PCN Salaried GP - Integrated Neighbourhood CareNHS

Job summary

Brunel Primary Care Network is seeking an enthusiastic and committed Salaried GP to join our developing Integrated Neighbourhood Care (INT) team, providing proactive, high-quality care to frail, housebound and clinically vulnerable patients across our three practices.

This is an exciting opportunity for a GP who enjoys working collaboratively across primary care and community services and who is keen to develop innovative approaches to supporting patients with complex and changing healthcare needs.

Brunel PCN also provides outreach support to homeless patients living across three local hostels.

The GP will provide clinical support and oversight to this service, working collaboratively with our Health Inclusion Team and other professionals to address the often complex health and social needs of this patient group.

Experience of working with frailty, housebound patients, homeless populations, complex care or multidisciplinary services would be advantageous, although we would welcome applications from GPs with the appropriate skills and enthusiasm to develop within the role.

The successful GP will have a varied role, combining proactive care, same-day acute visiting and outreach work.

Main duties of the job

The role will include:

• Providing proactive, holistic care to frail, housebound and clinically vulnerable patients.
• Working closely with the wider Integrated Neighbourhood Care multidisciplinary team, including nurses, pharmacists, social prescribers and other community professionals.
• Supporting the management of patients with complex and multiple long-term conditions, frailty and other vulnerabilities.
• Undertaking same-day acute visiting appointments as part of the Brunel Acute Visiting Service.
• Providing clinical oversight and support for the outreach service for homeless patients across three local hostels, working alongside our Health Inclusion Team and wider multidisciplinary services.
• Supporting admission avoidance and appropriate management of patients in their usual place of residence wherever clinically appropriate.
• Contributing to the ongoing development and improvement of the PCN's proactive care and acute visiting services.

Job description

Clinical Responsibilities

• Conduct home visits and community-based reviews for housebound and frail patients.
• Deliver long-term condition management (e.g. CHF, COPD, diabetes, hypertension).
• Lead or support anticipatory / future care planning and end-of-life discussions where appropriate.
• Undertake Dementia and Severe Mental Illness (SMI) annual health checks in line with QOF and PCN specifications.
• Support delivery of Learning Disability (LD) health assessments.
• Provide clinical leadership and support to the wider Integrated Neighbourhood Team (including nurses, AHPs, care coordinators and social prescribers).
• Work collaboratively with community and secondary care services to ensure continuity of care.
• Maintain accurate and timely clinical documentation in the relevant IT systems.

Professional Responsibilities

• Participate in clinical meetings, MDTs and case discussions.
• Engage in quality improvement initiatives related to frailty and proactive care.
• Commit to ongoing professional development and reflective practice.
• Adhere to GMC, CQC and safeguarding standards at all times.

About us

Our INT service aims to provide a coordinated approach to supporting patients with complex needs, with a particular focus on prevention, early intervention and admission avoidance.

This element of the role offers an opportunity to work within a flexible and multidisciplinary model, helping to improve access to primary care and reduce barriers to healthcare for patients who may otherwise struggle to engage with traditional services.

What We Offer

• 4 to 6 sessions per week, with flexibility around working arrangements.
• Competitive salary dependent on experience.
• 6 weeks annual leave plus bank holidays per annum
• An additional paid day off allocated to you for your birthday.
• Free access to an employee assistance provider
• Automatic enrolment into a generous NHS Pension Scheme.
• The opportunity to work across three practices within Brunel PCN.
• A varied role combining proactive care, acute visiting and Health Inclusion outreach.
• The opportunity to work closely with an established multidisciplinary team.
• Support for professional development and service development.
• The opportunity to contribute to and shape the future development of Integrated Neighbourhood Care within Brunel PCN.