Clinical Lead Nurse for Diabetes Neigbourhood Health Programme


Company:	NHS Jobs
Salary:	£49,387 - £56,515
Hours:	Full-time
Location:	Leeds, LS14 1HX
Job type:	Permanent
Posting date:	22 Aug 2026
Closing date:	13 Sept 2026

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Summary

The Clinical Lead Nurse for Diabetes is a senior clinical role within the Tier 2 Neighbourhood Support Team. The postholder holds a patient-facing caseload, delivering advanced diabetes nursing care in complex multimorbidity as an autonomous clinician. Responsibilities include insulin and injectable initiation and titration; use of CGM and Flash Glucose Monitoring data for titration; delivery of structured education; joint visits with district nursing for assisted insulin; contribution to the Tier 2 MDT and weekly Tier 3 MDT (combined with the LTHT community diabetes MDT); joint clinics with Practice Diabetes Leads; TARGET education across Tier 1; Advice and Guidance to primary care within 24-hour urgent and one-week routine SLAs; clinical leadership and supervision of nursing colleagues; and active outreach to people in deprivation deciles 1 to 3 and named priority groups. Contribution to service development, quality improvement and equity of diabetes care. Purpose of the role The Clinical Lead Nurse for Diabetes is a senior clinical role within the Tier 2 Neighbourhood Support Team of the Diabetes Neighbourhood Health Programme a new integrated model of care for adults aged 1867 with diabetes (any type) and two or more other long-term conditions, delivered across the Beeston and Middleton & Hunslet PCN footprint and expanding across the Multi-Neighbourhood over the three-year development period. The role is patient-facing, holds an active caseload within the Tier 2 cohort, and delivers advanced diabetes nursing care across injectable therapy, structured education and complex multimorbidity. The postholder is a core participant in the Tier 2 MDT and the weekly Tier 3 MDT (combined with the existing LTHT community diabetes MDT), provides Advice and Guidance to primary care, leads joint clinics with the Practice Diabetes Lead in each footprint practice, and drives workforce development across Tier 1 and Tier 2 through quarterly TARGET education. Active outreach and engagement with deprivation deciles 13 and named priority groups (people with learning disability, serious mental illness, those homeless or vulnerably housed, those who smoke or use substances, adults living alone) is a core expectation of the role. The postholder is expected to work in a person-centred, trauma-informed way, with a working understanding of the wider social determinants of health. Key duties and responsibilities Advanced diabetes nursing and injectable therapy Advanced clinical assessment and consultation with patients on the Tier 2 caseload, including remote and asynchronous consultation. Insulin initiation, titration and ongoing management across all regimens basal, biphasic, basal-bolus including remote support by phone and asynchronous tools. Subcutaneous GLP-1 receptor agonist initiation, titration and ongoing management (oral GLP-1 and GLP-1 / GIP formulations are prescribed at Tier 1). Use of Continuous Glucose Monitoring (CGM) and Flash Glucose Monitoring data for titration, escalation and shared decision-making. Joint visits with district nursing for patients requiring assisted insulin administration. Delivery of structured diabetes education DAFNE, DESMOND, Confidence with Carbohydrates or equivalent, and pre-conception / pre-pregnancy education where relevant. Non-Medical Prescribing within scope of practice (post-holders holding V300); clear escalation to Tier 2 Pharmacist or Tier 3 Consultant colleagues for complex prescribing decisions. Recognition of and appropriate response to acute deterioration, including sick-day rules education, hypo unawareness identification and referral to Tier 3 or Tier 4 as required. Care coordination and complex multimorbidity Holding and managing an active caseload within the Tier 2 cohort, with responsibility for planning, delivering and evaluating patient-centred nursing care. Care coordination across the Tier 2 team who holds the patient list, how follow-up cadence is decided, and how patients move safely between tiers. Contribution to the Tier 2 approach to cardio-renal-metabolic multimorbidity, working alongside the Specialist Pharmacist, Specialist Dietitian, Specialist Podiatrist and Registered Nurse development post. Recognition of psychological, social and mental health needs affecting engagement and self-management with liaison into mental health, learning disability, homelessness and substance-use services. Reconciliation of care following discharge from hospital or transfer from other services, working with community pharmacy and hospital teams to ensure continuity. MDT participation and clinical decision-making Active participation in the Tier 2 MDT fortnightly for complex / high-risk cases and 812 weekly for moderate-risk cases. Weekly attendance and active contribution to the Tier 3 Clinical Oversight Group MDT, combined with the existing LTHT community diabetes MDT. Presenting cases, drafting shared care plans and taking responsibility for nursing-related actions arising from MDT discussion. Escalation to Tier 4 for pump / hybrid closed loop, DKA / HHS follow-up, high-risk foot MDT, antenatal diabetes and other specialist pathways as required. Advice & Guidance and joint clinics with primary care Provide Advice and Guidance to primary care within agreed SLAs 24 hours for urgent enquiries, one week for routine for clinical questions beyond the Tier 1 remit and short of MDT escalation. Lead quarterly joint clinics with the Practice Diabetes Lead in each footprint practice, on the model described in the Programme Education, Training and Support Plan. Deliver nursing content within the quarterly TARGET education sessions for Practice Diabetes Leads, cascading learning into wider practice teams. Support Practice Diabetes Leads to cascade learning through practice clinical meetings. Outreach, equity and engagement Active recruitment and engagement from deprivation deciles 13, with DNA monitoring and proactive approaches to reduce DNAs. Outreach to named priority groups people with learning disability, serious mental illness, those homeless or vulnerably housed, those with substance-use co-morbidity, adults living alone. Flexible appointment access including evening, digital and asynchronous options; home visits where clinically indicated. Liaison with mental health teams for patients with SMI and antipsychotic-induced metabolic disturbance. Liaison with drug and alcohol services and homelessness services. Workplace engagement and reasonable-adjustment support via Healthy Working Lives. Working in partnership with third-sector and asset-based community delivery partners as active collaborators, not downstream referrals. Nursing quality, safety and improvement Work to NMC Code and professional standards; ensure practice, and that of colleagues, is grounded in evidence-based theoretical and practical knowledge. Identify cohorts of patients at high risk of harm through structured searches (EMIS / SystmOne) and act on findings. Contribute to clinical audit within the Tier 2 caseload and across the Programme; feed back results and implement changes with the Tier 2 team, Practice Diabetes Leads and the Tier 3 Clinical Oversight Group. Contribute to the Programme's outcomes and evaluation framework, particularly on nursing-related outcomes, safety indicators and equity of access. Comply with the organisations Infection Prevention and Control requirements, including bare below the elbows dress code. Leadership, supervision and workforce development Provide clinical leadership on diabetes nursing practice within the Tier 2 Neighbourhood Support Team. Provide supervision and mentorship to the Registered Nurse development post, and to less experienced colleagues within scope. Act as a role model to all staff, ensuring a professional service and image is maintained at all times. Contribute to workforce development plans across Tier 1 and Tier 2 nursing, in partnership with the Tier 3 Diabetes Matron and the wider Tier 3 group. Practice supervisor / educator role for pre-registration and post-qualification nursing learners as required. Effective and efficient use of clinical resources (staff, supplies) within own sphere of responsibility. Service development Contribute nursing advice for the development and iteration of the Diabetes Neighbourhood Health Programme model including step-up / step-down criteria, pathway design, and operational standards. Contribute to Year 2 and Multi-Neighbourhood expansion planning. Analyse, interpret and present nursing and outcomes data to highlight issues, opportunities and risks to support programme decision-making. Collaborative working relationships Work collaboratively with the Tier 2 clinical lead, Programme Manager, and the Tier 3 Clinical Oversight Group. Maintain strong relationships with PCN Clinical Directors, Practice Diabetes Leads and practice nursing teams across the footprint. Liaise with the Leeds ICB, LCH, LTHT and neighbouring GP federations for consistency of patient care. Engage with the Leeds diabetes nursing network and other diabetes special interest groups for peer support. Liaise with LCH community diabetes teams, LTHT specialist diabetes services, community pharmacy, mental health services, drug and alcohol services, and VCSE partners as required. Foster and maintain strong links with all services across the multi-neighbourhood footprint. Please see attached job description for more info

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