Advanced Clinical Practitioner for Proactive Care & Clinical Lead
| Company: | NHS Jobs |
|---|---|
| Salary: | £57,528 to £64,750 a year |
| Hours: | Full-time |
| Location: | Leeds, LS14 6NX |
| Job type: | Permanent |
| Posting date: | 11 Sept 2026 |
| Closing date: | 27 Sept 2026 |
Summary
Key responsibilities of the Role Provide expert advanced clinical practice for people living with frailty, multimorbidity, complex needs and high risk of deterioration or avoidable hospital admission. Lead the clinical and operational delivery of the PCN Proactive Care Team and ensure safe, effective and coordinated working across PCN practices and community settings. Lead implementation and delivery of the Proactive Care Programmes, including cohort identification, holistic assessment, personalised care planning, named care coordination and outcome monitoring. Lead care home Enhanced Health in Care Homes activity, ward rounds and MDT working in collaboration with practice GPs, ACPs, care home teams, pharmacists and community services. Develop Cross Gates PCNs neighbourhood health model by strengthening integration, coordination and communication between primary care, community services, mental health, social care, public health, housing and the voluntary sector. Use population health management and clinical judgement to target those with greatest unmet need and address health inequalities and wider determinants of health. Promote prevention, early intervention and proactive care to reduce deterioration, crisis, unnecessary use of reactive services and avoidable hospital admission. Outline of the Post 1. Advanced Clinical Practice Advanced assessment and treatment: Independently assess, examine, investigate, diagnose and treat patients with complex, undifferentiated, acute and deteriorating presentations in care homes and patients homes. Independent prescribing: Prescribe, deprescribe and optimise medicines within professional scope, evidence based guidance and local pathways. Frailty and complex care: Manage frailty, multimorbidity, polypharmacy, cognitive decline, dementia, long term conditions and complex social circumstances using a holistic, person centred approach. Care-home and home visiting: Lead care home ward rounds, urgent home visits, proactive frailty reviews, anticipatory care planning and escalation planning, working closely with practice clinical teams. Admission avoidance: Recognise deterioration early, coordinate timely intervention and maximise safe alternatives to hospital where clinically appropriate. Prevention and Vaccination: Actively support the planning and delivery of seasonal vaccination programmes for care home, housebound and proactive care cohorts, working with Clinical Care Coordinators and PCN clinicians to improve uptake, prevent avoidable illness and reduce the risk of deterioration and hospital admission. 2. Proactive Care and Population Health Population health management: Use population data, practice intelligence and clinical judgement to identify and prioritise people at greatest risk of deterioration or avoidable admission. Personalised proactive care: Ensure holistic assessment, personalised care planning, named care coordination and appropriate step-up and step-down of support for the proactive care cohort. Health inequalities: Target people with greatest unmet need and address wider determinants including housing, debt, isolation, carer pressures and barriers to accessing care. Prevention: Embed early intervention, self-management, health coaching, social prescribing and community support to help people maintain independence and wellbeing. 3. Clinical Leadership and Team Management Clinical leadership: Provide visible senior clinical leadership for the PCN Proactive Care Team and act as an expert resource for complex clinical and professional decision-making. Operational management: Lead the day to day clinical and operational management of the proactive care team, including workload, caseloads, job planning and delivery against priorities. Supervision and development: Provide clinical supervision, appraisal support, mentoring and workforce development, ensuring staff work within competency, professional and governance frameworks. Quality and safety: Lead clinical governance, risk management, incident learning, safeguarding, audit and continuous improvement across the service. 4. MDT and Neighbourhood Working MDT leadership: Chair and clinically lead proactive care and care home MDTs, ensuring clear ownership, timely actions, escalation and follow-up. Integrated neighbourhood working: Build effective working relationships across primary care, geriatric medicine, LCH community services, respiratory and cardiology teams, mental health, Adult Social Care, Linking Leeds, Housing, the Local Care Partnership and voluntary/community organisations. System leadership: Support the PCN Clinical Director, GP Lead and PCN Manager to develop neighbourhood health and represent the PCN in relevant partnership forums. 5. Service Development and Delivery Proactive Care: Lead delivery of the Proactive Care Programmes / Pilots, including service standards, coding, data quality and contractual requirements. Enhanced Health in Care Homes: Oversee delivery of care home enhanced care, ward rounds, proactive reviews and coordinated MDT support. Outcomes and performance: Monitor agreed activity and outcomes, including proactive care numbers, unplanned care use and patient experience. Transformation: Lead pathway redesign and service development across prevention, proactive and reactive care, testing new ways of working and integrating specialist support into neighbourhood teams. 6. Communication, Education and Professional Practice Communication and influence: Communicate complex and sensitive information effectively, facilitate shared decision making and influence across organisational boundaries. Education and learning: Provide teaching, mentorship, promote evidence based practice and support research, service evaluation and quality improvement. Professional practice: Maintain advanced clinical competence, CPD, supervision, appraisal and professional registration, revalidation requirements, and practise in line with relevant legislation, professional standards and organisational policies.