Severnvale PCN

Community Frailty Practitioner

The closing date is 19 December 2025

Job summary

Advanced Care Practitioner

Hours: Part time 20-30 hours per week. Salary dependant on experience and pro rata

An exciting opportunity has arisen to join our expanding Frailty Team. We are growing our service to enhance the care we provide to our local community, and were looking for a dedicated professional to become part of this forward-thinking team.

Our established Frailty Team currently includes a Community Frailty Practitioner, a Community Frailty Paramedic, and a Care Coordinator. A Non-Medical Prescribing qualification is essential for this role, and applicants must have successfully completed this qualification.

The PCN Frailty Team plays a key role in supporting our practices by conducting weekly ward rounds, monitoring new care home residents, and providing high-quality long-term condition management. In addition, the team delivers a non-urgent housebound service, offering vital support for patients who are unable to attend the surgery but require ongoing management of their long-term conditions.

This is a fantastic chance to be part of a dynamic, compassionate team dedicated to improving frailty care across our community.

Main duties of the job

Applicants should be experienced clinical practitioners who, acting within their professional boundaries, will provide care for housebound and care home patients including initial history taking, clinical assessment, diagnosis, treatment, and evaluation of care.

Lead long-term condition management focusing on elderly, frail, and housebound patients, including those in care homes.

They will demonstrate safe clinical decision-making and expert care, including assessment and diagnostic skills, for housebound and care home patients within the general practice setting.

The post holder will demonstrate critical thinking in the clinical decision-making process, with the ability to prioritise and triage the needs of the patients, accordingly, instigating appropriate investigations or referrals to colleagues and other care providers.

They will work collaboratively as part of the general practice multidisciplinary team to meet the needs of patients. The role is both varied and diverse with clinical support and mentorship provided to allow the successful candidate to flourish. The workload will consist of a mixture of home visits, care home visits and telephone consultations.

About us

Severnvale PCN (Primary Care Network) comprises five GP practices in South Gloucestershire delivering services to a population of circa 33,500 patients which includes 10 care homes. We are an enthusiastic, dynamic, and friendly PCN who constantly strive to improve patient pathways and health care outcomes.

The PCN team includes a Clinical Director, a PCN Manager, a Community Frailty Practitioner, a Community Frailty Practitioner, a Care Co-ordinator, 4 Clinical Pharmacists, a Pharmacy Technician, 7 Care Coordinator Prescription Clerks, 2 dedicated Social Prescribing Link Workers and First Contact Physiotherapists. The PCN is looking to appoint an Experience Practice Nurse to join our Frailty & Care Home Service.

Details

Date posted

09 December 2025

Pay scheme

Other

Salary

£49,000 to £51,697 a year Pro rata & Dependant on experience

Contract

Permanent

Working pattern

Part-time

Reference number

A1782-25-0007

Job locations

Eastland Road

Thornbury

Bristol

BS35 1DP


St. Mary Street Surgery

24 St. Mary Street

Thornbury

Bristol

BS35 2AT


Almondsbury Surgery

Sundays Hill

Almondsbury

Bristol

BS32 4DS


Pilning Surgery

Northwick Road

Pilning

Bristol

BS35 4JF


Job description

Job responsibilities

Job responsibilities,

To work as part of a multi-disciplinary team across the PCN to care for our housebound and care home patients, including proactive assessment, diagnosis and treatment of individuals using a holistic approach.To undertake care home weekly ward rounds.

To assess, diagnose, investigate, treat, refer or signpost patients/service users within the community with undifferentiated or undiagnosed condition relating to minor illness, minor injury or urgent problems.

The post holder will use advanced clinical skills to provide education to service users, promoting self-care and empowering them to make informed choices about their treatment.

The post holder must have access to a vehicle for home visits with mileage expenses remunerated by submission of a monthly mileage form. (Please note it is the postholders responsibility to ensure that their car insurance is covered for business use).

  • Visiting patients who are frail/have co morbidity in their homes or in a care home. Undertake care home ward rounds with the support of the PCNs Community Frailty Practitioner, Community Frailty Paramedic and Care Coordinator
  • Prescribe/issue medications as appropriate following policy, patient group directives and local pathways. Independent Prescriber qualifications is essential.
  • May be required to help with the Avoiding Unplanned Admission reviews
  • Consult with patients, take medical histories, perform physical examinations, analyse, diagnose and explain medical problems during consultations and home visits.
  • Recommend and explain appropriate diagnostic tests and treatment.
  • Formulate differential diagnoses and develop and deliver appropriate treatment and management plans. Request and interpret results of laboratory investigations when necessary.
  • Advanced end of life care planning to include ReSPECT discussions and development of Personalised Care and Support Plans.
  • Advise patients on general health care and minor ailments, with referral to other members of the primary and secondary health care team as necessary.
  • Undertake assessment for patients within their place of residence using diagnostic skills, initiation of investigations and feeding back to the patients GP where appropriate.
  • To help manage/support patients with their long term condition.
  • Support quality improvement and assurance initiatives within the PCN.
  • Promote public health and screening programs, including immunisations and cervical screening.
  • Integrate population health management approaches to reduce health inequalities.
  • Work collaboratively with the wider practice team to enhance patient care.
  • Work with local and national evidenced based policies and procedures.
  • To communicate at all levels within the team ensuring an effective service is delivered.
  • Ensure evidenced-based care is delivered at the highest standards ensuring delivery of high-quality patient care.

Job description

Job responsibilities

Job responsibilities,

To work as part of a multi-disciplinary team across the PCN to care for our housebound and care home patients, including proactive assessment, diagnosis and treatment of individuals using a holistic approach.To undertake care home weekly ward rounds.

To assess, diagnose, investigate, treat, refer or signpost patients/service users within the community with undifferentiated or undiagnosed condition relating to minor illness, minor injury or urgent problems.

The post holder will use advanced clinical skills to provide education to service users, promoting self-care and empowering them to make informed choices about their treatment.

The post holder must have access to a vehicle for home visits with mileage expenses remunerated by submission of a monthly mileage form. (Please note it is the postholders responsibility to ensure that their car insurance is covered for business use).

  • Visiting patients who are frail/have co morbidity in their homes or in a care home. Undertake care home ward rounds with the support of the PCNs Community Frailty Practitioner, Community Frailty Paramedic and Care Coordinator
  • Prescribe/issue medications as appropriate following policy, patient group directives and local pathways. Independent Prescriber qualifications is essential.
  • May be required to help with the Avoiding Unplanned Admission reviews
  • Consult with patients, take medical histories, perform physical examinations, analyse, diagnose and explain medical problems during consultations and home visits.
  • Recommend and explain appropriate diagnostic tests and treatment.
  • Formulate differential diagnoses and develop and deliver appropriate treatment and management plans. Request and interpret results of laboratory investigations when necessary.
  • Advanced end of life care planning to include ReSPECT discussions and development of Personalised Care and Support Plans.
  • Advise patients on general health care and minor ailments, with referral to other members of the primary and secondary health care team as necessary.
  • Undertake assessment for patients within their place of residence using diagnostic skills, initiation of investigations and feeding back to the patients GP where appropriate.
  • To help manage/support patients with their long term condition.
  • Support quality improvement and assurance initiatives within the PCN.
  • Promote public health and screening programs, including immunisations and cervical screening.
  • Integrate population health management approaches to reduce health inequalities.
  • Work collaboratively with the wider practice team to enhance patient care.
  • Work with local and national evidenced based policies and procedures.
  • To communicate at all levels within the team ensuring an effective service is delivered.
  • Ensure evidenced-based care is delivered at the highest standards ensuring delivery of high-quality patient care.

Person Specification

Experience

Essential

  • Experience of working to protocols or guidelines.
  • Experience in frailty care, chronic disease management, and care planning in community or primary care settings
  • CDM Management
  • Ongoing evidence of CPD

Desirable

  • Experience of offering mentorship and supervision to other nursing staff.
  • Experience of developing and implementing training programs.
  • Experience of working in care homes

Other

Essential

  • Meets DBS reference standards and criminal record checks
  • Willingness to work flexible hours when required to meet work demands
  • Access to own transport and ability to travel across the locality to visit people in their own homes.
  • Awareness of data protection (GDPR) and confidentiality issues particularly within a healthcare setting.

Qualifications

Essential

  • Batchelor Degree in Life Science/Biomedical/Nursing or Allied Health Science or equivalent
  • Health & Care Professions Council (HCPC) registration.
  • Able to operate at an advanced level of clinical practice, using Level 7 capabilities as defined by (NHE/I GP DES, ARRS funding) and HEE guidance.
  • Undergraduate attainment at minimum of Framework for Higher Education Qualification (FHEQ) Dip.HE. In a relevant subject.
  • Non-medical prescribing qualification
  • Full UK driving license and access to vehicle (for home visits as required

Desirable

  • Minimum 3 years post-registration experience.

Specialist knowledge/skills

Essential

  • IT literate / proficient in the use of the computer
  • Excellent interpersonal and organisational skills
  • Good problem solving and decision-making skills
  • Ability to manage workload effectively
  • A high standard of clinical skills and experience of using these skills in different situations.
  • Willingness to always work towards the best interest of the patient.
  • Team player / ability to liaise effectively with colleagues and other members of the multi-disciplinary team.
  • Ability to write comprehensive, accurate clinical notes, implement and evaluate care plans.

Desirable

  • Understand own scope of practice, the context of continual learning and the need to develop constantly to ensure safe, competent and confident practice.
  • Evidence of success in efficient and effective project and program management

Personal attributes & abilities

Essential

  • Ability to co-ordinate and prioritise workloads able to multi-task as well as be self-disciplined and highly motivated.
  • High degree of personal credibility, emotional intelligence, patience, and flexibility
  • Ability to cope with unpredictable situations.

Desirable

  • Confident in facilitating and challenging others
  • Demonstrates a flexible approach to ensure patient care is delivered.
Person Specification

Experience

Essential

  • Experience of working to protocols or guidelines.
  • Experience in frailty care, chronic disease management, and care planning in community or primary care settings
  • CDM Management
  • Ongoing evidence of CPD

Desirable

  • Experience of offering mentorship and supervision to other nursing staff.
  • Experience of developing and implementing training programs.
  • Experience of working in care homes

Other

Essential

  • Meets DBS reference standards and criminal record checks
  • Willingness to work flexible hours when required to meet work demands
  • Access to own transport and ability to travel across the locality to visit people in their own homes.
  • Awareness of data protection (GDPR) and confidentiality issues particularly within a healthcare setting.

Qualifications

Essential

  • Batchelor Degree in Life Science/Biomedical/Nursing or Allied Health Science or equivalent
  • Health & Care Professions Council (HCPC) registration.
  • Able to operate at an advanced level of clinical practice, using Level 7 capabilities as defined by (NHE/I GP DES, ARRS funding) and HEE guidance.
  • Undergraduate attainment at minimum of Framework for Higher Education Qualification (FHEQ) Dip.HE. In a relevant subject.
  • Non-medical prescribing qualification
  • Full UK driving license and access to vehicle (for home visits as required

Desirable

  • Minimum 3 years post-registration experience.

Specialist knowledge/skills

Essential

  • IT literate / proficient in the use of the computer
  • Excellent interpersonal and organisational skills
  • Good problem solving and decision-making skills
  • Ability to manage workload effectively
  • A high standard of clinical skills and experience of using these skills in different situations.
  • Willingness to always work towards the best interest of the patient.
  • Team player / ability to liaise effectively with colleagues and other members of the multi-disciplinary team.
  • Ability to write comprehensive, accurate clinical notes, implement and evaluate care plans.

Desirable

  • Understand own scope of practice, the context of continual learning and the need to develop constantly to ensure safe, competent and confident practice.
  • Evidence of success in efficient and effective project and program management

Personal attributes & abilities

Essential

  • Ability to co-ordinate and prioritise workloads able to multi-task as well as be self-disciplined and highly motivated.
  • High degree of personal credibility, emotional intelligence, patience, and flexibility
  • Ability to cope with unpredictable situations.

Desirable

  • Confident in facilitating and challenging others
  • Demonstrates a flexible approach to ensure patient care is delivered.

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).

Employer details

Employer name

Severnvale PCN

Address

Eastland Road

Thornbury

Bristol

BS35 1DP

Employer details

Employer name

Severnvale PCN

Address

Eastland Road

Thornbury

Bristol

BS35 1DP

Employer contact details

For questions about the job, contact:

PCN Manager

Ellie Webber-Priddy

ellie.webber-priddy@nhs.net

Details

Date posted

09 December 2025

Pay scheme

Other

Salary

£49,000 to £51,697 a year Pro rata & Dependant on experience

Contract

Permanent

Working pattern

Part-time

Reference number

A1782-25-0007

Job locations

Eastland Road

Thornbury

Bristol

BS35 1DP


St. Mary Street Surgery

24 St. Mary Street

Thornbury

Bristol

BS35 2AT


Almondsbury Surgery

Sundays Hill

Almondsbury

Bristol

BS32 4DS


Pilning Surgery

Northwick Road

Pilning

Bristol

BS35 4JF


Supporting documents

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