Advanced Nurse Practitioner (ANP) – Frailty Team Lead | Welby Group – Cleveland Surgery

Advanced Nurse Practitioner (ANP) – Frailty Team Lead

Location: Primary Care Network (PCN) / Community

Reports to: PCN Clinical Director / Business Development Manager

Contract: 37.5 hours per week, 18-month fixed-term

Job Overview

We are looking for a motivated and experienced Advanced Nurse Practitioner (ANP) to lead our innovative Frailty Team. This is an exciting opportunity to shape and deliver proactive, high-quality care for individuals with mild to moderate frailty across our Primary Care Network (PCN). The role combines clinical leadership, autonomous practice, care coordination, and multi-agency collaboration. You’ll be at the forefront of delivering patient-centred, preventative care within community settings and will play a vital role in driving service improvement.

Key Responsibilities

• Lead the PCN Frailty Team and champion evidence-based interventions.
• Conduct comprehensive geriatric assessments using appropriate tools.
• Develop and deliver individualised care plans based on clinical need and patient goals.
• Provide independent prescribing for frailty-related conditions within scope of practice.
• Monitor medication use and adjust treatment plans as required.
• Work closely with GPs, Occupational Therapists, Care Coordinators, Social Prescribers, and community nursing teams.
• Attend and lead MDT meetings and case reviews.
• Support patients and families in understanding and managing frailty.
• Promote lifestyle and self-management strategies to optimise health and independence.
• Identify patients in need of palliative support and facilitate advance care planning discussions.

Operational & Governance Responsibilities

• Ensure compliance with local and national frailty care guidelines.
• Maintain high-quality documentation and accurate coding of frailty status.
• Contribute to the development and implementation of frailty pathways within the PCN.
• Actively participate in audit and quality improvement initiatives.
• Track and report KPIs including patient outcomes, frailty identification and coding accuracy, and intervention effectiveness.
• Provide monthly reports and lead regular team meetings.

Professional Development

Engage in ongoing CPD activities related to frailty and older adult care. Act as a clinical mentor within the frailty team and wider PCN.

Person Specification

Essential:

• Registered Nurse with current NMC registration.
• MSc Advanced Clinical Practice or equivalent.
•  Independent Prescriber.

• Proven experience working with older adults or in frailty services.
• Ability to work autonomously and collaboratively.
• Strong leadership and communication skills.

Desirable:

• Experience in service development and quality improvement.
• Familiarity with frailty assessment tools (e.g., Rockwood, eFI).
• Knowledge of community and social care pathways.

How to Apply

To apply, please submit your CV and covering letter to: grace.bowker@nhs.net

Closing date : 8^th May 2025