The Frailty Practitioner will join the existing team, working in an integrated way with the wider MDT which currently exists to provide a pro-active service for the frail population. The Frailty Practitioner will be part of the primary healthcare multi-disciplinary team and will utilise the skills of the wider existing primary care team. Main Duties and Responsibilities 1. To complete the requested assessments for registered patients allocated to the team and maintain appropriate records of treatment given and NHS services provided; When appropriate, to make a relevant diagnosis and management plan, implement this plan and subsequently evaluate it. 2. Carry out consultations and physical assessments as requested, formulate a diagnosis and maintain high quality contemporaneous records using SystmOne. 3. The post-holder will undertake visits to care and nursing homes and the housebound as requested, assessing patients, liaising with the GPs and attending MDT meetings where possible. 4. Liaise with other members of community teams, as appropriate to individual patient needs, 5. Arrange referrals for the patient. 6. Note any possible issues with medication compliance identified during any patient contact. 7. Actively work with the wider MDT by working with, but not exclusively, the community nurses, discharge co-ordinators, elderly care teams, dieticians, tissue viability team, CPN, CRT, physio, SALT, falls prevention services. 8. Be prepared to make clinical judgement based on either provided data and noted review or both to reach a conclusion regarding whether a patient needs to be assessed by the team. 9. Evaluate MDT data to determine the need for patients to be reviewed by the team. 8. Maintain appropriate levels and means of communication ie mobile phone, professional email 9. Clinical governance will be provided by the GP partners and the lead GPs. 10. Training opportunities can be discussed when appropriate.