Advanced Clinical Practitioner - Frailty
We are lookingfor an ACP to join our innovative Ageing Well Team across the PCN. The postholder will provide proactive, person-centered care for people living withmoderate frailty, including undertaking and coordinating ComprehensiveGeriatric Assessments (CGA) to identify medical, functional, psychological andsocial needs and agree individualised care plans.
This is anexciting opportunity for an enthusiastic, motivated ACP (who could be from a nursingor therapy background), working closely with our O/T, physio & carecoordinators to provide proactive care for the moderately and severely frail. Thisrole is integral to the assessment of patient frailty levels & assistingwith review of patients to allow the best access to care required for theirsupport. You will be an autonomous practitioner who is adaptable, has aflexible can-do attitude with a passion for excellence & ability to workwell both on their own & as part of a team.
This is acommunity-based role, which predominantly requires assessment of patients intheir own home, therefore applicants must have a full driving license &access to a vehicle daily.
Main duties of the job
The successful candidateshould be an experienced practitioner who willwork in partnership with other health professionals in supporting frailpatients and providing holistic patient care. They will act within theirprofessional boundaries and competencies, assessing, planning &implementing patient care.
They will participate inMDT meetings to discuss patients that the Ageing Well Team are supporting. Asa result, they must have high levelcommunication/interpersonal skills to negotiate & establish collaborativepartnerships with patients & care professionals and have enthusiasm &the ability to use their own initiative.
About us
Employed by Selby Prime Care Ltd but subcontracted to Selby Town PCN,this is a role to support patients across Selby Town PCN.
The PCNworks over four practice sites (Beech Tree Surgery, Escrick Surgery,Posterngate Surgery and Scott Road Medical Centre) a local voluntary sectorsite & our local community hospital.
The PCNhas a Clinical Director, two Clinical Lead GPs and is managed by the PCNOperations Manager & Business Manager. We work in increasinglycollaborative partnerships across several workstreams, which include importantpriority areas of mental health, frailty, urgent care and health inequalities.Our team consists of a diverse multi-professional workforce which includespharmacists, MSK practitioners, mental health workers, care coordinators,social prescribing link workers, a frailty therapy team, an urgent carecoordinator, UCPs, paramedics, ACPs, a transformation lead, a digital lead,health & wellbeing coach.
Job responsibilities
To visit clients who meet the Frailty assessmentcriteria within their usual place of residence.
To assess and identify the health needs ofpatients who are frail and who may have long-term conditions.
To undertake and coordinate ComprehensiveGeriatric Assessments (CGA), within professional competence, covering physicalhealth, medicines, cognition, mood, mobility, falls risk, nutrition,continence, functional ability, social circumstances and future care wishes.
To use CGA findings to develop, document andreview person-centered, strengths-based care and support plans with patients,carers and the multidisciplinary team, escalating clinical concernsappropriately.
To provide clinical leadership, guidance andsupport to care coordinators, including advice on patient care, riskmanagement, escalation and effective multidisciplinary working within agreedprofessional boundaries.
To assess, plan, implement and evaluateprogrammes of care to address the identified needs of patients identified asbeing frail and/or those with long-term conditions.
To support the development of patientsindividual Personal Health and Social Care Plans.
Develop disease specific patient informationand education to support patients self care.
Participate in education &staff development, including specialised CPD relevant to Frailty and Dementiaand actively participate in regular supervision.
Participate in regular MDTmeetings and complex case management discussions.
Person Specification
Other requirements
- Please see attached for full job description and person specification.
Experience
- Significant post-registration clinical experience, including recent experience working autonomously in an advanced or senior clinical role.
- Experience of delivering patient education and promoting self-directed care
- Experience of working with people living with frailty and long-term conditions in community or primary care settings
- Experience of working autonomously within professional boundaries and competence
- Experience of assessing, planning, implementing and evaluating person-centered care for people living with frailty
- Experience of undertaking or contributing to Comprehensive Geriatric Assessment, including physical health, medicines, cognition, mood, mobility, falls risk, nutrition, continence, functional ability and social circumstances.
- Experience of translating assessment findings into coordinated strengths-based care and support plans including, completing Advanced Care Plans and RESPECT documentation.
- Experience of multidisciplinary working and contributing effectively to MDT meetings
- Experience of providing clinical leadership, guidance or support to care coordinators or other members of a multidisciplinary team
- Experience of identifying and managing clinical risk, escalating concerns appropriately and safeguarding adults
- Experience of using the Rockwood Clinical Frailty Scale
- Experience in primary care, urgent care, general practice or a Primary Care Network setting.
- Experience of working across multiple sites or within a multidisciplinary team.
- Experience of audit, quality improvement, service development or clinical supervision.
Qualifications
- Registered healthcare professional with current NMC or HCPC registration.
- Advanced Clinical Practitioner qualification or evidence of working towards an accredited advanced practice qualification.
- Evidence of continuing professional development relevant to advanced clinical practice.
- Masters level qualification in Advanced Clinical Practice.
- NHSE Centre for Advancing Practice recognition/digital badge or working towards this.
- Teaching, mentorship, supervision or assessor qualification.
- Willingness to develop skills in medication review and de-prescribing
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.
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Advanced Clinical Practitioner in Harrogate employer: Selby Town PCN
Selby Town PCN is an excellent employer, offering a collaborative work culture where healthcare professionals thrive in a supportive environment. With a focus on employee growth and development, you will have access to continuous training opportunities while making a meaningful impact on patient safety and care optimisation in the community. Located in Selby, you will enjoy a fulfilling career that prioritises both professional satisfaction and work-life balance.
