Advanced Nurse Practitioner (Frailty and Proactive Care)NHS
Job summary
The Advanced Nurse Practitioner (ANP) for Frailty and Proactive Care will provide expert clinical leadership and advanced practice to provide more joined-up care for high-priority cohorts through integrated neighbourhood teams (INTs), with a focus on delivering proactive support for people with frailty and long-term conditions.
Main duties of the job
The post holder will work across Bradford City PCN4 practices and within community settings to identify, assess and manage patients with moderate to severe frailty, helping them remain independent and avoid unnecessary hospital admissions.
The role will focus on proactive care, comprehensive geriatric assessment, anticipatory care planning, multidisciplinary team working and patients with declining health.
The post holder will work autonomously within their scope of practice, undertaking advanced clinical assessments, diagnosis, treatment and prescribing where appropriate.
Job description
Clinical Practice
Undertake advanced clinical assessment of patients with frailty, complex needs and multiple long-term conditions
Provide holistic assessment including physical, psychological, functional and social needs
Undertake Comprehensive Geriatric Assessments (CGA)
Diagnose and manage acute and chronic conditions within professional competence
Independently prescribe medication where qualified and appropriate
Develop personalised care and support plans
Complete anticipatory care planning and advance care planning discussions
Undertake home visits for housebound and vulnerable patients
Support care home residents through regular clinical reviews
Identify patients at risk of deterioration, admission or crisis and implement preventative interventions
Participate in multidisciplinary case management meetings
Frailty and Proactive Care
Lead the identification of patients living with moderate and severe frailty using risk stratification tools and clinical judgement
Support delivery of PCN proactive care and personalised care programmes
Develop pathways for frailty management and prevention
Support falls prevention initiatives and medication reviews
Coordinate care for patients with complex needs and frequent hospital admissions
Work collaboratively with community services to reduce avoidable admissions and improve patient outcomes
Promote healthy ageing and independence
Leadership and Service Development
Provide clinical leadership for integrated services across the PCN
Support service redesign and quality improvement initiatives
Participate in audit, evaluation and service development projects
Support implementation of local and national priorities relating to frailty
Contribute to workforce development and training of other healthcare professionals
Partnership Working
Work collaboratively with GPs, Clinical Pharmacists, Social Prescribers, Care Coordinators, Community Nurses, Therapists and Social Care teams
Attend multidisciplinary team meetings and neighbourhood team meetings
Develop effective relationships with secondary care, community providers, voluntary sector organisations and care homes
Support integrated working across organisational boundaries
Clinical Governance
Maintain accurate and contemporaneous clinical records
Work within NMC Code, professional standards and local policies
Participate in clinical audit and quality improvement activity
Maintain mandatory training and continuing professional development
Support safeguarding processes for adults at risk
Contribute to incident reporting and learning.
About us
Bradford City Primary Care Network 4 (PCN4) is a network of Bradford City Practices working collaboratively across the network area to look after the health of our local population. The PCN which comprises of 5 local Practices with a total population of around 48,000 registered patients.