Frailty Nurse

NHS; St Helens; On-site; GBP 30,000 - 45,000; Full time

Job summary

A national health service provider is seeking an experienced Frailty Nurse to offer person-centred care to adults living with frailty. You will work within a multidisciplinary team to conduct assessments and provide ongoing care, preventing hospital admissions and promoting independence. Strong nursing qualifications and experience in frailty care are essential for this critical role.

Qualifications

• Minimum 5 years post-registration experience.
• Post registration education/experience in frailty, care of the elderly, and dementia.
• Registered Nurse (Adult) essential.

Responsibilities

• Conduct comprehensive geriatric assessments.
• Provide expert clinical advice on frailty and end-of-life care.
• Support care home residents with weekly care.

Skills

Compassion

Clinical assessment

Communication

Team collaboration

Leadership

Education

MSc in Advanced Clinical Practice

Professional registration with NMC

Independent prescribing (V300)

Clinical exam and diagnostics Level 7

Job description

We are looking for an experienced and compassionate Frailty Nurse to join our dedicated team. You will play a key role in supporting adults living with frailty, working across care homes, practices, and the community.

This is an exciting opportunity to work autonomously within a multidisciplinary team to improve outcomes, prevent avoidable hospital admissions, and promote independence for our patients.

Main duties of the job

Key Responsibilities:

• Provide comprehensive geriatric assessments and personalised care planning.
• Support care home residents with proactive and reactive care, including weekly visits.
• Recognise and manage deterioration, coordinating escalation and advance care planning.
• Deliver expert clinical advice on frailty, dementia, long-term conditions, and end-of-life care.
• Undertake clinical interventions (e.g., wound care, catheter care, falls risk assessments).
• Work closely with GPs, community teams, social care, and voluntary sector partners.
• Contribute to service improvement, audits, and training of junior staff and students.

About us

About Us:

St Helens South Primary Care Network (PCN) is a collaboration of 10 GP practices serving around 85,000 patients. We are committed to delivering high-quality, person-centred care and developing innovative services to support our local community.

Job responsibilities

Jobtitle

FrailtyNurse

LineManager

FrailtyMatron

Accountableto

PCNBoard Directors / PCN Clinical Lead

BoweryHub / Field Based

Full-time/ Part-time considered (37.5 hours FTE)

OrganisationalOverview

Primary Care Networks (PCNs) are a key part of the NHS Long TermPlan, with General Practices grouping together to form a network ofPractices, supported by a number of additional clinical roles.

The St Helens South Primary Care Network Limited Company (PCN)is the organisation that delivers the core components of the PCN Contract aswell as supports the wider Primary Care system and tenders for, designs anddevelops new/ existing services for the benefit of the St Helens Southpopulation.

The PCN is comprised of 10 Practices in the St Helens Southareas. The practices have a combined geographic area made up of around 85,000patients.

This role will contribute to the improving quality of care ofour patients across the PCN and its network of practices.

JobSummary

The post holder will play a vital role in deliveringhigh-quality, person-centred care to adults living with frailty within thePrimary Care Network (PCN). Working as an autonomous practitioner andintegral member of the multidisciplinary team, the Frailty Nurse will assess,plan, deliver and evaluate holistic care for patients identified as livingwith moderate to severe frailty.

The role involves advanced clinical assessment, care planning,medication review support, health promotion, and the coordination ofproactive and reactive care to prevent avoidable hospital admissions andpromote independence.

PCNValues and Employee Statement

Behaveconsistently with the values and beliefs of the PCN and promote these on aday-to-day basis. By actively living out the PCN CARE Values in everyday work,helping to create a positive and supportive culture while contributing to ahigh-quality experience for both colleagues and patients.

Primaryresponsibilities

ClinicalPractice:

• Contribute to the delivery of careprovision to our frail and elderly populations including proactivePerson-Centred Care Planning and collaborative working to deliver theEnhanced Health in Care Homes DES as a senior member of the Frailty team.
• Early identification and recognitionof deterioration to include proactive care and escalation planning.
• Full comprehensive geriatricassessment for residents that have moderate to severe frailty to support thecoordination of care with community and urgentcare services.
• Recognising common medications relating to frailty.within caseload for acute and chronic conditions.
• Understand the degree of frailty,mild moderate or severe and the 5 frailty syndromes enabling the correctproportionate response to a patient need
• To support proactive, anticipatoryand advance care planning using an agreed set of validated, evidence-basedassessment tools to help identify the degree of need, e.g. Respect and EPaCCS
• Ordering, performing and interpretingrelevant clinical test and investigations
• Providing expert frailty advice andguidance and education where necessary to medical, nursing, clinical carecoordinators and other MDT colleagues.
• Assess and manage acute, chronic andacute on chronic conditions in relation to frailty to uphold patient safetyand prevent admission where possible.
• Provide weekly care home support and management in conjunction withhomes and community service
• Support necessary vaccination campaigns within care homes
• Provide high quality mental health and dementia care, offering supportand guidance to homes, working in collaboration with community services
• Undertake high standards of clinical record keeping includingelectronic data entry and recording of patient record
• Deliver nursing interventions such as wound care, catheter care, andfalls risk assessments.

Coordinationand Partnership Working:

• Liaise with GPs, social workers, occupational / therapists, carecoordinators, social prescribers and voluntary sector partners.
• Working with other practitioners and agencies within the Primary CareNetwork and local system as necessary to develop patient specific treatmentplans and ensure Care Pathways are utilised.
• Lead or contribute to MDT meetings, virtual wards, and care home wardrounds.
• Develop relationships with care homes and domiciliary care providersto support consistent care.
• Act as a key point of contact for patients, carers, and families topromote continuity of care.

Education,Support & Development:

• Support training and development of junior nurses, Clinical Care Coordinatorsand student nurses (where applicable)
• Educate patients and carers in self-management and preventativestrategies.
• Identify and support educational opportunities to work with carehomes, for example completion of Respect Documents, hydration and nutritionalsupport and good oral health care
• Monitor and lead improvements tostandards of care through, supervision of practice, clinical audit,evidence-based practice, teaching and supporting professional colleagues andthe provision of skilled professional leadership.
• Participate in audits, QI projects and service developmentinitiatives.

Leadershipand Governance:

• Adhere to NMC Code of Conduct and professional standards at all times.
• Maintain accurate clinical documentation and use clinical systems(e.g., EMIS/GP Connect).
• Contribute to safeguarding reviews, risk assessments and incidentreporting.
• Work within agreed local policies, PCN protocols and nationalframeworks (e.g., NHS Long Term Plan, EHCH DES).

Qualifications

• MSc in Advanced Clinical Practice orequivalent (Desirable)
• Professionalregistration with NMC (Essential)
• Independentprescribing (V300) (Desirable)
• Clinicalexam and diagnostics (or equivalent) Level 7 (Essential)
• Post registration education/experience infrailty, care of the elderly, palliative care, dementia, long term conditions (Essential)
• Minimum5 years post-registration experience (Essential)

Person Specification

Qualifications

• Qualifications
• Registered Nurse (Adult) (essential)
• MSc in Advanced Clinical Practice or equivalent (desirable)
• Professional registration with NMC (essential)
• Independent prescribing (V300) (desirable)
• Clinical exam and diagnostics (or equivalent) Level 7(essential)
• Post registration education/experience in frailty, care of the elderly, palliative care, dementia, long term conditions(essential)
• Minimum 5 years post-registration experience(essential)

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.