Frailty Nurse: MDT Assessments, Home Visits & Plans

The Methodist Church in Britain; Totton; Presencial; GBP 30.000 - 42.000; Jornada completa

Descripción de la vacante

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.

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

NMC registration

Frailty assessment

Primary care experience

Care planning

Home visits

Travel between sites

Educación

Nursing degree

Non-medical prescribing (optional)

Herramientas

EHR systems

Descripción del empleo

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.