PCN Mental Health Enhanced Practice Nurse in Ruislip

Work autonomously and accountably within the NMC Code, local policies, agreed clinical pathways and the limits of the role and individual competence. Undertake comprehensive, holistic assessments of mental health, learning-disability needs, physical health, cognition, communication, social circumstances, functioning, strengths, risks and protective factors.

Use enhanced mental health and physical assessment skills to identify deterioration, relapse, unmet need, adverse treatment effects, diagnostic overshadowing and conditions requiring urgent medical or specialist review. Develop, implement and evaluate personalised care and support plans in partnership with patients, families, carers, advocates and the multidisciplinary team, promoting recovery, independence and quality of life.

Provide enhanced-level management for one or more defined specialist areas, such as severe mental illness, depression and anxiety, learning disabilities, autism, dementia, neurodevelopmental needs or another locally agreed priority. Complete and coordinate physical health reviews for people with severe mental illness, including relevant observations, lifestyle review, cardiovascular and metabolic risk assessment, blood tests, screening, medicines monitoring and follow-up within competence.

Undertake or coordinate annual health checks and health action plans for people with learning disabilities, ensuring reasonable adjustments, accessible communication and timely action on identified physical and mental health needs. Review treatment effectiveness and, where qualified as an independent prescriber, prescribe, deprescribe and review medicines in accordance with evidence, national guidance, local formularies and professional accountability.

Monitor the safety and effectiveness of psychotropic and other medicines, support adherence, identify adverse effects and interactions, and arrange appropriate investigation, referral or specialist review. Use psychologically informed and evidence-based approaches to support self-management, emotional wellbeing, relapse prevention, behaviour change, coping strategies and recovery goals within scope of practice.

Assess risk relating to self-harm, suicide, self-neglect, exploitation, abuse, violence, vulnerability, deterioration or carer breakdown, and develop proportionate safety, crisis and escalation plans. Recognise mental health crisis, acute behavioural change, delirium, severe distress, safeguarding concerns and urgent or emergency presentations; initiate immediate care and escalate or refer without delay.

Assess decision-making capacity relevant to the care or treatment being considered, support communication and involvement, and follow legal and organisational requirements for consent and best-interest decision-making. Undertake home, care home, supported-living or community visits when required by the service and when clinically appropriate.

Maintain accurate, contemporaneous and complete clinical records, including clear documentation of assessment, formulation, clinical reasoning, risk, capacity, consent, plans, advice, escalation and outcomes.

Population Health and PCN Service Delivery: Use practice and PCN data to identify people with severe mental illness, learning disabilities, autism or other mental health needs who are at risk, overdue review, experiencing poor access or likely to benefit from proactive intervention. Support achievement of relevant Quality and Outcomes Framework, PCN, local enhanced service and contractual priorities while maintaining person-centred and clinically appropriate care.

Improve uptake and quality of severe mental illness physical health checks, learning-disability annual health checks, screening, immunisation and other prevention activity through proactive recall, follow-up and reasonable adjustments. Identify and address physical health inequalities, premature mortality risks, barriers to access and unmet health needs affecting people with mental illness or learning disabilities.

Support proactive care for people with complex mental, physical and social needs through risk stratification, anticipatory care, personalised care planning and multidisciplinary review. Contribute to enhanced access and other PCN-wide clinical services, including delivery across different member practices and community settings where required.

Work with integrated neighbourhood teams and partner organisations to improve continuity, care coordination, crisis prevention and outcomes for people who may otherwise experience fragmented care. Evaluate the impact of clinical interventions and service changes using agreed outcome measures, patient and carer feedback, inequalities data and audit findings.