A new role working in partnership with the wider healthcare system to ensure visibility of Treatment Escalation Plans across all providers within respective IT systems in order that patients wishes and requirements are known and can be acted on accordingly. This will include but not be limited to South Central Ambulance Service, Southern Health NHS Foundation Trust, Solent NHS Trust, Portsmouth Hospitals University Trust and Primary Care colleagues.

I am delighted to have been accepted to join the Wessex cohort as a member of the rapidly developing and evolving Q community. This is not a taught programme or a formal job role but an opportunity to join a 'network of support' designed to connect people who have improvement expertise across the UK. I am hoping to share good practice and learning, to listen and network with others, to engage in co-production and to collaborate to sustainably improve health and care outcomes.

Working to transform services and to support connectivity between the CCGs, the PCNs and wider communities in order to co-design collaborative local changes that are safe, sustainable, and that aim to improve population health, patient access, outcomes and wellbeing.In this position I set up the East Hants Health and Wellbeing Partnership. This works with many stakeholders including representatives from Health, the Voluntary Sector, Public Health and Local Authorities. I also co-designed a Health and Wellbeing Referral Scheme in partnership with Everyone Active and East Hants PCN, and supported Vaccine inequalities work and ICS Community Engagement

I joined Homewell Practice to work 0.5 WTE as a Specialist Nurse Practitioner undertaking home visits to the frail and housebound, co-ordinating Gold Standards Framework meetings and providing support to residents in Care Homes and Nursing Homes and for the remaining 0.5WTE I was offered the opportunity to work as the Respiratory Transformation Lead on behalf of Strawberry Health PCN to which the Homewell Practice belongs. After only 3 weeks in post the Covid-19 pandemic hit and lockdown commenced. Home visits were strictly limited and I spent much of my time undertaking 'Covid-19 shielding' work on behalf of the Practice. This involved contacting and providing support for the housebound and vulnerable, linking to the voluntary sector where necessary, assessing individual Covid-19 risk status, and advising on and interpreting Government shielding policy and guidance. I also began to provide remote care home support, calling Nursing Homes, Care Homes and homes for residents with Learning Disabilities on a weekly basis to provide proactive care to residents and their families and to support Care Home staff. This work has continued and I have undertaken many remote consultations and joint ward rounds to Homes using video conferencing technology. I have also liaised with patients and families to record end of life and future care wishes and also participate in weekly multidisciplinary meetings with members of the community team and Primary Care Network to co-ordinate care and referrals for those with especially complex needs.

In February 2020 I was very excited to be offered the position of Respiratory Transformation Lead for Strawberry Health Primary Care Network (PCN) (Homewell and Vine Medical Group). This 0.5 WTE role complements my role as Specialist Nurse Practitioner 0.5 WTE for the Homewell Practice. I started this position three weeks before lockdown commenced due to Covid-19. The Vision of Strawberry Health PCN is to work together with community partners to deliver early interventions to improve population health outcomes by supporting delivery of Primary Care in Havant and Waterlooville.In order to support the development of Respiratory Care across the PCN I have written a Respiratory Strategy document to identify work-streams that will standardise and align care and improve outcomes for patients living with Respiratory Disease and other Long Term Conditions though innovation, education and partnership across the PCN. I have undertaken care audits across the Network for example a spirometry quality audit to facilitate early and accurate diagnosis, looked at Best Practice Guidance and Winter Pressures work, and joined the Portsmouth and SE Hants Respiratory Task and Finish Group to advise on local CQUIN development. I have begun to map local resources to support patient education and self-management, have set up a trial of the myCOPD app across the PCN on behalf of SE Hants CCG collating metrics and data to demonstrate change and improvement. I have also led Respiratory meetings across the PCN, undertaken and analysed a patient survey, and presented the PCN's Respiratory Pathway at TARGET. Next steps will be to link with local care providers and community based assets and the wider system to improve care provision locally, to participate in the development of a 'Patient Voice' Group across the PCN and to look at workforce and training needs.

I was fortunate enough to design this frontline community-based role which aimed to improve care and co-ordination for the frail, elderly and housebound practice population at The Eastshore Partnership. I undertook much of the End of Life care for the surgery, writing Future Care Plans and helping to co-ordinate a peaceful and dignified death for patients and their families wherever possible. I regularly visited patients at the end of their life at home, discussing many areas relating to death and dying including resuscitation status, preferred place of care and death, use and provision of anticipatory medication and treatment escalation. I liaised often with District Nurse and Palliative Care teams. I also undertook many 'acute home visits' for patients requesting a home visit because they were too unwell to attend the practice, and examined, diagnosed and planned care and treatment for these patients in partnership with the GPs. I referred patient's for community interventions, for example from PRRT, OT, Physiotherapy, District Nurses and Adult Social Care and organised further investigation and/or hospital admission as required. I also worked in conjunction with the in-house pharmacist to undertake 'Frailty' and 'Poly-pharmacy' reviews for the frail elderly and carried out many post-discharge reviews. I updated and added to the Gold Standards and Virtual Ward registers and assessed and help to co-ordinate care for some of the most vulnerable patients in the practice who required multi-agency support. I undertook dementia screening, assisted with safeguarding concerns - especially in the elderly housebound population and helped to support and signpost families who were in crisis. I participated in audit and CQUIN work for the practice, attended Best Interest Meetings, and liaised regulary with patients and their families. I retained a keen interest in Quality Improvement and always strived to deliver high quality, safe and person-centred patient care.

In April 2015 I was appointed by Portsmouth CCG as a Primary Care Clinical Director, acting on behalf of GP practices within the north of Portsmouth. The main focus of this role is practice cluster development and the implementation of new ways of integrated working that will improve care and outcomes for older people and those with long term conditions. I will also work as part of an integrated locality leadership team, providing clinical leadership that will support the development of integrated solutions to enable care delivery outlined in the Portsmouth Better Care Plan.

Following completion of the Quality Improvement Fellowship and IHM Accredited Manager programme, Portsdown Group Practice offered me the position of Associate Clinical Director - Innovation and Integration. I continued to run research at the practice (which cared for over 33,000 patients), but also became involved in new initiatives. I worked as Co-Clinical Director on a GP pilot which aimed to better integrate services in order to improve care for the frail elderly and worked closely with Solent NHS Trust and Portsmouth CCG. As part of this pilot I led work with the Northern Cluster of GP practices in Portsmouth to enable locality development and sustainability, a role I very much enjoyed. From Oct 2014 I supported Better Care Fund scoping and engagement work in order to integrate health and social care in the north of Portsmouth and across the city. I also participated in a quality improvement programme led by NHSIQ which was attended by members of Fareham, Gosport, SE Hants and Portsmouth CCGs. I am keen to undertake more improvement work in the future. In April 2015, after a successful pilot I was appointed as Clinical Director for the North Cluster (see above) but still give strategic support to research activity at Portsdown Group Practice. Under my leadership the practice has retained 'Sessional' status and now works across six sites to offer research opportunities to 38,000 patients. I was part of a team that submitted a bid for Wave 2 of the Prime Minister's Challenge Fund and was named in Portsmouth's Vanguard application 2015. I hope to continue working with local practices, Portsmouth CCG and Wessex Local Area Team to support the transformation and development of Primary Care in line with Portsmouth CCG's 20/20 Vision, the Joint Strategic Needs Assessment for Portsmouth and The Five Year Forward View. On the 24th April 2015 I was delighted to win the Patient Champion Award at Portsmouth CCG's Anniversary Awards evening.

Ran Unscheduled care pilot from Nov 2010 till Nov 2011, then seconded to Portsmouth shadow CCG to disseminate results across all 27 GP Practices in Portsmouth. Reviewed Nurse section on Primary Care Information Portal and then finished secondment at end of Sep 2012 to begin 1 year Quality Improvement Fellowship with Wessex Deanery (see entry below).Research Lead for Portsdown Group Practice and chosen as Research Nurse Champion for HIOW PCRN in July 2012. Involved in Primary Care Telehealth project and audit.Continued engagement with PCRS Leadership programme, and selected to attend ERS as part of PCRS mentorship scheme in Sep 2011.Led practice to achieve 'Sessional' research status and to become top recruiter for PCRN SW East Hub May 2013 and August 2013.

One of four founding members of the newly formed Portsmouth Primary Care Alliance Ltd.I worked on behalf of member practices to support Primary Care development within Portsmouth.

Fellowship in Quality Improvement, championing Respiratory Networks in South Central SHA, in support of the Primary Care Respiratory Society (PCRS) UK National Programme. Also completed Institute of Healthcare Management Accredited Manager programme.

Lead Respiratory nurse for practice, and Triage nurse in busy duty team. Completed Independent and Supplementary Nurse Prescribing course, Winchester University, 2010

General practice nurse.

Community Nursing covering large geographical area, triaging and responding to calls and referrals.

Community Nursing and on call responsibility on weekend rota.

Caring for housebound and terminally ill patients, and their families, within their own homes.

Respiratory Medical and Surgical Ward.

Bank work on Oncology Wards