PCN Frailty Home Visiting Nurse

Our Frailty Service is a multidisciplinary one for those over 65 years of age who demonstrate two or more of the five frailty indicators (including falls, immobility, incontinence, delirium, medication side effects susceptibility). These patients are comprehensively assessed in their own home (or care home) following which a bespoke patient centred care plan will be created. The intention is to either improve or maintain their level of health and wellbeing and also to enable them to remain as independent as possible in their own residence. The Frailty Team does not carry a caseload; each referral is classed as an intervention. Following review from the Frailty Team the patient care is handed back to their GP practice. Each patient is assessed for falls prevalence and has their medications reviewed. An independent prescriber would be an advantage for this role but it is not essential as other members of the team can issue medication You will attend weekly MDT meetings with a consultant
geriatrician hosted by our frailty team to discuss the most complex patients who have regular home visits. You will also closely liaise with the wider PCN team as needed in order to deliver a truly holistic healthcare service. The successful candidate will need to be passionate about improving patient health outcomes Please see uploaded Job Specification document for full list