Job description

Job responsibilities

Job role:

The post holder is an experienced nurse who, acting within their professional boundaries, will provide care for the presenting patient from initial history taking, clinical assessment, diagnosis, treatment and evaluation of care. They will demonstrate safe, clinical decision-making and expert care, including assessment and diagnostic skills at an advanced level, for patients within the general Primary Care Network. The post holder will demonstrate critical thinking in the clinical decision-making process. They will work collaboratively with the general Primary Care Network team to meet the needs of patients, supporting the delivery of policy and procedures. In order to work at this level, NMC requirements for advanced Primary Care Network must be met

KEY RESPONSIBILITIES

Clinical Primary Care Network

Assess, diagnose, plan, implement and evaluate treatment/interventions and care for patients presenting with an undifferentiated diagnosis

Clinically examine and assess patient needs from a physiological and psychological perspective, and plan clinical care accordingly

Assess, diagnosis, plan, implement and evaluate interventions/treatments for patients with highly complex needs

Proactively identify, diagnose and manage treatment plans for patients at risk of developing a long-term condition (as appropriate)

Diagnose and manage both acute and chronic conditions, integrating both drug- and non-drug-based treatment methods into a management plan

Prescribe and review medication for therapeutic effectiveness, appropriate to patient needs and in accordance with evidence-based Primary Care Network and national and Primary Care Network protocols, and within scope of Primary Care Network

Communication

Utilise and demonstrate sensitive communication styles, to ensure patients are fully informed and consent to treatment

Communicate with and support patients who are receiving bad news

Communicate effectively with patients and carers, recognising the need for alternative methods of communication to overcome different levels of understanding, cultural background and preferred ways of communicating

Anticipate barriers to communication and take action to improve communication

Maintain effective communication within the Primary Care Network environment and with external stakeholders

Act as an advocate for patients and colleagues

Ensure awareness of sources of support and guidance (e.g. PALS) and provide information in an acceptable format to all patients, recognising any difficulties and referring where appropriate

Delivering a quality service

Recognise and work within own competence and professional code of conduct as regulated by the governing body

Produce accurate, contemporaneous and complete records of patient consultation, consistent with legislation, policies and procedures

Prioritise, organise and manage own workload in a manner that maintains and promotes quality

Deliver care according to NSF, NICE guidelines and evidence-based care

Assess effectiveness of care delivery through self and peer review, benchmarking and formal evaluation

Initiate and participate in the maintenance of quality governance systems and processes across the organisation and its activities

Utilise the audit cycle as a means of evaluating the quality of the work of self and the team, implementing improvements where required

In partnership with other clinical teams, collaborate on improving the quality of health care responding to local and national policies and initiatives as appropriate

Evaluate patients response to health care provision and the effectiveness of care

Support and participate in shared learning across the Primary Care Network and wider organisation

Use a structured framework (e.g. root-cause analysis) to manage, review and identify learning from patient complaints, clinical incidents and near-miss events

Assess the impact of policy implementation on care delivery

Monitor and develop the performance of the GPN team in accordance with local policies

Approve the performance of the team, providing feedback as appropriate

Understand and apply legal issues that support the identification of vulnerable and abused children and adults, and be aware of statutory child/vulnerable patients health procedures and local guidance

Ensure you have skills and knowledge regarding domestic violence, vulnerable adults, substance abuse and addictive behaviour. Provide guidance and support to ensure appropriate referral if required

Personal development

Take responsibility for own learning and performance including participating in clinical supervision and acting as a positive role mode

Support staff development in order to maximise potential

Actively promote the workplace as a learning environment, encouraging everyone to learn from each other and from external good Practice

Encourage others to make realistic self-assessment of their application of knowledge and skills, challenging any complacency or actions that are not in the interest of the public and/or users of services

Critically evaluate and review innovations and developments that are relevant to the area of work

Enlist support and influence stakeholders and decision-makers in order to bring about new developments in the provision of services

Take a lead role in planning and implementing changes within the area of care and responsibility

Contribute to the development of local guidelines, protocols and standards

Maintain effective communication with those responsible for the overall commissioning and procurement process

Maintain active involvement in the planning and processes of Primary Care Network-based commissioning or similar initiatives

Market the role of the advanced nurse practitioner in general Practice

Team working

Understand own role and scope and identify how this may develop over time

Work as an effective and responsible team member, supporting others and exploring the mechanisms to develop new ways of working

Delegate clearly and appropriately, adopting the principles of safe Practice and assessment of competence

Create clear referral mechanisms to meet patient need

Prioritise own workload and ensure effective time-management strategies are embedded within the culture of the team

Work effectively with others to clearly define values, direction and policies impacting upon care delivery

Discuss, highlight and work with the team to create opportunities to improve patient care

Manage and lead on the delivery of specifically identified services or projects as agreed with the Primary Care Network and Practice management team

Agree plans and outcomes by which to measure success

Management of risk

Manage and assess risk within the areas of responsibility, ensuring adequate measures are in place to protect staff and patients

Monitor work areas and practices to ensure they are safe and free from hazards and conform to health, safety and security legislation, policies, procedures and guidelines

Ensure appropriate supervision of safe storage, rotation and disposal of vaccines and drugs

Apply infection-control measures within the Primary Care Network according to local and national guidelines

Advocate for policies that reduce environmental health risks, are culturally sensitive and increase access to health care for all

Interpret national strategies and policies into local implementation strategies that are aligned to the values and culture of general Practice.

Managing information

Use technology and appropriate software as an aid to management in planning, implementation and monitoring of care, presenting and communicating information

Review and process data using accurate Read codes in order to ensure easy and accurate information retrieval for monitoring and audit processes

Manage information searches using the internet and local library databases

Understand responsibility of self and others to the Primary Care Network and Practice regarding the Freedom and Information Act

Manage, in conjunction with the QoF team, the QoF targets or the equivalent SPQS requirements.

Learning and development

Undertake mentorship for more junior staff, assessing competence against set standards

Disseminate learning and information gained to other team members in order to share good practice and inform others about current and future developments (e.g. courses and conferences)

Assess own learning needs and undertake learning as appropriate

Provide an educational role to patients, carers, families and colleagues in an environment that facilitates learning

Establish an evidence base for practice, through benchmarking, audit, Quality Improvement and research ensuring that outcomes are disseminated locally, regionally, and nationally as appropriate.

Equality and diversity

Identify patterns of discrimination and take action to overcome this and promote diversity and equality of opportunity

Enable others to promote equality and diversity in a non-discriminatory culture

Support people who need assistance in exercising their rights

Monitor and evaluate adherence to local chaperoning policies

Act as a role model in the observance of equality and diversity good practice

Accept the rights of individuals to choose their care providers, participate in care and refuses care. Assist patients from marginalised groups to access quality care

Person Specification

Qualifications

Essential

• Registered first level nurse
• MSc or equivalent
• Independent/supplementary prescribing qualification
• Advanced specialist qualification
• Relevant nursing/health degree
• Clinical supervision training and experience

Desirable

• Mentor/teaching qualification

Experience

Essential

• Advanced clinical practice skills
• Management of patients with long-term conditions
• Management of patients with complex needs
• Clinical examination skills
• Accountability of own role and other roles in a nurse-led service
• Local and national health policy
• Clinical governance issues in primary care
• Patient group directives and associated policy
• Communication skills, both written and verbal
• Communication of difficult messages to patients and families
• Negotiation and conflict management skills
• Change management
• Resource management
• Experience
• Minimum 5 years post-registration experience
• At least 2 years recent primary / community nursing experience
• Nurse prescribing
• Nurse-led management of minor illness, minor ailments and injuries
• Nurse-led triage
• Compiling protocols and clinical guidelines
• Audit
• Research
• QI

Desirable

• Knowledge of public health issues
• Able to identify determinants on health in the area
• Knowledge of public health issues in the area
• Experience of working in Primary Care

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.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Taunton Deane West Primary Care Network

Address

Lister House Surgery

Croft Way

Wiveliscombe

Somerset

TA4 2BF

United Kingdom

Employer's website

https://tauntondeanewestpcn.gpweb.org.uk/our-primary-care-network (Opens in a new tab)

Job description

Job responsibilities

Key Responsibilities

Clinical Responsibilities

• Assess, diagnose, treat, and manage patients presenting with a range of acute, urgent, and long-term conditions.
• Undertake same-day appointments and home visits across the PCN.
• Work autonomously within agreed clinical protocols, escalating to GPs or senior clinicians where appropriate.
• Identify red flags and refer patients appropriately to secondary care, community services, or emergency services.
• Prescribe medications (where appropriately qualified and authorised) in line with local and national policy.
• Support admission avoidance and proactive patient management.
• Contribute to improved access and continuity of care within the PCN.

Multidisciplinary Team Working

• Work as an integral member of the PCN multidisciplinary team (MDT), including GPs, nurses, pharmacists, and allied health professionals.
• Participate in MDT meetings, clinical supervision, and PCN forums as required.
• Communicate effectively with individual member practices regarding patient care and service delivery.

Operational Responsibilities

• Deliver services across one of the PCN practice sites, in line with agreed rotas and service models.
• Record all patient activity accurately and contemporaneously on the clinical system - SystmOne.
• Ensure all patient contacts are appropriately coded and recorded to support ARRS reporting and funding assurance.
• Adhere to PCN and practice policies, including lone working, safeguarding, infection control, and zero tolerance.

Clinical Governance & Quality

• Maintain professional registration with the Health and Care Professions Council (HCPC).
• Work within the ARRS role scope and PCN governance arrangements.
• Participate in clinical audit, quality improvement activity, and learning events.
• Comply with information governance, safeguarding, and health & safety requirements.
• Participate in incident reporting and reflective learning.

Education, Training & Development

• Maintain ongoing Continuing Professional Development (CPD) in line with HCPC requirements.
• Participate in appraisal, supervision, and PCN development programmes.
• Support training and development of colleagues where appropriate.

Person Specification

Qualifications

Essential

• HCPC registered Paramedic
• Eligible for employment under the ARRS scheme
• Relevant post-registration clinical experience
• Ability to work autonomously and make sound clinical decisions
• Strong communication and teamwork skills
• Ability to work across multiple practice sites
• IT literate with the ability to use GP clinical systems
• Full UK driving licence and access to a vehicle
• Maintain professional competence through Continuous Professional Development (CPD) and share knowledge with PCN colleagues
• Work within own professional scope and code of conduct HCPC and College of Paramedics
• Evaluate care delivery through self and peer review and benchmarking, and audits
• Participate in research and audit cycles to improve service quality
• Collaborate with clinical teams to implement improvements aligned with local and national initiatives

Desirable

• Desirable
• Experience working in primary care or general practice
• Independent prescribing qualification
• Experience of home visiting services
• Experience working within a PCN or MDT setting

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.

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

Taunton Deane West Primary Care Network

Address

Lister House Surgery

Croft Way

Wiveliscombe

Taunton

Somerset

TA4 2BF

United Kingdom

Employer's website

https://tauntondeanewestpcn.gpweb.org.uk/our-primary-care-network (Opens in a new tab)

Job description

Job responsibilities

A QOF and Primary Care Performance

• Support Wellington Medical Centre with monitoring and improving QOF performance
• Asist with regular clinical searches and data analysis to identify patients who meet QOF criteria or require clinical review
• Produce accurate practice-level QOF reports dashboards and performance summaries
• Assist with Identify missing incomplete or inaccurate clinical coding that may affect QOF achievement or patient care
• Work with clinicians and administrative staff to improve clinical coding and data recording
• Support QOF planning monitoring validation and year-end preparation
• Maintain an up-to-date understanding of QOF requirements clinical coding and relevant primary care contractual requirements

B Data Analysis Clinical Searches and Population Health

• Extract and analyse data from EMIS Web and other approved data sources
• Undertake clinical searches to identify patients requiring reviews screening monitoring recalls follow-up or proactive intervention
• Use practice data QOF information risk stratification and population health intelligence to identify patient groups with unmet health needs
• Identify trends variations in care health inequalities and opportunities for earlier intervention
• Support proactive management of patients at risk of deterioration hospital admission or loss to follow-up
• Produce accurate reports dashboards and data summaries for clinical and management teams
• Support clinical audits service evaluations and quality improvement projects
• Provide data to support practice planning service development and decision-making
• Monitor the outcomes of interventions and use data to assess their effectiveness
• Ensure that data is accurate appropriately interpreted and presented in a clear and useful format

C Data Quality and Clinical Coding

• Monitor the quality completeness and consistency of patient data
• Identify missing inappropriate or inconsistent clinical coding
• Work with Data quality Manager and administrative teams to improve the accuracy of patient records
• Support the practice in maintaining high-quality consistent and appropriately coded clinical information
• Develop and maintain data quality reports and action plans
• Provide guidance to relevant staff on appropriate data entry and coding where required
• Identify data quality issues that may affect QOF patient safety recalls research or service planning
• Support standardisation of data collection and reporting within the practice

3 Care Coordination Navigation and Personalised Care

The post holder will undertake care coordination responsibilities appropriate to the role and in line with the PCN Care Coordinator ARRS requirements and local PCN arrangements

Patient Identification and Caseload Management

• Use clinical searches QOF data population health information and risk stratification to identify patients who may benefit from proactive care coordination
• Support the management of an appropriate caseload of patients particularly those with long-term conditions multiple health needs frailty complex needs or identified health and social care requirements
• Work with GPs nurses and other members of the multidisciplinary team to identify appropriate patients for care coordination
• Maintain accurate records of patient contacts interventions referrals care plans and outcomes
• Regularly review caseloads and escalate changes in patient needs to the appropriate clinician or MDT member

Care Navigation and Coordination

• Act as a point of contact for identified patients and help them understand and navigate available health social care and community services
• Support patients to access appropriate services including primary care community services secondary care social prescribing voluntary and community organisations and other PCN services
• Make appropriate referrals and coordinate communication between services
• Support patients before and after appointments by helping them understand agreed actions and access appropriate follow-up
• Assist with arranging appointments and other services where appropriate
• Follow up patients to establish whether referrals agreed actions or services have been accessed
• Identify barriers to accessing care and work with patients and relevant professionals to address these where possible
• Escalate clinical safeguarding or other concerns promptly to an appropriate clinician

Personalised Care and Support

• Support personalised care and support planning in collaboration with patients and the wider MDT
• Use personalised conversations to understand what matters to patients including their health wellbeing social circumstances and personal goals
• Encourage patients to participate actively in decisions about their care
• Support patients to identify realistic health and wellbeing goals
• Encourage self-management and access to appropriate health and wellbeing resources
• Signpost or refer patients to social prescribing health and wellbeing coaching and other community support where appropriate
• Promote patient independence choice and involvement in their care
• Support carers and families where appropriate and within the scope of the role
• Contribute to reducing health inequalities by identifying barriers to care and supporting appropriate solutions

4 Multidisciplinary Team Working

• Work as an integral member of the practice and PCN multidisciplinary team
• Contribute relevant patient population health and data intelligence
• Coordinate and follow up actions arising from MDT discussions
• Facilitate communication between patients clinicians practice staff PCN staff community services social care and other organisations
• Work collaboratively with GPs practice nurses clinical pharmacists Social Prescribing Link Workers Health and Wellbeing Coaches and other ARRS roles
• Develop effective working relationships with statutory voluntary community and social care organisations
• Ensure relevant information is communicated appropriately between professionals involved in a patient's care
• Contribute to a coordinated patient-centred approach to care

5 Research and Research Data

• Support approved research studies undertaken through Wellington Medical Centre and the PCN
• Identify potentially eligible patients using approved clinical searches and study criteria
• Support appropriate patient identification and recruitment in accordance with research protocols
• Undertake data searches collection validation and monitoring for approved research projects
• Maintain accurate research databases spreadsheets and study documentation
• Prepare anonymised or appropriately pseudonymised information where authorised and required
• Support patient follow-up for approved research studies where appropriate
• Monitor research recruitment data collection and project progress
• Liaise with authorised research organisations research networks and other relevant stakeholders
• Ensure research data is handled in accordance with study protocols approvals confidentiality requirements and information governance procedures
• Support research findings to inform audit quality improvement and service development where appropriate

6 Audit Quality Improvement and Service Development

• Use data and research findings to identify opportunities for improvement
• Contribute to quality improvement initiatives and evaluation of new services or pathways
• Monitor the effectiveness of interventions and report findings to the Practice Management and clinical teams
• Support the practice in developing evidence-based approaches to improve patient outcomes
• Identify opportunities to improve processes patient access service coordination and data quality
• Contribute to PCN initiatives relating to prevention early intervention and population health

7 Health Inequalities and Population Health

• Use practice data to identify groups experiencing poorer health outcomes or barriers to accessing services
• Support targeted interventions for patients identified through population health management
• Consider health inequalities when undertaking searches and developing patient cohorts
• Identify patients who may benefit from prevention early intervention or proactive care
• Work with the wider PCN and community partners to improve access to appropriate services
• Support initiatives designed to reduce health inequalities and improve health outcomes
• Monitor and report relevant outcomes where appropriate

8 Reporting and Communication

• Translate complex data into clear and practical information for clinical and non-clinical audiences
• Maintain accurate records of searches audits reports patient contacts and actions undertaken
• Assist to provide authorised data requests within agreed timescales
• Communicate effectively with clinicians practice managers administrators PCN staff research teams and external organisations
• Ensure communication with patients is clear respectful and appropriate to their individual needs

9 Information Governance and Confidentiality

• Maintain strict confidentiality when handling patient staff and organisational information
• Comply with UK GDPR the Data Protection Act NHS information governance requirements and relevant practice and PCN policies
• Only access patient-identifiable information where there is a legitimate and authorised reason
• Follow approved procedures for data extraction storage analysis and transfer
• Ensure information is anonymised or pseudonymised where appropriate
• Maintain secure records of patient and practice information
• Report actual or potential information governance breaches promptly
• Complete all mandatory information governance data security and safeguarding training

Person Specification

Experience

Essential

• Essential
• Experience working with data databases spreadsheets or information systems
• Experience using EMIS Web or another GP clinical system
• Strong analytical and numerical skills
• Excellent attention to detail and accuracy
• Good knowledge of Microsoft Excel and data reporting
• Ability to undertake searches and analyse primary care data
• Ability to identify trends discrepancies and data quality issues
• Excellent organisational and time-management skills
• Ability to work independently and manage competing priorities
• Excellent written and verbal communication skills
• Ability to communicate effectively with clinical and nonclinical colleagues
• Understanding of confidentiality and information governance
• Ability to work effectively as part of a multidisciplinary team
• Ability to communicate appropriately and sensitively with patients
• Understanding of professional boundaries and the need to escalate clinical concerns

Desirable

• Desirable
• Experience working within NHS primary care
• Experience with QOF monitoring and reporting
• Knowledge of primary care clinical coding
• Experience undertaking clinical searches and audits
• Experience in care coordination or patient navigation
• Experience supporting patients with long-term conditions or complex needs
• Experience supporting research studies or research data collection
• Knowledge of population health management
• Experience with Power BI dashboards or other data visualisation tools
• Knowledge of personalised care and support planning
• Experience working with multidisciplinary teams
• Understanding of health inequalities and social determinants of health
• Research governance or Good Clinical Practice training

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.

Employer details

Employer name

Taunton Deane West Primary Care Network

Address

Wellington Medical Centre

Mantle Street

Wellington

Somerset

TA21 8BD

United Kingdom

Employer's website

https://tauntondeanewestpcn.gpweb.org.uk/our-primary-care-network (Opens in a new tab)