Develop, manage and maintain appropriate relationships and rapport with people, their families, carers, colleagues and providers Back to Duty

S9: Facilitate discussions with individuals and their families to set an indicative Personal Health Budget Back to Duty

S10: Identify responsible commissioner for individuals referred into the continuing healthcare service Back to Duty

S11: Commission a package of care for an individual eligible for continuing healthcare Back to Duty

S12: Manage and prioritise competing demands, prioritising workload based on level of risk Back to Duty

S13: Process referrals in a timely manner Back to Duty

S14: In a range of settings, recognise where people could be at risk, including from neglect, and take appropriate action to report potiential risk for assessment Back to Duty

S15: Commission safe, effective and person-centred health and social care packages for people who have co-morbidities and complex care needs Back to Duty

S16: Participate in data collection to support service delivery evaluation, audit or assurance activity to identify appropriate quality improvement activities or any gaps within the provider market Back to Duty

S17: Works within limits of own competence, experience and training, delegating tasks and escalating issues and duties appropriately Back to Duty

S18: Act as an advocate for the individual Back to Duty

S19: Use facilitation and co-ordination skills to make best use of the contributions of others across the multidisciplinary team for the purposes of a lawful assessment or review Back to Duty

S20: Apply the principles of effective leadership Back to Duty

S21: Act as a role model to colleagues, supervising and providing feedback about behaviour and actions of others, motivating them to reflect on and develop their practice Back to Duty

S22: Ensure the wellbeing and resilience needs of the team are met and recognise signs of vulnerability in themselves or their colleagues Back to Duty

S23: Act in accordance with legislation, national guidance and local policy at all times Back to Duty

S24: Can proactively engage with the individual or representative to support an amicable and lawful resolution of conflict or disagreement Back to Duty

S25: Identify and collate documents and evidence demonstrating current health and social care need from all professionals involved in the care of the individual, for lawful assessment or review of health and social care need to be undertaken Back to Duty

S26: Use a range of digital technologies to access, input, share and apply information and data within teams and between agencies Back to Duty

S27: Complete, store and retain accurate and contemporaneous records and data Back to Duty

S28: The ability to read, interpret and understand clinical records and notes Back to Duty

Behaviours

B1: Act in a non-discriminatory fashion, treating people with dignity and respecting individual's diversity, beliefs, culture, needs, values, privacy and preferences Back to Duty

B2: Be caring, sensitive and compassionate, nurturing the potential in others Back to Duty

B3: Have the courage to speak up and challenge areas of concern or any discriminatory behaviour, providing honest, accurate and constructive feedback Back to Duty

B4: Be competent, reliable and committed, using reflection to constantly improve and work to evidence based best practice always working within limits of own competence, experience and training Back to Duty

B5: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness and demonstrate leadership Back to Duty

B6: Communicate in ways that are sensitive and appropriate, considering emotional, psychological, cognitive, language, social and other circumstances Back to Duty

B7: Constantly works to build the development of a positive associate CHC practitioner-patient relationship as a core element of the role Back to Duty

B8: Act as an ambassador and promote trust, upholding the reputation and promoting public confidence in the continuing healthcare service Back to Duty

B9: Demonstrates accountability in practice, engaging proactively in continuing development and training Back to Duty


Qualifications

English & Maths

Apprentices without level 2 English and maths will need to achieve this level prior to taking the End-Point Assessment. For those with an education, health and care plan or a legacy statement, the apprenticeship’s English and maths minimum requirement is Entry Level 3. A British Sign Language (BSL) qualification is an alternative to the English qualification for those whose primary language is BSL.


Additional details

Occupational Level:

5

Duration (months):

24

Review

This standard will be reviewed after three years.

Status: Approved for delivery
Level: 5
Reference: ST0786
Version: 1.0
Approved for delivery: 11 July 2019
Route: Health and science
Typical duration to gateway: 24 months (this does not include EPA period)
Maximum funding: £10000
Trailblazer contact(s): jonathanwebster@nhs.net
Employers involved in creating the standard: NHS, Islington Clinical Commissioning Group (CCG), Surrey CCG, Midlands & Lancashire CCG, Wirral CCG, Northumberland CCG, Ealing CCG, Doncaster CCG, St Helens CCG, Barnet CCG, Skills for Health
LARS Code: 483

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