Housebound Nurse in Farnham

Farnham Integrated Care Services are looking for a housebound nurse to develop, review and enable effective care support for frail and housebound patients registered with our Farnham PCN Practices. We are looking for 1 day a week (7.5 hours) which can be worked over 2 days if desired. This is to meet the remaining QOF need for 2026/2027. Hours and days can be flexible. This is a fixed term contract until end of March 2027 with a view to extension. Start date is as soon as possible. Enhanced access hours may also be available.

Main duties of the job

• Patient Assessment and Care Planning: To assess, devise, and evaluate care plans for housebound patients, ensuring that their unique health needs are met in alignment with PCN and QOF care goals. Engage with patients, families, and caregivers to promote a patient-centred approach and ensure care aligns with both patient preferences and QOF targets. Identify patients suitable for pro-active care via the Frailty and integrated care team MDTs and remote monitoring programme. Referring as appropriate.
• Clinical Responsibilities: Conduct long-term condition reviews, including diabetes, cancer, learning disabilities, dementia, mental health, and blood pressure management, to support QOF performance and outcomes. Working in collaboration with practices/clinicians. Deliver specialist care in line with your scope of practice. Use prescriptive authority (where qualified) to enhance medication management, especially in managing long-term conditions, with attention to QOF outcomes. Provide patient and family education on managing health conditions, preventive care strategies, and self-management aligned with QOF indicators.
• Leadership and Development: Act as a clinical role model, delivering evidence-based care and contributing to the professional development of team members. Mentor supporting roles to achieve relevant patient outcomes. Oversee planning and co-ordination to support effective service delivery.
• Clinical Governance, Audit, and Research: Participate in clinical audits and research projects, implementing improvements based on findings to enhance patient care protocols. Contribute to the development and revision of PCN guidelines, protocols, and procedures, ensuring adherence to national and local standards, including QOF requirements. Actively engage in PCN quality improvement initiatives aimed at enhancing patient identification, assessment, and long-term support aligned with QOF.
• Strategic and Collaborative Work: Work proactively with PMs and directors to develop integrated care pathways, contributing to a holistic model of care. Advise on policy development and contribute to the PCNs strategic work streams.

Person Specification

• Qualifications: Qualified Registered Nurse with a degree in nursing or a Registered Nurse Degree Apprenticeship (RNDA). Registered with the Nursing & Midwifery Council (NMC). Level 7 or above post-graduate qualification in a relevant area, such as frailty, wound care, diabetes, respiratory/CVD, or public health management. Prescribing qualification is preferred, ideally Independent/Supplementary Prescriber status.
• Experience: Demonstrated experience in enhanced practice and familiarity with Primary Care and General Practice Nursing Career and Core Capabilities. Interest in frailty and experience in caring for elderly, housebound, or vulnerable patients. Strong communication, problem-solving, and organisational skills. Ability to work independently and within an MDT, providing leadership and mentoring as required.

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.