Advanced Nurse Practitioner (Frailty and Proactive Care)
The Advanced Nurse Practitioner (ANP) for Frailty and Proactive Care will provide expert clinical leadership and advanced practice to provide more joined‑up care for high‑priority cohorts through integrated neighbourhood teams (INTs), with a focus on delivering proactive support for people with frailty and long‑term conditions.
Main duties of the job
The post holder will work across Bradford City PCN4 practices and within community settings to identify, assess and manage patients with moderate to severe frailty, helping them remain independent and avoid unnecessary hospital admissions.
The role will focus on proactive care, comprehensive geriatric assessment, anticipatory care planning, multidisciplinary team working and care for patients with declining health.
The post holder will work autonomously within their scope of practice, undertaking advanced clinical assessments, diagnosis, treatment and prescribing where appropriate.
About us
Bradford City Primary Care Network 4 (PCN4) is a network of Bradford City Practices working collaboratively across the network area to look after the health of our local population. The PCN comprises 5 local Practices with a total population of around 48,000 registered patients.
Job responsibilities
Clinical Practice
- Undertake advanced clinical assessment of patients with frailty, complex needs and multiple long‑term conditions.
- Provide holistic assessment including physical, psychological, functional and social needs.
- Undertake Comprehensive Geriatric Assessments (CGA).
- Diagnose and manage acute and chronic conditions within professional competence.
- Independently prescribe medication where qualified and appropriate.
- Develop personalised care and support plans.
- Complete anticipatory care planning and advance care planning discussions.
- Undertake home visits for housebound and vulnerable patients.
- Support care home residents through regular clinical reviews.
- Identify patients at risk of deterioration, admission or crisis and implement preventative interventions.
- Participate in multidisciplinary case‑management meetings.
Frailty and Proactive Care
- Lead the identification of patients living with moderate and severe frailty using risk stratification tools and clinical judgement.
- Support delivery of PCN proactive care and personalised care programmes.
- Develop pathways for frailty management and prevention.
- Support falls prevention initiatives and medication reviews.
- Coordinate care for patients with complex needs and frequent hospital admissions.
- Work collaboratively with community services to reduce avoidable admissions and improve patient outcomes.
- Promote healthy ageing and independence.
Leadership and Service Development
- Provide clinical leadership for integrated services across the PCN.
- Support service redesign and quality improvement initiatives.
- Participate in audit, evaluation and service development projects.
- Support implementation of local and national priorities relating to frailty.
- Contribute to workforce development and training of other healthcare professionals.
Partnership Working
- Work collaboratively with GPs, Clinical Pharmacists, Social Prescribers, Care Coordinators, Community Nurses, Therapists and Social Care teams.
- Attend multidisciplinary team meetings and neighbourhood team meetings.
- Develop effective relationships with secondary care, community providers, voluntary sector organisations and care homes.
- Support integrated working across organisational boundaries.
Clinical Governance
- Maintain accurate and contemporaneous clinical records.
- Work within NMC Code, professional standards and local policies.
- Participate in clinical audit and quality improvement activity.
- Maintain mandatory training and continuing professional development.
- Support safeguarding processes for adults at risk.
- Contribute to incident reporting and learning.
Person Specification
Knowledge and Skills
- Advanced clinical assessment and diagnostic skills.
- Knowledge of frailty syndromes and management.
- Understanding of Comprehensive Geriatric Assessment.
- Knowledge of personalised care and anticipatory care planning.
- Understanding of safeguarding adults.
- Excellent communication and interpersonal skills.
- Ability to work independently and manage competing priorities.
- Ability to influence and lead change.
Experience
- Significant experience working as an Advanced Nurse Practitioner.
- Experience managing people with frailty and multiple long‑term conditions.
- Experience of autonomous clinical decision making.
- Experience undertaking home visits.
- Experience of multidisciplinary team working.
- Experience of clinical assessment and diagnosis of complex patients.
- Experience working within Primary Care.
- Experience supporting care homes.
- Experience of service development and quality improvement.
- Experience of Comprehensive Geriatric Assessment.
Qualifications
- Registered Nurse with current NMC registration.
- MSc Advanced Clinical Practice or equivalent advanced practice qualification.
- Evidence of ongoing professional development.
- Qualification in Frailty, Gerontology or Older Persons Care.
Personal Attributes
- Compassionate and patient‑centred.
- Highly motivated and proactive.
- Flexible and adaptable.
- Strong team player.
- Professional and approachable.
- Committed to reducing health inequalities and improving outcomes.
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.
Depending on experience. Full Time (minimum of 30 hrs per week) or job share.
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