Main Duties and Job Responsibilities Undertake clinical nursing practice using knowledge and clinical skills to deliver holistic care to people accessing primary healthcare services, including home visits. Refer patients as appropriate to other members of the MDT, secondary care and other statutory and voluntary organisations. Make clinical judgements appropriate to the expectations and demands of the job. Offer a holistic service to patients and their families/ carers in conjunction with the wider multi-disciplinary team; developing where appropriate and on-going plan of care/ support, with an emphasis on prevention and self-care Complete memory assessments Complete frailty and dementia reviews Respond to sudden changes in health or social circumstance Present complex issues at the multi-disciplinary meetings and chair if necessary Be aware of, and contribute to planning and delivery of service, promoting integrated and seamless pathways of care. Work and adhere to evidence based practice, recognised clinical guidelines and practice policies. Advise, support and mentor other members of the clinical team. Effectively manage own time, workload and resources. Identify safeguarding concerns and make referrals as appropriate Administration and professional responsibilities: Participate in the administrative and professional responsibilities of the practice team Ensure accurate and contemporaneous notes of all consultations and patient contacts are recorded. Ensure QOF templates are completed accurately. Ensure accurate completion of all necessary documentation associated with patient health care and registration with the practice Attend and participate in practice/nursing meetings as required.