Practice Nurse - Diabetes

Job responsibilities

KEY RESPONSIBILITIES

1. Clinical Patient Care & Management

• Maintain a defined caseload of patients with diabetes (Type 1, Type 2, and other forms) and deliver ongoing assessment, monitoring, review, and follow-up.
• Undertake complex assessments (clinical history, physical exam, risk stratification, complication screening) and develop individualised care plans.
• Monitor and interpret relevant investigations (HbA1c, lipids, renal function, microalbuminuria, liver function, etc.).
• Initiate, titrate, adjust and monitor diabetes medications (oral and insulin therapies) in line with agreed protocols and prescribing qualifications.
• Manage insulin initiation, intensification, and review, including basalbolus regimes, premixed insulins, andwhere appropriateadvanced or technology-assisted therapies.
• Educate patients in self-management: blood glucose monitoring, carbohydrate counting, sick-day rules, prevention of hypoglycaemia, lifestyle modification, and foot care.
• Provide structured education (or refer/deliver programmes such as DESMOND/DAFNE/equivalent) for newly diagnosed and existing patients.
• Conduct group and one-to-one education and support sessions to promote behaviour change and adherence.
• Identify, assess, and refer patients with complications (e.g. retinopathy, neuropathy, foot problems, renal disease) as appropriate.
• Provide telephone, virtual, or in-person follow-up as clinically required.
• Undertake home visits where necessary (e.g. housebound patients) for assessment, treatment, or education.
• Ensure continuity of care and coordinate with secondary care and community services to support integrated diabetes management.

2. Clinical Leadership & Service Development

• Lead and coordinate diabetes clinics within the practice, including scheduling, patient recall, and quality assurance.
• Develop, implement, and review local pathways, policies, and protocols in diabetes care (e.g. insulin safety, hypoglycaemia management, foot screening).
• Audit and monitor diabetes care metrics (QOF indicators, IIF, local targets, and clinical outcomes) and drive improvement initiatives.
• Act as a specialist resource and support for practice staff (GPs, nurses, HCAs), providing expert advice, support, and supervision.
• Deliver or facilitate in-house training sessions and case-based discussions to enhance team competence in diabetes care.
• Contribute to the planning and delivery of health promotion and prevention programmes (e.g. prediabetes identification, obesity management, smoking cessation).
• Liaise closely with local diabetes networks, community teams, and secondary care providers to promote continuity and best practice.
• Support implementation of new technologies such as continuous glucose monitoring (CGM), flash monitoring, and digital diabetes tools.
• Lead or contribute to quality improvement projects, audits, and service redesign initiatives aligned with local and national priorities.

3. Professional & Quality Assurance Duties

• Maintain up-to-date knowledge of national and local diabetes guidance (NICE and local ICS pathways) and ensure clinical compliance.
• Maintain accurate, contemporaneous, and professional clinical records in accordance with NMC and practice standards.
• Participate in practice clinical governance processes, including risk management, incident review, and medicines safety.
• Undertake regular audits and contribute to service evaluation, research, and outcome measurement.
• Participate in and support CQC, or other relevant quality frameworks as required.
• Engage in continuing professional development (CPD) and reflective practice to maintain and develop specialist competence.
• Maintain professional registration andif applicableindependent prescribing qualification.
• Adhere to the NMC Code, professional boundaries, and practice policies including confidentiality, data protection, and safeguarding.

KEY RESPONSIBILITIES ADMINISTRATIVE

• Accurately record all consultations, care plans, and interventions on the clinical system.
• Ensure appropriate coding to support QOF and local enhanced service reporting.
• Maintain and review diabetes registers, ensuring systematic recall and proactive management using PARM clinical management software.
• Contribute to data collection, audits, and reporting for clinical and performance monitoring.
• Participate in the review and development of practice policies and standard operating procedures.
• Attend and contribute to clinical meetings, case reviews, and multidisciplinary discussions.

KEY RESPONSIBILITIES PROFESSIONAL

Professional Registration

• Be professionally accountable for nursing practice in accordance with the NMC Code.
• Maintain active NMC registration and up-to-date professional knowledge.
• Participate in annual appraisal and maintain a personal development plan.
• Attend relevant training, study days, and clinical supervision sessions to maintain and enhance clinical competence.
• Recognise and work within scope of professional practice, seeking advice and support when required.

CONFIDENTIALITY

• Patients entrust sensitive information to the practice, which must be handled with the utmost confidentiality.
• Information relating to patients, carers, colleagues, or the business of the practice must not be disclosed to unauthorised persons and must be processed in line with data protection legislation.
• All staff must comply with the Practice Confidentiality Policy and the NMC Code regarding confidentiality.

SAFEGUARDING

• Demonstrate commitment to safeguarding and promoting the welfare of children, young people, and vulnerable adults.
• Follow practice safeguarding procedures and attend appropriate training.
• The postholder will be required to undergo an enhanced DBS check.

EQUALITY AND DIVERSITY

• Uphold the principles of equality, diversity, and human rights in all patient and team interactions.
• Deliver care that is respectful of privacy, dignity, and cultural or individual needs.
• Promote a non-judgemental and inclusive environment for patients and colleagues.

PERSONAL / PROFESSIONAL DEVELOPMENT

• Participate in an annual performance review and maintain an up-to-date record of CPD.
• Take responsibility for personal learning, reflective practice, and skill development.
• Contribute to the training and supervision of student nurses, medical students, or other trainees within the practice.

COMMUNICATION

• Communicate effectively with patients, carers, colleagues, and partner organisations.
• Use motivational interviewing, shared decision-making, and other techniques to support engagement and self-management.
• Recognise the need for alternative methods of communication and adapt accordingly.
• Contribute to effective communication across the multidisciplinary team.

OTHER DUTIES

• Undertake any other duties commensurate with the role as required by the Partners or Lead Nurse.
• Actively participate in reviewing systems, suggesting and implementing improvements to enhance quality of care and patient experience.

SUMMARY

This role provides an exciting opportunity for an experienced diabetes nurse to deliver expert, compassionate care in a forward-thinking primary care environment. The postholder will combine advanced clinical practice with leadership, education, and quality improvement to drive excellence in diabetes management across the practice population.

Experience

Essential

• Broad knowledge of general practice and experience of working as a Practice or Community Nurse
• Experience with diabetes and other chronic disease management
• Experience of working autonomously
• Experience of infection prevention and control measures
• Experience of managing elderly and housebound patients

Desirable

• Experience of quality initiatives, i.e., benchmarking
• An appreciation of the NHS landscape including the relationship between individual organisations, PCNs and the commissioners

Clinical Knowledge and Skills

Essential

• Experience of Practice Nurse skills including wound care, ECG, venepuncture, immunisations, new patient medicals and womans health (cervical cytology, contraception etc.)
• Request pathology tests and process the results, advising patients accordingly
• Understanding of the importance of evidence-based practice
• Ability to promote best practice regarding nursing matters
• Ability to work within own scope of practice and understand when to refer to GPs
• Good clinical system IT knowledge and an ability to record accurate clinical notes
• Ability to communicate complex and sensitive information effectively with people by telephone, email and face to face
• Understanding of safeguarding adults and children
• Understanding and knowledge of healthcare provision in GP surgeries, QOF and enhanced service
• Effectively able to communicate and understand the needs of the patient

Desirable

• Broad knowledge of clinical governance
• Awareness of issues within the wider health arena and knowledge of health promotion strategies
• Knowledge of public health issues in the local area
• Knowledge of national standards that inform general practice (NSF NICE guidelines)

Qualifications

Essential

• Registered General Nurse
• Qualification in Diabetes
• Evidence or working at relevant level of practice required for this post

Desirable

• Cervical Screening
• Mentor or teaching qualification
• Family planning qualification
• Non-Medical Prescriber

Personal qualities

Essential

• Effective time management (planning and organising)
• Ability to follow legal, ethical and professional policies/local policies/procedures and codes of conduct
• Knowledge of IT systems including the ability to use word processing skills, emails and the internet
• Understand the requirement for PGDs and associated policy
• Ability to use own initiative, discretion, and sensitivity
• Able to get along with people from all backgrounds and communities, respecting lifestyles and diversity
• Ability to identify risk and assess/manage risk when working with individuals
• Ability to work as a team member and autonomously
• Good interpersonal and organisational skills
• Sensitive and empathetic in distressing situations
• Commitment to ongoing professional development
• Clear, polite telephone manner
• Disclosure Barring Service (DBS) check
• Occupational Health clearance
• Meet the requirements and produce evidence for professional revalidation
• Evidence of CPD commensurate with the role

Desirable

• Demonstrate personal accountability, emotional resilience and work well under pressure

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).