Frailty Community Specialist Nurse

NHS; Sunderland; On-site; GBP 30,000 - 40,000; Full time

Job summary

A national healthcare service in Sunderland is seeking a dedicated Frailty Community Specialist Nurse to improve healthcare for the ageing population. This role involves collaborating with multidisciplinary teams to develop care plans and provide clinical assessments for frail patients. Candidates should be professionally registered nurses with experience in varied clinical settings, strong communication skills, and a level 7 qualification in long-term conditions. Join a supportive organization committed to enhancing patient care and promoting innovation.

Benefits

33 days annual leave

Gold Award for Better Health at Work

Not-for-profit organization fostering better services for patients

Qualifications

• Extensive experience in caring for patients across various clinical settings.
• Experience in innovation and change management.
• Understanding of health promotion and counselling.

Responsibilities

• Collaborate with multidisciplinary teams to develop care plans for frail patients.
• Conduct thorough geriatric assessments for the ageing population.
• Provide expert management of conditions associated with frailty.

Skills

Advanced communication skills

Problem-solving skills

Decision-making skills

Clinical assessment

Education

Professionally Registered Nurse

Current registration with NMC

Level 7 qualification in long-term conditions

Independent/Supplementary Prescribing (V300)

Job description

Are you ready to be at the forefront of addressing the challenges posed by our frail and ageing population and make a lasting impact on the NHS?

We are seeking a dedicated and passionate Frailty Community Specialise Nurse to join our dynamic team and work closely with Primary Care Networks, integrating with the wider community nursing teams. As a Frailty Nurse, you will play a vital role in improving patient outcomes and shaping the future of healthcare provided to our ageing population.

Frailty is a long‑term condition and a clinically recognised state of increased vulnerability among older adults. With an increasingly ageing population, Primary Care Networks and Sunderland Community Nursing Teams are joining forces to develop an integrated frailty team.

Advanced communication, problem‑solving and decision‑making skills will be used to assess and provide on‑going patient care. Working within local and nationally agreed protocols and guidelines, the Frailty Nurse exercises independent judgement to assess, investigate, diagnose, plan, implement and evaluate the clinical care and management of community patients.

The post holder will be part of a team that leads non‑medical models of care across primary and community‑based settings, including care homes and within community teams. The Frailty Nurse will play a crucial role in step‑up, step‑down and proactive care through timely assessment, referral, responsive intervention and care planning.

Main duties of the job

Brief Responsibilities:

• Collaborate with Primary Care Networks and a diverse multidisciplinary team to develop and implement comprehensive care plans for frail patients.
• Work closely with the wider Frailty Team such as the Frailty Advanced Clinical Practitioners, Community Frailty Team, Social Prescribing, Social Workers and General Practice Teams.
• Conduct thorough geriatric assessments to identify the unique physical, cognitive, and psychosocial needs of the ageing population.
• Provide expert clinical assessment and management of complex medical conditions associated with frailty, including falls, polypharmacy, and cognitive impairment.
• Support the development of and implement innovative strategies to optimise care and enhance the well‑being of frail patients, all while considering the impact on the NHS.

Support primary care practices in identifying and managing patients at risk of frailty, and proactively intervene to prevent complications, playing a lead role in the MDT focussing on ageing well and frailty.

Foster effective communication and coordination between primary care, community services, and secondary care services to ensure seamless patient care.

About us

For the second year in a row, Sunderland Alliance has been listed in The Sunday Times Best Places to Work and Better Health At Work – Gold Award, offering 33 days annual leave plus many other benefits.

Sunderland GP Alliance is owned by the GP Practices of Sunderland and helps GPs work collaboratively for the benefits of patients and staff. We are a not‑for‑profit organisation, ensuring any surplus is reinvested back into better services for patients.

Person Specification

Experience

• Extensive experience in caring for patients across a wide variety of clinical settings
• Experience of Innovation and change management
• Understanding of health promotion and counselling
• Experience in applying research findings to practice
• Experience of providing clinical supervision in practice

Qualifications

• Professionally Registered Nurse
• Current registration with NMC
• Level 7 qualification in a long‑term condition, Older Person's Course or Public Health Course (not including the District Nursing course)
• Independent/Supplementary Prescribing (V300) or a willingness to undertake the course
• Clinical skills or a willingness to undertake the course

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.