Frailty Nurse

The Methodist Church in Britain; Totton; In loco; GBP 30.000 - 42.000; Tempo pieno

Descrizione del lavoro

Testvale Surgery is recruiting a fixed-term frailty nurse for the Totton Primary Care Network, a multidisciplinary team serving Totton and the outer New Forest. The two-year post centres on frailty assessment and personalised care planning for patients who are moderately or severely frail, with a focus on preventing admissions and linking primary, community and acute services.

Home visits and travel between PCN sites are part of the role.

Competenze

• Current NMC registration as a registered nurse.
• Experience with older adults and/or people living with frailty.
• Experience of clinical assessment and care planning.
• Experience in primary care, community services or a similar healthcare setting.

Mansioni

• Carry out comprehensive frailty assessments covering clinical, functional, psychological and social needs.
• Develop, review and update personalised care and support plans with patients, carers and the wider MDT.
• Provide clinical reviews and ongoing monitoring for patients who are moderately or severely frail.
• Reduce hospital admissions through early intervention, escalation planning and coordination with community and acute teams.
• Contribute to anticipatory care planning, including end-of-life and advance care planning.
• Work closely with GPs, ANPs, care coordinators, social prescribers, pharmacists and community teams.
• Take part in MDT meetings, case discussions and proactive care planning forums.
• Act as the PCN's clinical resource for frailty advice.
• Liaise with secondary care, community services and voluntary sector organisations to keep care pathways joined up.
• Help develop and deliver PCN frailty services in line with DES requirements.
• Support quality improvement work on frailty and proactive care.
• Keep accurate, timely clinical records.

Conoscenze

NMC registration

Frailty assessment

Primary care experience

Care planning

Home visits

Travel between sites

Formazione

Nursing degree

Non-medical prescribing (optional)

Strumenti

EHR systems

Descrizione del lavoro

Testvale Surgery is recruiting a fixed-term frailty nurse for the Totton Primary Care Network, a multidisciplinary team serving Totton and the outer New Forest. The two-year post centres on frailty assessment and personalised care planning for patients who are moderately or severely frail, with a focus on preventing admissions and linking primary, community and acute services. Home visits and travel between PCN sites are part of the role. Current NMC registration and experience with older adults, frailty or primary care are required.

What the job involves

• Carry out comprehensive frailty assessments covering clinical, functional, psychological and social needs
• Develop, review and update personalised care and support plans with patients, carers and the wider MDT
• Provide clinical reviews and ongoing monitoring for patients who are moderately or severely frail
• Reduce hospital admissions through early intervention, escalation planning and coordination with community and acute teams
• Contribute to anticipatory care planning, including end-of-life and advance care planning
• Work closely with GPs, ANPs, care coordinators, social prescribers, pharmacists and community teams
• Take part in MDT meetings, case discussions and proactive care planning forums
• Act as the PCN's clinical resource for frailty advice
• Liaise with secondary care, community services and voluntary sector organisations to keep care pathways joined up
• Help develop and deliver PCN frailty services in line with DES requirements
• Support quality improvement work on frailty and proactive care
• Keep accurate, timely clinical records

What’s required

Registration & licences

• Current NMC registration as a registered nurse

Experience

• Experience with older adults and/or people living with frailty
• Experience of clinical assessment and care planningli>
• Experience in primary care, community services or a similar healthcare setting

Skills & knowledge

• Strong clinical assessment and decision-making skills
• Knowledge of frailty, long-term conditions and proactive care approaches
• Excellent communication and interpersonal skills, working collaboratively in an MDT
• Good IT skills and accurate record keeping
• Patient-centred, compassionate approach to care

Checks & eligibility

• DBS check and occupational health clearance
• Valid driving licence, with own car and business insurance for home visits

Other

• Working autonomously and managing a clinical caseload while prioritising competing demands
• Organised, flexible and adaptable approach to work
• Commitment to equality, diversity and inclusion
• Willingness to travel between PCN sites
• Commitment to ongoing professional development

Nice to have

• Experience of proactive or anticipatory care
• Experience working with care homes or long-term conditions
• Experience of working within a PCN or MDT setting
• Degree-level qualification or equivalent experience
• Non-medical prescribing qualification or willingness to work towards one
• Knowledge of PCN structures and DES requirements
• Understanding of population health and personalised care