Job summary
Newcastle Central PCN is launching a new Frailty Pilot Service
aimed at providing proactive, personalised, and integrated care for older
adults living with frailty. We are seeking a dynamic, experienced Advanced
Nurse Practitioner (ANP) to help lead and shape this innovative service.
Main duties of the job
Perform holistic assessments and care planning for older
adults with frailty, including home visits to independently assess, diagnose,
treat, and evaluate patients with complex health and social care needs, identifying areas
of unmet need (including patient goals and priorities) and develop an action
plan.
Collaborate with GPs, care coordinators, social prescribers,
community teams, and voluntary services to deliver wraparound care and
participate in MDT meetings.
Initiate and manage treatment plans, including prescribing
medications within your scope of practice.
Support advanced care planning, including ReSPECT
conversations and anticipatory care.
Provide leadership in frailty management, including case
finding, MDT working, and pathway development.
Facilitate transitions of care from hospital to community,
reducing avoidable admissions.
Deliver health promotion advice to support self-care,
nutrition and dentition, independence, and wellbeing.
Participate in audits, data reporting, and service evaluation
to inform and improve the pilot.
Supervise and support colleagues and students, contributing to
a culture of learning.
About us
Newcastle Central PCN serves a diverse urban population and is
committed to delivering high-quality, patient-centred care. This new frailty
service is part of our commitment to integrated, preventative, and
person-focused healthcare.
Our PCN is made up of experienced and supportive teams,
including GPs, pharmacists, paramedics, care coordinators, social prescribers,
and mental health practitioners. You will be supported by strong clinical
leadership and a responsive management team that values innovation and
flexibility.
Job description
Job responsibilities
Job Summary
Working as part of a multi-disciplinary team, the successful
candidate will play a key role in identifying, assessing, and managing patients
with moderate to severe frailty, both reactively and through proactive
outreach. You will have autonomy to deliver high-quality clinical care while
contributing to the development of new models of care that promote
independence, prevent avoidable deterioration, and support ageing well.
This is an exciting opportunity for an ANP looking to be at
the forefront of integrated frailty care, with flexibility to tailor working
hours to individual needs, including portfolio careers and caring
responsibilities.
Main Duties of the Job
Perform holistic assessments and care planning for older
adults with frailty, including home visits to independently assess, diagnose,
treat, and evaluate patients with complex health and social care needs, identifying areas
of unmet need (including patient goals and priorities) and develop an action
plan.
Collaborate with GPs, care coordinators, social prescribers,
community teams, and voluntary services to deliver wraparound care and
participate in MDT meetings.
Initiate and manage treatment plans, including prescribing
medications within your scope of practice.
Support advanced care planning, including ReSPECT
conversations and anticipatory care.
Provide leadership in frailty management, including case
finding, MDT working, and pathway development.
Facilitate transitions of care from hospital to community,
reducing avoidable admissions.
Deliver health promotion advice to support self-care, nutrition
and dentition, independence, and wellbeing.
Participate in audits, data reporting, and service evaluation
to inform and improve the pilot.
Supervise and support colleagues and students, contributing to
a culture of learning.
About Us
Newcastle Central PCN serves a diverse urban population and is
committed to delivering high-quality, patient-centred care. This new frailty
service is part of our commitment to integrated, preventative, and
person-focused healthcare.
Our PCN is made up of experienced and supportive teams,
including GPs, pharmacists, paramedics, care coordinators, social prescribers,
and mental health practitioners. You will be supported by strong clinical
leadership and a responsive management team that values innovation and
flexibility.
Job description
Job responsibilities
Job Summary
Working as part of a multi-disciplinary team, the successful
candidate will play a key role in identifying, assessing, and managing patients
with moderate to severe frailty, both reactively and through proactive
outreach. You will have autonomy to deliver high-quality clinical care while
contributing to the development of new models of care that promote
independence, prevent avoidable deterioration, and support ageing well.
This is an exciting opportunity for an ANP looking to be at
the forefront of integrated frailty care, with flexibility to tailor working
hours to individual needs, including portfolio careers and caring
responsibilities.
Main Duties of the Job
Perform holistic assessments and care planning for older
adults with frailty, including home visits to independently assess, diagnose,
treat, and evaluate patients with complex health and social care needs, identifying areas
of unmet need (including patient goals and priorities) and develop an action
plan.
Collaborate with GPs, care coordinators, social prescribers,
community teams, and voluntary services to deliver wraparound care and
participate in MDT meetings.
Initiate and manage treatment plans, including prescribing
medications within your scope of practice.
Support advanced care planning, including ReSPECT
conversations and anticipatory care.
Provide leadership in frailty management, including case
finding, MDT working, and pathway development.
Facilitate transitions of care from hospital to community,
reducing avoidable admissions.
Deliver health promotion advice to support self-care, nutrition
and dentition, independence, and wellbeing.
Participate in audits, data reporting, and service evaluation
to inform and improve the pilot.
Supervise and support colleagues and students, contributing to
a culture of learning.
About Us
Newcastle Central PCN serves a diverse urban population and is
committed to delivering high-quality, patient-centred care. This new frailty
service is part of our commitment to integrated, preventative, and
person-focused healthcare.
Our PCN is made up of experienced and supportive teams,
including GPs, pharmacists, paramedics, care coordinators, social prescribers,
and mental health practitioners. You will be supported by strong clinical
leadership and a responsive management team that values innovation and
flexibility.
Person Specification
Experience
Essential
- Significant post-registration experience in primary, urgent or community care
- Proven experience managing patients with complex health and social needs
- Demonstrated leadership in service development, audit, or protocol implementation
- Experience in multidisciplinary working and case management
- Triage and autonomous clinical decision-making
Desirable
- Project or pilot programme delivery
- Recent experience in frailty or care of older adults
- Health inequalities or population health management projects
Qualifications
Essential
- MSc in Advanced Practice (or working towards)
- NMC registration
- Independent and Supplementary Prescriber (V300)
- Clinical Assessment and Diagnostics qualification
- Teaching, assessing, or clinical supervision training
Desirable
- Qualification or experience in frailty, older adults, community care, or palliative care
- Minor illness/minor injury certification
- Counselling or motivational interviewing skills
Knowledge & Skills
Essential
- Comprehensive assessment and clinical decision-making skills
- Knowledge of frailty syndromes, polypharmacy, and advanced care planning
- Familiarity with national frailty and ageing-well policies
- Excellent communication and negotiation skills
- Able to manage competing priorities and work independently
- IT skills including EMIS or equivalent systems
Other
Essential
- Full UK driving licence and access to a car (or ability to travel across sites)
- Able to work flexibly across the PCN practices and patients' homes
- Commitment to ongoing CPD and role development
- Willingness to engage in service evaluation and improvement
Person Specification
Experience
Essential
- Significant post-registration experience in primary, urgent or community care
- Proven experience managing patients with complex health and social needs
- Demonstrated leadership in service development, audit, or protocol implementation
- Experience in multidisciplinary working and case management
- Triage and autonomous clinical decision-making
Desirable
- Project or pilot programme delivery
- Recent experience in frailty or care of older adults
- Health inequalities or population health management projects
Qualifications
Essential
- MSc in Advanced Practice (or working towards)
- NMC registration
- Independent and Supplementary Prescriber (V300)
- Clinical Assessment and Diagnostics qualification
- Teaching, assessing, or clinical supervision training
Desirable
- Qualification or experience in frailty, older adults, community care, or palliative care
- Minor illness/minor injury certification
- Counselling or motivational interviewing skills
Knowledge & Skills
Essential
- Comprehensive assessment and clinical decision-making skills
- Knowledge of frailty syndromes, polypharmacy, and advanced care planning
- Familiarity with national frailty and ageing-well policies
- Excellent communication and negotiation skills
- Able to manage competing priorities and work independently
- IT skills including EMIS or equivalent systems
Other
Essential
- Full UK driving licence and access to a car (or ability to travel across sites)
- Able to work flexibly across the PCN practices and patients' homes
- Commitment to ongoing CPD and role development
- Willingness to engage in service evaluation and improvement
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).
