Frailty Nurse - Frailty Team

Integrated Care System; St Helens; On-site; GBP 25,000 - 31,000; Full time

Job summary

A leading healthcare provider in St Helens is seeking an experienced Band 5 Registered Nurse to join the Frailty Team. In this role, you will deliver high-quality nursing care to older adults living with frailty across the community. The ideal candidate will have clinical skills in assessment and care planning, experience in community nursing, and a commitment to compassionate patient-centered care.

Benefits

Access to Training Hub for ongoing CPD

Membership of the NHS Pension Scheme

Regular clinical supervision and peer support

Qualifications

• Experience in delivering patient-centered care to frail, elderly patients.
• Knowledge of assessment tools and community nursing interventions.
• Commitment to ongoing professional development.

Responsibilities

• Deliver holistic nursing assessments and care for frail patients.
• Work closely with multidisciplinary teams for coordinated care.
• Support and mentor junior colleagues.

Skills

Effective communication skills

Clinical nursing skills

Knowledge of frailty syndromes

Ability to manage time effectively

Education

Registered Nurse with current NMC registration

Post-registration qualification in frailty or community nursing

Job description

Central PCN is seeking an experienced and motivated Band 5Registered Nurse to join our Frailty Team. This exciting role offers theopportunity to deliver high-quality nursing care to older adults living withfrailty across the community.

As part of a multi-disciplinary team, you will undertake comprehensiveassessment, care planning, and management for frail patients, supporting themto maintain independence and wellbeing. You will also contribute to clinicalgovernance, service development, and support junior staff within the PCN.

A full, clean driving licence and access to your own car fordaily work travel is essential.

Thisrole is 24 hours to be worked across 3 days.

Interviews will take place on Wednesday 1st Octorber 2025

Main duties of the job

You will be a qualified Registered Nurse with experience in frailty, elderly, and community nursing. You will demonstrate excellent clinical skills, strong communication, and a commitment to delivering compassionate, patient-centered care. Experience working within primary care or community settings is highly desirable.

You will:

• Deliver holistic nursing assessments and personalised care for patients with frailty.
• Work closely with multidisciplinary teams to coordinate integrated care.
• Support patients and carers through education and health promotion.
• Maintain accurate documentation and ensure adherence to clinical governance standards.
• Act as a mentor and support for junior and unregistered staff.
• Participate in audit, quality improvement, and service development initiatives.

About us

St Helens Central PCN serves a diverse population of approximately 39,000 patients across eight GP practices. We are a proactive and collaborative team, committed to delivering high-quality healthcare services to the people of St Helens.

Supported by our Clinical Director and dedicated member practices, we pride ourselves on fostering a positive, team-focused environment. Our staff are enthusiastic, innovative, and committed to working together to develop new projects and adopt forward-thinking approaches that address the evolving challenges in Primary Care.

Our PCN is home to a wide range of enhanced services delivered by our multidisciplinary team, including Clinical Pharmacists, First Contact Practitioners, Mental Health Practitioners, Social Prescribers, Health & Wellbeing Coaches and Care Coordinators. We also work closely with community teams and other local healthcare providers, ensuring integrated and person-centred care for our patients.

By joining our network, you will benefit from:

• Regular clinical supervision and peer support
• A supportive and friendly team environment
• Access to a well-established Training Hub for ongoing CPD and development
• Membership of the NHS Pension Scheme

We are passionate about building a resilient, skilled, and compassionate workforce to meet the needs of our community. If you share that vision, wed love to hear from you.

Job responsibilities

The post holder will work across the primary, community, secondary, and social care interface to deliverholistic, patient-centered care for frail and elderly patients within the communityand primary care network setting.

Activelyassess, plan, implement, and evaluate care across the full patient pathwayin partnership with multidisciplinary teams (MDT), patients, and carers.

Utiliseclinical expertise in frailty and community nursing to support patientsindependence and wellbeing.

Workwithin NHS structures and adhere to the Nursing and Midwifery Council code of conduct to maintain professional standards.

Contributeto service development through clinical governance activities, audit, andquality improvement initiatives.

Supportand mentor junior colleagues, student nurses, and healthcare assistants todevelop clinical skills and knowledge relevant to community and frailtycare.

Provideleadership within the team and deputize for senior staff when required.

Musthold a full, clean driving licence and have access to a car for daily useto enable travel across the PCN area.

CORE ROLE & RESPONSIBILITIES

Professional Leadership / Management

Workcollaboratively with MDT to ensure coordinated care for frail, elderlypatients, supporting their health and independence.

Mentorand support junior staff, student nurses, and healthcare assistantsthrough supervision, assessment, and induction processes.

Actas a clinical role model, promoting best practice and professionalism.

Identifyand address challenges affecting patient care delivery, empowering teammembers to make decisions.

Leadcare coordination or team activities in the absence of senior staff.

Ensurepatients and carers views inform care planning and service improvement.

Leadon specific clinical initiatives or projects related to frailty andcommunity care.

Clinical Practice

Maintainand develop clinical competence in frailty assessment tools and relevantcommunity nursing skills.

Provideexpert nursing care to a defined caseload of frail elderly patients,managing complex needs across settings.

Deliverhealth promotion and education tailored to the elderly and their carers,supporting self-management.

Provideclinical advice and support to colleagues across the PCN and community.

Ensureall care is documented accurately in line with local and nationalstandards.

Coordinatenurse-led interventions, including falls prevention, medication reviews,and advance care planning.

Collaboratein developing and delivering integrated care pathways for frailtymanagement.

Promotedignity, respect, and individualised care in all patient interactions.

Clinical Governance

Participateactively in appraisal and personal development planning.

Complywith mandatory training, clinical policies, and NMC standards.

Engagein audit, research, and quality improvement activities related to frailtyand community nursing.

Reportincidents and participate in investigations as required, supporting riskmanagement and patient safety.

Assistin delivering competency-based training programs for the team.

Contributeto service evaluation and development to enhance care for frail elderlypatients.

Nurse Responsibilities

Maintainactive registration with the NMC and adhere to professional standards.

Keepclinical skills and knowledge updated, maintaining a professionalportfolio.

Complywith Trust and PCN policies, including confidentiality and informationgovernance.

Person Specification

Skills & Knowledge

• Knowledge of frailty syndromes, assessment tools, and management approaches in community settings.
• Clinical nursing skills in assessment, care planning, and delivery for elderly patients with complex needs.
• Understanding of multidisciplinary team working and integrated care pathways.
• Effective communication skills, including the ability to engage patients, carers, and colleagues with empathy and clarity.
• Ability to prioritise and manage time effectively in a complex and changing workload.
• Knowledge of professional nursing standards, including NMC Code of Conduct, and clinical governance frameworks.
• Awareness of mental health conditions common in the elderly (e.g., dementia, depression) and relevant nursing approaches.
• IT Skills
• Evidence of recognised knowledge / skills in service improvement.

Experience

• Proven experience delivering holistic, patient-centered care to frail, elderly patients in community or primary care settings.
• Experience in clinical assessment, care planning, implementation, and evaluation in partnership with multidisciplinary teams.
• Demonstrable use of frailty assessment tools and community nursing interventions.
• Ability to manage a defined caseload of complex patients independently and deputise for senior staff.
• Experience working collaboratively within multidisciplinary teams and external agencies.
• Strong communication and interpersonal skills for patient, carer, and team engagement.
• Commitment to equality, diversity, and inclusion in healthcare delivery.
• Previous experience specifically within frailty or elderly care teams.
• Experience working within Primary Care Networks or on the community.
• Familiarity with clinical systems.

Qualifications

• Registered Nurse with current, active registration with the Nursing and Midwifery Council.
• Evidence of ongoing professional development relevant to community nursing and frailty care.
• Full, clean driving licence with access to a car for daily use.
• Post-registration qualification or training in frailty, community nursing, or related specialties.
• Qualification or training in specific clinical areas such as falls prevention, medication review, or advance care planning.

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.