Advanced Frailty Practitioner - ANP/ParamedicNHS

Job summary

Harrow East Primary Care Network (PCN) is seeking an enthusiastic, experienced and highly motivated Advanced Frailty Practitioner (Advanced Nurse Practitioner or Advanced Paramedic Practitioner) to join our established multidisciplinary team.

This is an exciting opportunity for an autonomous clinician with a passion for frailty care, proactive case management and improving outcomes for older and vulnerable patients.

The successful candidate will play a key role in delivering our frailty service across three GP practices, providing comprehensive clinical assessments, personalised care planning and timely interventions to support patients in remaining safe, independent and well within their own homes and communities.

We are looking for a confident, compassionate practitioner who enjoys collaborative working, can manage complex clinical presentations and is committed to delivering high-quality, patient-centred care while helping reduce avoidable hospital admissions.

Main duties of the job

The postholder will work autonomously within their professional scope of practice, providing advanced clinical assessment, diagnosis, treatment and ongoing management for patients with frailty, multiple long-term conditions and complex health and social care needs.

Key responsibilities include undertaking comprehensive frailty assessments, conducting home visits, developing personalised care plans and proactively case managing patients at risk of deterioration or hospital admission.

The role will involve independent prescribing, where clinically appropriate, and working closely with GPs, community services, hospitals, social care professionals and the wider multidisciplinary team to ensure coordinated, effective and responsive patient care.

The successful candidate will also support the assessment and management of minor illnesses and long-term conditions, contribute to multidisciplinary team discussions and support the ongoing development and improvement of our frailty service.

Job description

Advanced Frailty Practitioner Advanced Nurse Practitioner / Advanced Paramedic PractitionerOrganisation: Harrow East Primary Care Network (PCN)

Location: Stanmore, Harrow, London

Working pattern: Full-time

Salary: Competitive, dependent on qualifications and experience (£50,000)

Accountable to: PCN Clinical Director

Job purposeThe Advanced Frailty Practitioner will provide high-quality, autonomous clinical care to patients living with frailty, multiple long-term conditions and complex healthcare needs across Harrow East PCN.

The postholder will play a central role in identifying, assessing and proactively managing vulnerable patients, supporting early intervention, preventing avoidable deterioration and reducing unnecessary hospital admissions.

Working collaboratively with GPs, community healthcare professionals, acute services and social care teams, the postholder will contribute to the delivery and ongoing development of an effective, integrated frailty service.

The role requires advanced clinical assessment, diagnostic reasoning, independent prescribing and care coordination skills, alongside a commitment to maintaining the highest standards of patient safety and clinical governance.

Key responsibilities1. Advanced clinical assessment and management

• Undertake comprehensive clinical assessments of patients presenting with complex health needs, frailty and multiple long-term conditions.
• Exercise advanced clinical reasoning and decision-making to assess, diagnose, treat and manage patients independently within professional competence.
• Develop, implement and regularly review evidence-based management and treatment plans.
• Prescribe medications safely and appropriately in accordance with independent prescribing qualifications, professional standards and local prescribing guidance.
• Recognise clinical deterioration, red flags and safeguarding concerns, escalating appropriately.
• Assess and manage minor illnesses and acute presentations where appropriate to the postholder's clinical competence.

2. Frailty and proactive case management

• Proactively identify and manage patients living with moderate and severe frailty.
• Undertake comprehensive frailty assessments, incorporating physical, psychological, functional and social care needs.
• Develop personalised care and support plans, including anticipatory and escalation planning where appropriate.
• Support patients to maintain independence and remain safely within their homes and communities.
• Identify patients at increased risk of deterioration, falls, hospital admission or readmission and coordinate timely interventions.
• Support medication reviews, falls prevention, rehabilitation planning and appropriate referrals to community services.
• Contribute to the identification and management of patients approaching the end of life, working collaboratively with GPs and specialist palliative care teams.
• Ensure patients and their families or carers are actively involved in decisions about their care.

3. Home visits and community-based care

• Undertake planned and clinically indicated home visits for housebound, frail and vulnerable patients.
• Assess patients within their home environments, identifying clinical, functional and social factors affecting their health and wellbeing.
• Initiate appropriate treatment, investigations, referrals and follow-up arrangements.
• Work closely with district nursing teams, community matrons, therapists, social care professionals and other community services.
• Recognise when urgent escalation or hospital assessment is required.

4. Multidisciplinary working and care coordination

• Work collaboratively with GPs, Advanced Practitioners, Clinical Pharmacists, care coordinators and wider PCN teams.
• Participate in multidisciplinary team meetings and frailty case discussions.
• Coordinate care across primary, community, secondary and social care services.
• Support effective communication and information sharing between professionals involved in patient care.
• Facilitate timely referrals and follow-up to promote continuity of care and reduce duplication.
• Contribute to effective discharge planning and post-discharge reviews to reduce the risk of hospital readmission.

5. Clinical governance and patient safety

• Maintain accurate, timely and comprehensive clinical records using the practice's electronic clinical systems.
• Work in accordance with relevant professional codes, clinical guidelines, local policies and evidence-based practice.
• Maintain patient confidentiality and comply with information governance requirements.
• Participate in clinical audits, quality improvement initiatives, significant event reviews and service evaluations.
• Identify and appropriately escalate clinical risks, safeguarding concerns and incidents.
• Maintain professional registration, prescribing competency and continuing professional development.

6. Service development and improvement

• Contribute to the ongoing development of the PCN frailty service, supporting proactive, coordinated and person-centred models of care.
• Identify opportunities to improve patient pathways, clinical processes and multidisciplinary working.
• Support the development of effective systems for identifying, reviewing and monitoring patients living with frailty.
• Contribute to the achievement of relevant PCN and NHS service objectives.
• Promote effective use of healthcare resources while maintaining high standards of clinical care.
• Participate in relevant training, professional development and service improvement activities.

Professional responsibilitiesThe postholder will be expected to exercise sound professional judgement, demonstrate accountability for their clinical practice and work effectively both independently and as part of a multidisciplinary team.

They must maintain professional registration with the Nursing and Midwifery Council (NMC) or Health and Care Professions Council (HCPC), as appropriate, and practise within their demonstrated competencies and professional scope of practice.

The above duties are not exhaustive and may be reviewed in accordance with the evolving requirements of the service, following appropriate discussion with the postholder.

About us

Harrow East Primary Care Network is a collaborative network of three GP practices dedicated to delivering accessible, innovative and high-quality healthcare to our local population.

We are a forward-thinking, patient-centred organisation with an established multidisciplinary workforce, bringing together GPs, Advanced Practitioners, Clinical Pharmacists, Practice Nurses, Healthcare Assistants and wider healthcare professionals.

Our PCN has a strong focus on proactive care, frailty management, long-term conditions and integrated working with community and secondary care services.

We offer a supportive and collaborative working environment, access to established clinical systems including EMIS Web, Docman and AccuRx, and opportunities to contribute to service development and quality improvement.

We value clinical autonomy, professional development and multidisciplinary collaboration, and are committed to supporting our teams in delivering compassionate, coordinated and effective care.