Diabetes NurseNHS

Job summary

Role Purpose

• The Primary Care Diabetes Specialist Nurse provides expert clinical care, education, and support to patients with diabetes within primary care settings. The role focuses on improving glycaemic control, preventing diabetes-related complications, and empowering patients to self-manage their condition.
• The role contributes to reducing health inequalities by supporting earlier diagnosis, optimising long term management, and improving outcomes for underserved or high-risk populations.
• The nurse supports GP practices by providing specialist diabetes expertise, reviewing complex cases, optimising treatment plans, and helping practices meet national diabetes care standards.

Main duties of the job

• Provide specialist assessment, management and support for patients with Type 1, Type 2, gestational and other forms of diabetes, including LADA, MODY and secondary diabetes. Undertake comprehensive reviews covering glycaemic control, cardiovascular risk, medication optimisation and lifestyle. Initiate and titrate diabetes medication, including insulin where appropriately trained, and support use of CGM/flash monitoring.
• Identify and manage acute issues including hypoglycaemia, hyperglycaemia and DKA risk, providing safety-netting and sick-day advice. Monitor and manage risk of long-term complications including cardiovascular, renal, neurological and retinal disease.
• Provide personalised education on self-management, nutrition, weight management, physical activity, glucose monitoring and medication adherence.
• Provide specialist advice, education and training to GPs, practice nurses and primary care teams, supporting complex diabetes management, insulin initiation/titration and care planning.
• Identify and proactively manage high-risk patients and contribute to personalised care plans, audit, quality improvement and service development.
• Work collaboratively with primary and secondary care MDTs and facilitate appropriate referrals. Maintain competencies through CPD, reflective practice and training.

Job description

Role Accountabilities

Specialist Clinical Care

• Provide specialist assessment and management for patients with:
• Type 1 Diabetes primarily managed within OCDEM; however, some individuals will attend primary care for ongoing support, reviews, or shared care management.
• Type 2 Diabetes.
• Gestational Diabetes postpartum follow up within primary care.
• Other forms of diabetes, including:
• Latent Autoimmune Diabetes in Adults (LADA).
• Maturity Onset Diabetes of the Young (MODY).
• Steroid induced hyperglycaemia and diabetes.
• Secondary diabetes (e.g., pancreatic disease, endocrine disorders).
• Drug induced diabetes (e.g., antipsychotics, immunosuppressants).
• Support patients using diabetes technologies such as continuous glucose monitoring (CGM) and flash glucose monitoring.
• Provide safety netting advice including sick day rules and escalation pathways.
• Review and rationalise medication regimens, including deprescribing where clinically appropriate.
• Conduct comprehensive diabetes reviews, including:
• Glycaemic control.
• Cardiovascular risk assessment.
• Medication optimisation.
• Lifestyle review.
• Interpret and monitor glycaemic markers such as HbA1c.
• Initiate and titrate diabetes medications, including insulin where appropriately trained.
• Identify and manage acute diabetes issues such as:
• Hypoglycaemia.
• Hyperglycaemia.
• Early identification of Diabetic Ketoacidosis risk.

Chronic Disease Management

• Provide structured diabetes care aligned with national diabetes guidelines.
• Support achievement of key diabetes care processes within GP practices.
• Monitor patients for long-term complications including:
• Cardiovascular disease.
• Kidney disease.
• Neuropathy.
• Retinopathy.

Patient Education and Self-Management

• Deliver personalised diabetes education to individuals and families.
• Promote lifestyle interventions including:
• Diet modification.
• Weight management.
• Physical activity.
• Support behaviour changes to improve long-term outcomes.
• Educate patients on blood glucose monitoring and medication adherence.
• Digital literacy support.

Practice and Primary Care Support

• Provide specialist advice to GPs and practice nurses on diabetes management.
• Support primary care teams with:
• Insulin initiation and titration.
• Complex medication regimes.
• Difficult-to-control diabetes.
• Contribute to development of diabetes care pathways within the practice.

Population Health and Case Management

• Identify high-risk patients through practice diabetes registers.
• Prioritise patients with poor glycaemic control or complications.
• Support proactive care planning and personalised care plans.

Multidisciplinary Working

• Work collaboratively with:
• Endocrinology specialists.
• General practitioners.
• Practice nurses.
• Dietitians.
• Podiatrists.
• Pharmacists.
• Community healthcare teams.
• Facilitate referrals to secondary care when appropriate.

Quality Improvement and Service Development

• Participate in clinical audits and quality improvement initiatives.
• Support practices in meeting diabetes quality indicators.
• Contribute to development of integrated diabetes services across primary and secondary care.

Education and Training

• Provide training and mentorship to practice nurses and healthcare assistants.
• Deliver diabetes education sessions within the primary care team.
• Promote best practice in diabetes management.
• Maintains and updates competencies through CPD, reflective practice and training.

Position Purpose

• The Diabetes Specialist Nurse (DSN) provides expert clinical care, education, and support for patients with diabetes. The role focuses on improving diabetes management, preventing complications, and promoting patient self-management through specialist assessment, treatment planning, and multidisciplinary collaboration.
• The DSN acts as a key resource for patients, families, and healthcare professionals regarding diabetes management and current best practice.

Additional Accountabilities

• Assess, plan, implement, and evaluate care for patients with Type 1, Type 2, and gestational diabetes.
• Provide specialist advice on:
• Insulin therapy.
• Oral and injectable diabetes medications.
• Continuous glucose monitoring (CGM).
• Monitor and manage complex diabetes cases including:
• Poor glycaemic control.
• Recurrent hypoglycaemia.
• Diabetic ketoacidosis (DKA).
• Support inpatient diabetes management and provide consultation to ward staff.
• Deliver structured diabetes education programs.
• Teach patients:
• Blood glucose monitoring.
• Insulin administration.
• Diet and lifestyle management.
• Hypoglycaemia recognition and treatment.
• Support behaviour changes to improve long-term diabetes control.
• Work collaboratively with the multidisciplinary team including:
• Endocrinologists.
• Dietitians.
• Podiatrists.
• Pharmacists.
• Primary care MDT.
• Contribute to clinical audits and service evaluations.
• Implement evidence-based diabetes guidelines and protocols.
• Participate in development of diabetes care pathways and policies.
• Provide training and guidance to healthcare professionals on diabetes care.
• Mentor junior nursing staff and students.
• Promote best practice in diabetes management across healthcare settings.
• Maintain awareness of advances in diabetes treatments and technology.

About us

Banbury Cross Health Centre is owned and operated by Principal Medical Limited (PML), which works in partnership with the NHS to deliver primary care services in GP practices and community settings.

Founded in 2004 as a not-for-profit organisation by local GPs, PML was established to enable healthcare professionals to develop and deliver innovative services at scale. Today, 70% of GP practices in Oxfordshire and 22% in Northamptonshire are associated with the Federation.

PML is the largest GP Federation in Oxfordshire and South Northamptonshire, serving nearly 800,000 patients. We believe local providers are best placed to deliver high-quality, cost-effective care that meets community needs.

With over 20 years of experience, PML has a strong track record of delivering NHS, ICB and Public Health services. Our work is guided by five core values: being Compassionate, Competent, Courteous, Collaborative and Committed. We welcome applicants from diverse backgrounds and those with protected characteristics under the Equality Act 2010.