Proactive Care / Care Homes ANP


Company:	NHS Jobs
Salary:	Negotiable
Hours:	Full-time
Location:	Leeds, LS12 1HU
Job type:	Permanent
Posting date:	13 Aug 2026
Closing date:	11 Sept 2026

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Summary

1. Clinical Practice Deliver advanced, holistic clinical care to patients in care home settings. Identify and respond to early signs of deterioration, including escalation planning. Assess and manage acute, chronic, and complex conditions related to frailty. Prescribe and deprescribe safely within scope of practice and professional competencies. Undertake Comprehensive Geriatric Assessments to inform care planning and coordination. Order, perform, and interpret diagnostic tests and investigations. Initiate diagnosis for long-term conditions (e.g. diabetes, COPD, asthma, IHD) and refer appropriately. Directly admit patients to secondary care when clinically indicated. 2. Care Planning and Coordination Deliver proactive, anticipatory, and advance care planning using evidence-based tools (e.g. ReSPECT, EPaCCS). Undertake holistic, person-centred needs assessments and develop individual care plans. Maintain and manage a caseload of care homes patients. Collaborate with the multidisciplinary team (MDT) to develop and implement patient-specific care pathways. Proactively manage long-term conditions and support admission avoidance strategies. 3. Communication and Collaborative Working Work independently and in partnership with GPs and the wider MDT. Communicate effectively with healthcare professionals to ensure coordinated care. Build and maintain strong relationships with statutory, voluntary, and third-sector organisations. Organise, chair, and contribute to MDT meetings to support integrated care delivery. Advocate for patients and families where necessary. 4. Health Promotion and Patient Support Promote health, wellbeing, and independence for patients in care home settings. Provide education to patients and carers to support self-management and behaviour change. Support vaccination programmes within care homes. Deliver education and guidance to care home staff (e.g. nutrition, hydration, oral care, ReSPECT planning). 5. Service Delivery and Development Work flexibly across GP practices, and care homes Support Proactive Care Coordinators in delivering high-quality care. Contribute to service development and innovation in Proactive Care pathways. Participate in audits, data collection, and quality improvement initiatives. Contribute to achieving local and national targets and maintaining disease registers. 6. Administration and Governance Maintain accurate, contemporaneous patient records using EMIS and SystmOne. Ensure compliance with CQC standards and relevant policies (e.g. infection control, safeguarding, risk management). Promote safe medication management practices. Support effective communication within the PCN and across partner organisations. Contribute to contractual and reporting requirements. 7. Professional Development Maintain high standards of professional practice, conduct, and clinical excellence. Participate in appraisal processes and align objectives with organisational goals. Undertake mandatory training and continuing professional development. Keep up to date with current guidelines, policies, and contractual changes. Engage in reflective practice and lifelong learning. General Responsibilities Attend and actively contribute to team, practice, and PCN meetings. Work within all relevant policies, procedures, and professional standards. Maintain confidentiality and uphold information governance requirements. Carry out any other duties commensurate with the role. Key Working Relationships PCN Clinical Director Proactive Care Team PCN Clinical Leads GPs, Practice Managers, nurses and other practice staff. PCN teams - Clinical Pharmacists, Social Prescribers, Dietician, Health and Wellbeing Coaches. Providers of care including acute trusts, independent sector and providers, neighbourhood teams, community services, geriatricians, community matrons, community mental health services. Local Care Partnerships linked to the PCN Confidentiality Ensure that confidentiality is adhered to in terms of patient information and the protection of personal and sensitive data. Health and Safety Identify risks involved in work activities and undertake activities in a way that manages risks. Actively report health and safety hazards and infection hazards immediately when recognised. Maintenance of general standards of cleanliness consistent with the scope of the role. Equality and Diversity Act in a way that recognises the importance of peoples rights, interpreting them in a way that is consistent with PCN practice procedures and policies, and current legislation.Safeguarding Be familiar with and adhere to PCN practice safeguarding policies, procedures and guidelines for both children and adults at risk of abuse or neglect in conjunction with Multi-agency Safeguarding Children and Safeguarding Adults at risk of abuse and/or neglect policy, protocols, and guidelines.

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