PCN - Community GP in Chesterfield

This is an exciting and unique opportunity to be at the forefront of the delivery of our new Ageing Well model of care. The role will operate across the traditional health and social care organisational boundaries, including with our GP practice partners, to help clinically lead the service on a day to day basis. The aim for the service is to ultimately provide a holistic approach to acute on day / rapid response services, enhanced care into care homes and enhanced proactive care for older people with frailty for patients with multifaceted health problems.

Interviews will be held face to face on the morning of 19 March 2026 at Dunston Innovation Centre. Please note we are not an Agenda for Change organisation. The post is for 4 sessions per week working between the hours of 8.00am-6.30pm.

Main duties of the job

• On a day to day basis the post holder will provide clinical leadership for the multi-disciplinary and multi-agency service to deliver effective, efficient and high quality services for service users, providing mentorship, guidance and support where needed to clinical decision making.
• Alongside this the post holder will work with team members developing the necessary skills and competencies to meet the service need.
• The post holder will also provide medical assessment and management where needed on behalf of, or in conjunction with, team members and deliver the senior clinical triage function for the Acute Home Visiting element of the service, to determine the urgency and type of response needed, according to clinical need.
• Working in conjunction with the PCN Clinical Lead and PCN Operational Manager the post holder will develop and deliver a safe and effective service, developing new ways of working and clinical pathways in accordance with key local and national clinical standards, for the service areas of Acute Home visiting, urgent community response, enhanced health in care homes and anticipatory care.
• The post holder will work with key stakeholders and partners locally to contribute to the ongoing development of the service, promoting a cross organisational and multi-agency approach to the delivery of care for local residents.

About us

Arc Primary Care is the umbrella organisation of the Primary Care Network (PCN) in Chesterfield and Dronfield. Arc Primary Care is an alliance of GP Practices. Our members consist of 10 GP practices which cover a population of over 103,000 patients. At Arc we are committed to ensuring the sustainability of General Practice and realising the benefits of working together. We deliver enhanced services within the PCN designed to support and enhance the services offered by our member GP Practices within Chesterfield.

Our mission: Committed to high quality collaborative person-centred care. Delivered with integrity and transparency, improving health and wellbeing for all.

Benefits of working with us:

• NHS Pension Scheme, offering flexible retirement choices, an ill health retirement pension, life assurance and an optional lump sum on retirement.
• On appointment 30 days plus 8 Bank Holiday annual leave entitlement which rises annually with length of service up to 33 days (pro rata for part time staff).
• Up to 5 days professional/study leave per annum (pro rata).
• Access to Well-Being Support.
• Blue light Card Discount.

KEY DUTIES AND RESPONSIBILITIES

• Leading a clinical team to provide proactive and reactive general medical services to the housebound population, including those in care homes, in collaboration with registered practices where appropriate.
• Leading and coordinating across organisations.
• Promote and deliver a multi-skilled team response that includes GP Acute Home Visits, holistic assessment, care, pro-active follow up and care planning.
• Develop and deliver an efficient, high quality, multi-disciplinary Acute Home Visiting and Community Urgent Response Service to people who have an urgent need that is best provided in their own home, or wherever they call home.
• Ensure that the Acute Home Visiting and Community Rapid Response Service that supports and links well to system infrastructure provided at a bigger scale e.g. Acute Hospitals, 999, 111, Ambulance services.
• Ensure Acute Home Visiting and Community Urgent Response Service that links well to routine and proactive services.
• Developing expertise within the community for improving the lives of people living with frailty.
• Promoting the use of supportive, non-statutory services to support self-care and social prescribing agendas.
• Maximise best care in the patients own home in order to reduce the need for hospital or care home admissions.
• Ensure that the care and support people receive is based on their wishes, preferences and aspirations, particularly towards the end of their lives.
• Provide medical expertise in the management of older people living with frailty in the defined community.
• Support ACPs and wider MDT members working in the community by providing Senior GP clinical triage for all Acute Home Visit requests to determine the urgency and type of response needed, according to clinical need.
• Regular debrief sessions for patients on their caseload.
• Lead and support the ACPs in their role in the MDT.
• Deliver formal and informal education for the ACPs during clinical interactions.
• Advise on complex clinical situations including; where there are difficult clinical risk decisions, where there is disagreement between professionals, patients or their carers, diagnosis is uncertain, identification of end of life is difficult.
• Liaison with GPs and frailty unit when needed.
• Chairs and contribute to multidisciplinary meetings/rounds.
• Contribute to the development and implementation of new care pathways, systems and processes to support the service delivery.
• Contribute towards the development and implementation of new standards, policies and procedures.
• Advise local GP practices within the defined population to implement effective multidisciplinary working for people with frailty.
• Contribute to CPD programmes for the members of the ageing well team: Clinical Mentorship/educational supervision of the team members including GP Registrars, Trainee ACPs, First contact practitioners.
• Ensure contemporaneous notes are recorded and clinical tasks are updated and completed within the agreed timescales.
• To work collaboratively with other teams and services to maintain an effective and efficient service.
• Participate in quality improvements and innovations, e.g. audits, significant events analysis and development of protocols and new services.

Person Specification

Experience

• Experience and evidence of an interest in care of the Elderly.
• Understanding of adult safeguarding and Deprivation of liberty procedures.
• Experience of multidisciplinary working.
• Experience of senior clinical triage for the Acute Home Visiting to determine the urgency and type of response needed, according to clinical need.
• Knowledge and experience of carrying out Comprehensive Geriatric Assessment.
• Experience of medical education/clinical supervision.
• Experience of using SystmOne or another clinical device.
• Experience of working in a multi-disciplinary team.

Skills and Abilities

• The ability to understand the competencies of others and support them to work within and at the top of those competencies.
• Ability to work effectively and provide leadership across traditional organisational and professional boundaries.
• Ability to demonstrate leadership skills within a multidisciplinary team.
• Excellent organisational and communication skills.
• Ability to work effectively as a member of a team.
• Ability to work effectively with colleagues, patients and external organisations.
• Ability to triage patients in order of clinical need.
• Effective communication, verbally and in writing.
• Full driving license required as travelling required for the role.
• Committed to the development of integrated community teams.
• Leadership of service delivery/change.

Values, Drivers & Motivators

• Committed to the ongoing development of team members.
• A passion for excellent, holistic, patient centred care for older people with frailty.

Qualifications

• A vocationally trained and accredited GP.
• Current registration with GMC.
• On the GP performers list.
• MRCGP.
• Recognised qualification in Care of the Elderly.
• Recognised qualification in medical education/clinical supervision.
• Evidence of leadership development.

Aptitude & Personal Qualities

• Recognise the benefits of multiagency & multidisciplinary team working.
• Ability to work as part of a multi-disciplinary team.
• Willingness to contribute to and participate in a peer support group.

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 to check for any previous criminal convictions.