Job summary
We are looking for a motivated and experienced Advanced Nurse Practitioner (ANP) to lead our innovative Frailty Team. This is an exciting opportunity to shape and deliver proactive, high-quality care for individuals with mild to moderate frailty across our Primary Care Network (PCN). The role combines clinical leadership, autonomous practice, care coordination, and multi-agency collaboration. Youll be at the forefront of delivering patient-centred, preventative care within community settings and will play a vital role in driving service improvement.
Main duties of the job
- Lead the PCN Frailty Team and champion evidence-based interventions.
- Conduct comprehensive geriatric assessments using appropriate tools.
- Develop and deliver individualised care plans based on clinical need and patient goals.
- Provide independent prescribing for frailty-related conditions within scope of practice.
- Monitor medication use and adjust treatment plans as required.
- Work closely with GPs, Occupational Therapists, Care Coordinators, Social Prescribers, and community nursing teams.
- Attend and lead MDT meetings and case reviews.
- Support patients and families in understanding and managing frailty.
- Promote lifestyle and self-management strategies to optimise health and independence.
- Identify patients in need of palliative support and facilitate advance care planning discussions.
About us
About us
Trent Care Network (TCN)
consists of 5 GP surgeries in Saxilby, Gainsborough and Hibaldstow. We cover a population size of 40,198 patients
with a range of diversity.
We pride ourselves on being an
active PCN within our local system working with local system partners including
NHS trusts, local council and voluntary sector.
We can offer you a generous NHS
Pension, up to 33 days holiday (dependant on NHS service) and training
opportunities as well as the opportunity to influence and develop this new role
and team.
By working together our ambition
is to strengthen and stabilise general practice.
Our aim is to continue to
provide high quality healthcare to our patients in the community, whilst taking
up opportunities to improve and extend our services.
PLEASE NOTE: We
reserve the right to close this vacancy early should we receive a sufficient
number of applications
Job description
Job responsibilities
Key Responsibilities
- Lead the PCN Frailty Team and champion evidence-based interventions.
- Conduct comprehensive geriatric assessments using appropriate tools.
- Develop and deliver individualised care plans based on clinical need and patient goals.
- Provide independent prescribing for frailty-related conditions within scope of practice.
- Monitor medication use and adjust treatment plans as required.
- Work closely with GPs, Occupational Therapists, Care Coordinators, Social Prescribers, and community nursing teams.
- Attend and lead MDT meetings and case reviews.
- Support patients and families in understanding and managing frailty.
- Promote lifestyle and self-management strategies to optimise health and independence.
- Identify patients in need of palliative support and facilitate advance care planning discussions.
Operational & Governance Responsibilities
- Ensure compliance with local and national frailty care guidelines.
- Maintain high-quality documentation and accurate coding of frailty status.
- Contribute to the development and implementation of frailty pathways within the PCN.
- Actively participate in audit and quality improvement initiatives.
- Track and report KPIs including patient outcomes, frailty identification and coding accuracy, and intervention effectiveness.
- Provide monthly reports and lead regular team meetings.
Professional Development
Engage in ongoing CPD activities related to frailty and older adult care. Act as a clinical mentor within the frailty team and wider PCN.
Job description
Job responsibilities
Key Responsibilities
- Lead the PCN Frailty Team and champion evidence-based interventions.
- Conduct comprehensive geriatric assessments using appropriate tools.
- Develop and deliver individualised care plans based on clinical need and patient goals.
- Provide independent prescribing for frailty-related conditions within scope of practice.
- Monitor medication use and adjust treatment plans as required.
- Work closely with GPs, Occupational Therapists, Care Coordinators, Social Prescribers, and community nursing teams.
- Attend and lead MDT meetings and case reviews.
- Support patients and families in understanding and managing frailty.
- Promote lifestyle and self-management strategies to optimise health and independence.
- Identify patients in need of palliative support and facilitate advance care planning discussions.
Operational & Governance Responsibilities
- Ensure compliance with local and national frailty care guidelines.
- Maintain high-quality documentation and accurate coding of frailty status.
- Contribute to the development and implementation of frailty pathways within the PCN.
- Actively participate in audit and quality improvement initiatives.
- Track and report KPIs including patient outcomes, frailty identification and coding accuracy, and intervention effectiveness.
- Provide monthly reports and lead regular team meetings.
Professional Development
Engage in ongoing CPD activities related to frailty and older adult care. Act as a clinical mentor within the frailty team and wider PCN.
Person Specification
Qualifications
Essential
- Registered Nurse with current NMC registration.
- MSc Advanced Clinical Practice or equivalent.
- Independent Prescriber.
Experience
Essential
- Proven experience working with older adults or in frailty services.
- Ability to work autonomously and collaboratively.
- Strong leadership and communication skills.
Desirable
- Experience in service development and quality improvement.
- Familiarity with frailty assessment tools (e.g., Rockwood, eFI).
- Knowledge of community and social care pathways.
Person Specification
Qualifications
Essential
- Registered Nurse with current NMC registration.
- MSc Advanced Clinical Practice or equivalent.
- Independent Prescriber.
Experience
Essential
- Proven experience working with older adults or in frailty services.
- Ability to work autonomously and collaboratively.
- Strong leadership and communication skills.
Desirable
- Experience in service development and quality improvement.
- Familiarity with frailty assessment tools (e.g., Rockwood, eFI).
- Knowledge of community and social care pathways.
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.
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
Additional information
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.
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
