Frailty Nurse
| Dyddiad hysbysebu: | 23 Medi 2025 |
|---|---|
| Cyflog: | Heb ei nodi |
| Gwybodaeth ychwanegol am y cyflog: | Negotiable |
| Oriau: | Llawn Amser |
| Dyddiad cau: | 07 Hydref 2025 |
| Lleoliad: | St. Helens, WA9 5PR |
| Cwmni: | NHS Jobs |
| Math o swydd: | Parhaol |
| Cyfeirnod swydd: | A2201-25-0012 |
Crynodeb
Job title Frailty Nurse Line Manager Frailty Matron Accountable to PCN Board Directors / PCN Clinical Lead Location or work Bowery Hub / Field Based Hours per week Full-time / Part-time considered (37.5 hours FTE) Organisational Overview Primary Care Networks (PCNs) are a key part of the NHS Long Term Plan, with General Practices grouping together to form a network of Practices, 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 as well as supports the wider Primary Care system and tenders for, designs and develops new/ existing services for the benefit of the St Helens South population. The PCN is comprised of 10 Practices in the St Helens South areas. The practices have a combined geographic area made up of around 85,000 patients. This role will contribute to the improving quality of care of our patients across the PCN and its network of practices. Job Summary The post holder will play a vital role in delivering high-quality, person-centred care to adults living with frailty within the Primary Care Network (PCN). Working as an autonomous practitioner and integral member of the multidisciplinary team, the Frailty Nurse will assess, plan, deliver and evaluate holistic care for patients identified as living with moderate to severe frailty. The role involves advanced clinical assessment, care planning, medication review support, health promotion, and the coordination of proactive and reactive care to prevent avoidable hospital admissions and promote independence. PCN Values and Employee Statement Behave consistently with the values and beliefs of the PCN and promote these on a day-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 a high-quality experience for both colleagues and patients. Primary responsibilities Clinical Practice: Contribute to the delivery of care provision to our frail and elderly populations including proactive Person-Centred Care Planning and collaborative working to deliver the Enhanced Health in Care Homes DES as a senior member of the Frailty team. Early identification and recognition of deterioration to include proactive care and escalation planning. Full comprehensive geriatric assessment for residents that have moderate to severe frailty to support the coordination of care with community and urgent care 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 correct proportionate response to a patient need To support proactive, anticipatory and advance care planning using an agreed set of validated, evidence-based assessment tools to help identify the degree of need, e.g. Respect and EPaCCS Ordering, performing and interpreting relevant clinical test and investigations Providing expert frailty advice and guidance and education where necessary to medical, nursing, clinical care coordinators and other MDT colleagues. Assess and manage acute, chronic and acute on chronic conditions in relation to frailty to uphold patient safety and prevent admission where possible. Provide weekly care home support and management in conjunction with homes and community service Support necessary vaccination campaigns within care homes Provide high quality mental health and dementia care, offering support and guidance to homes, working in collaboration with community services Undertake high standards of clinical record keeping including electronic data entry and recording of patient record Deliver nursing interventions such as wound care, catheter care, and falls risk assessments. Coordination and Partnership Working: Liaise with GPs, social workers, occupational / therapists, care coordinators, social prescribers and voluntary sector partners. Working with other practitioners and agencies within the Primary Care Network and local system as necessary to develop patient specific treatment plans and ensure Care Pathways are utilised. Lead or contribute to MDT meetings, virtual wards, and care home ward rounds. Develop relationships with care homes and domiciliary care providers to support consistent care. Act as a key point of contact for patients, carers, and families to promote continuity of care. Education, Support & Development: Support training and development of junior nurses, Clinical Care Coordinators and student nurses (where applicable) Educate patients and carers in self-management and preventative strategies. Identify and support educational opportunities to work with care homes, for example completion of Respect Documents, hydration and nutritional support and good oral health care Monitor and lead improvements to standards of care through, supervision of practice, clinical audit, evidence-based practice, teaching and supporting professional colleagues and the provision of skilled professional leadership. Participate in audits, QI projects and service development initiatives. Leadership and 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 incident reporting. Work within agreed local policies, PCN protocols and national frameworks (e.g., NHS Long Term Plan, EHCH DES). Person Specification Care coordinator 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)