Advanced Nurse Practitioner - Integrated Neighbourhood Care Team

An exciting opportunity has arisen to join a newly established Integrated Neighbourhood Care Team designed to transform care for housebound patients and residents of care homes. The service brings together multidisciplinary expertise to provide proactive, coordinated and person-centred care closer to home.

The Advanced Nurse Practitioner will play a pivotal role in reducing health inequalities, improving access to care, preventing avoidable hospital admissions, and enhancing outcomes for some of the most vulnerable members of the community. The post holder will work autonomously and collaboratively across organisational boundaries to deliver high-quality clinical care, leadership, education and service development.

The role will contribute significantly to building resilience within the neighbourhood team by supporting proactive population health management, urgent and reactive care provision, end of life care, and the development of care home and carer capability.

Identify and manage patients at risk of deterioration, hospital admission or increasing frailty

Undertake comprehensive holistic assessments for housebound patients and care home residents

Develop, implement and review personalised care and support plans

Lead case management of patients with complex long-term conditions, frailty and multimorbidity

Support anticipatory care planning, including ReSPECT discussions and advance care planning

Contribute to multidisciplinary team meetings and neighbourhood population health initiatives

Use risk stratification and population health data to identify unwarranted variation and address health inequalities

Facilitate early interventions which maintain independence and quality of life

Provide rapid clinical assessment and treatment for acutely unwell housebound patients and care home residents

Independently assess, diagnose and manage a wide range of presenting conditions

Prescribe safely and effectively within scope of practice using independent prescribing qualifications

Determine appropriate escalation, referral or admission when necessary

Support admission avoidance through timely intervention and treatment

Respond to clinical deterioration and urgent requests from care homes, carers and other healthcare professionals

Liaise closely with ambulance services, community services and secondary care colleagues

Conexus Healthcare is a community interest company and is the federation for general practice in Wakefield.

Ability to work across different settings

The role holder will be expected to work within the PCN/Primary Care as well as develop experience in a number of different settings such as care homes, long term care, palliative and end of life care, community, hospital or mental health services.

Patient Care and understanding the services provided

The role holder understands the needs of a more diverse community/patient group(s) and prioritises patient needs within the scope of the role. The role holder is able to show a level of experience and

ability to support patients, adapting communication, style and approach to meet the needs of a diversity of patient requirements and care needs with a track record of positive patient outcomes. Accesses advice and guidance from peers and supervisor on how to support patient requirement and care needs when faced with situations outside their scope of knowledge or practice.

The role holder will be a positive role model to others on how to adapt care, practices and communication styles to meet the needs of a different patient requirements and care needs within the scope of the role in order to support other support roles and the wider Multi…