PCN Matron/ACP & Clinical Lead for Proactive Care

NHS Jobs; Leeds; On-site; GBP 50,000 - 58,000; Full time

Job summary

NHS Jobs is recruiting for a PCN Matron & Clinical Lead for Proactive Care based across Cross Gates PCN in East Leeds. You will provide senior clinical leadership and oversee proactive care delivery in practice and community settings.

The role emphasizes advanced clinical practice, population health management and leading multidisciplinary teams to improve outcomes for frailty and multimorbidity. A partnership-focused approach is essential.

Qualifications

• Senior clinical leader with extensive experience in proactive care and frailty management.
• Experience in multidisciplinary team working and primary care settings.
• Ability to lead population health management initiatives and outcome monitoring.
• Strong communication and collaborative skills with health and social care partners.

Responsibilities

• Provide expert advanced clinical practice for frailty and high-risk patients.
• Lead the clinical and operational delivery of the PCN Proactive Care Team across practice and community settings.
• Deliver proactive care programmes including cohort identification, holistic assessment and personalised care planning.
• Lead Enhanced Health in Care Homes activity and MDT working.
• Strengthen integration with primary, community, mental health, social care and housing services.

Skills

Advanced clinical practice

Clinical leadership

Team leadership

Population health management

Job description

PCN Matron/ACP & Clinical Lead for Proactive Care

Job Title: PCN Matron & Clinical Lead for Proactive Care Band: Equivalent to NHS Agenda for Change Band 8a Hours: Full Time (37.5 hours per week) Hosted by: Cross Gates Primary Care Ltd Line Manager: PCN Business Manager Professionally Accountable To: PCN Clinical Director Base: Cross Gates PCN practices and community settings across East Leeds, including care homes and patients' homes. Job Summary The PCN Matron & Clinical Lead for Proactive Care will provide senior clinical leadership and operational oversight for the PCN Proactive Care Team while maintaining a substantial advanced clinical practice role. The postholder will lead delivery of the PCN Proactive Care model, Enhanced Health in Care Homes activity, frailty work, proactive case management, personalised care planning and multidisciplinary working. Working closely with the PCN Clinical Director, GP Lead and PCN leadership team, the postholder will help develop a coordinated, preventative and population-based model of care that improves outcomes for people living with frailty, multimorbidity and complex health and social care needs. The role supports proactive care delivery across four care homes and leads the continued development of proactive care services across the wider PCN population through a population health management approach. Main Duties and Responsibilities Provide expert advanced clinical practice for people living with frailty, multimorbidity, complex needs and at high risk of deterioration or avoidable hospital admission. Lead the clinical and operational delivery of the PCN Proactive Care Team across practice and community settings. Deliver and develop proactive care programmes, including cohort identification, holistic assessment, personalised care planning and outcome monitoring. Lead Enhanced Health in Care Homes activity, care home ward rounds and multidisciplinary team working. Strengthen integration and partnership working across primary care, community services, mental health, social care, housing and voluntary sector organisations. Use population health management approaches to identify patients with the greatest unmet need and address health inequalities. Promote prevention, early intervention and proactive care to reduce avoidable deterioration and hospital admissions. Independently assess, diagnose, treat and prescribe for patients with complex, undifferentiated and deteriorating presentations. Lead and support multidisciplinary team meetings, clinical decision-making and neighbourhood health initiatives. Provide clinical supervision, workforce development, quality improvement and service transformation leadership. Working Relationships The postholder will work closely with GPs, Advanced Clinical Practitioners, Nursing Teams, Clinical Pharmacists, Care Coordinators, Community Services, Adult Social Care, Mental Health Services, Housing Services, Linking Leeds, the Local Care Partnership and voluntary sector organisations. About the Service Cross Gates Primary Care Network brings together Colton Mill and The Grange Medical Centre, Keystone GP Partnership and Family Doctors, serving approximately 33,000 patients across six sites in East Leeds. The proactive care model is built around multidisciplinary working, integrated neighbourhood care and strong partnerships across the local health and care system. Professional Responsibilities Maintain professional registration, advanced clinical competence and continuing professional development. Comply with information governance, data protection and confidentiality requirements. Maintain safeguarding knowledge and practice relating to adults and children. Promote equality, diversity, inclusion and culturally competent care. Comply with health and safety, infection prevention and lone working requirements.