Are you passionate about improving the lives of frail older adults? Join our new Community Frailty Ward as a Frailty Practitioner!
In this rewarding role, you will complete frailty assessments and manage complex care for frail patients. Your expertise in physical assessments, diagnostic reasoning, and polypharmacy management will help prevent unnecessary hospital admissions and prolonged stays.
You will work with a multidisciplinary team to provide high-quality care across a 7 day service, supporting in the completion of Comprehensive Geriatric Assessments (CGA), and create treatment plans for patients facing crises or exacerbations of long-term conditions to prevent unwanted hospital admissions. You will also deliver frailty education to patients, families, and professionals.
Key Responsibilities:
* Conduct frailty assessments and manage care for older adults with complex medical needs
* Provide advice to patients, families, and the MDT
* Address polypharmacy issues and conduct medication reviews
* Facilitate coordinated assessments and treatment plans
* Contribute to the Ageing Well MDT and support Livewell community teams
What You will Bring:
* Expertise in frailty, CGA, and clinical reasoning
* Strong leadership and autonomy in a multidisciplinary team
* Ability to deliver education and empower others in frailty care
* Passion for improving patient outcomes and reducing hospital admissions
Join us and make a lasting impact in community healthcare. We would love to hear from you!
Main duties of the job
The Frailty Practitioner for the Frailty Virtual Ward will support the delivery of frailty education to colleagues, students & service users. You will lead people management tasks, including staff engagement, workforce planning, performance management, & training, with operational leads' support. As a clinical leader, you will complete CGA's, manage complex care plans & provide advice to the multidisciplinary team (MDT).
Key responsibilities include managing referrals, ensuring case finding, initiating person-centred care plans & facilitating early discharge to prevent unnecessary hospital admissions. You will provide mentorship, supervision, appraisals & support practice supervision. Participation in service development, policy compliance, resource management & budget support are essential.
You will collaborate with professionals to enhance care pathways, lead clinical audits & contribute to policy development. Strong communication skills are necessary for managing sensitive patient situations & fostering relationships with patients, carers, & professionals. Additionally, you will contribute to research, support safeguarding & engage in ongoing personal development.
Additional duties include managing staff safety, adhering to infection control protocols & reducing environmental impact. This role requires a proactive, adaptable professional committed to high standards of care.
Job description
Job Title: Frailty Practitioner Band: Band 7 Locality: Adult Frailty and Specialist Services Base: Community Settings Responsible to: Integrated Operational Lead
Job Purpose:
The Frailty Practitioner leads on frailty care within community integrated teams. They use their expertise in physical and diagnostic assessments, medication reviews, and geriatric assessments (CGA) to help prevent hospital admissions and improve care for frail older adults. The role involves providing specialist advice, case management, and supporting multidisciplinary teams in comprehensive geriatric assessments.
Main Duties & Responsibilities:
People Management:
* Plan and deliver frailty education programs for community team members, students, service users, and professionals.
* Manage staff tasks, including communication, appraisals, training, and performance management.
* Function as a clinical mentor and role model, supporting staff and students.
* Offer support in handling complaints and incidents, ensuring work is appropriately delegated to the multidisciplinary team (MDT).
Financial & Physical Resources:
* Ensure efficient resource usage and assist with budget management, forecasting, and cost control.
* Provide support in developing business cases and monitor skill mix for the team.
* Manage the provision and safety of equipment in line with policies.
Administration:
* Manage time effectively to balance patient care and non-clinical duties.
* Maintain accurate, confidential records, using paper or IT systems as specified in organizational policies.
* Participate in managing referrals and liaise with operational leads to support service delivery.
People Using Our Services:
* Perform comprehensive geriatric assessments, collaborating with the MDT to support frail patients.
* Lead advanced care planning and ensure the proper documentation of care plans and treatment escalation.
* Provide clinical case management to prevent unnecessary hospital admissions and readmissions.
Policy & Service Development:
* Lead or participate in audits and service improvement activities.
* Develop and implement policies and protocols to improve patient care and outcomes.
* Comply with national standards and guidelines, supporting the organization in maintaining high-quality care and compliance with Care Quality Commission (CQC) standards.
Other Responsibilities:
* Develop competencies toward becoming an Independent Prescriber if appropriate for the profession.
* Participate in the annual appraisal process, ensuring ongoing learning and development.
* Work within professional and organizational standards, ensuring evidence-based practice.
Communications & Relationships:
* Maintain strong relationships with multidisciplinary professionals and non-professionals.
* Ensure effective communication through appropriate forums, respecting patient confidentiality.
* Communicate sensitive information to patients, carers, and colleagues in a professional and compassionate manner.
Physical & Mental Demands:
Physical Demands:
* Moderate physical effort is required, including moving furniture in patient homes and transporting equipment.
* Daily driving and potentially working in adverse weather conditions.
Mental Effort:
* Regularly performing complex assessments and prioritising tasks in response to urgent care needs.
* Handling interruptions and managing time-sensitive situations.
Working Conditions:
* Exposure to bodily fluids, poor hygiene, and potential exposure to communicable diseases.
* Potential for encountering verbal and physical aggression, particularly in home visits.
Additional Information:
* The post holder must adhere to all organizational policies and participate in mandatory training, including safeguarding and infection control.
* The role may involve engagement in research or audits, supporting sustainability and climate change initiatives.
* The job description is subject to review at least annually and may be updated in consultation with the postholder.
Risk Management, Health & Safety, and Safeguarding:
* The role includes active participation in risk management, adhering to safety policies, and safeguarding children and adults.
* Regular updates on health and safety practices, infection control, and safeguarding policies are required.
Sustainability & Climate Change:
* Employees are encouraged to reduce carbon emissions and contribute to sustainability efforts within the organisation.
Other:
* The position requires adherence to the Working Time Regulations, with no staff expected to work over 48 hours per week unless in exceptional cases.
Compliance with the organisation's no smoking and no alcohol policies is mandatory
Person Specification
Knowledge
Essential
* Knowledge of Community Services/Third sector services suitable for frail patients
* Knowledge and understanding of legislation relevant to practice
* Experience of using electronic patient / service user record systems
* Understanding of frailty syndromes
Skills
Essential
* Ability to develop effective interpersonal relationships with colleagues in an MDT setting.
* Ability to communicate in a variety of settings with patients of varying levels of understanding.
* Ability to communicate unpleasant and sensitive information.
* Able to manage own workload, plan the work of others and work autonomously
* Logical and good at problem solving.
* Operational/organisational skills and ability to work and prioritise and work under pressure
* Demonstrable knowledge of assessment and therapeutic interventions in area of specialism
* Skills and experience of developing specialist programmes of care for an individual or groups of patients/clients and of providing highly specialist advice
* Skills for assessing and interpreting specialist patient/client conditions in order to make a clinical judgement regarding diagnosis and interventions.
* Skills to develop and deliver educational packages in frailty across the MDT
* Able to overcome barriers to understanding where there are physical or mental disabilities
* Ability to develop role to meet the changing needs of the service
* Ability to work across community locations in Plymouth, South Hams and West Devon
Qualifications
Essential
* Registered practitioner
* Professional knowledge acquired through degree supplemented by post graduate diploma with significant relevant experience.
* Specialist training and experience, short courses plus further specialist training
* Membership of the relevant Professional Body
* Evidence of recent professional development in an up-to-date portfolio
* Leadership and management qualification/training or evidence of experience in this area
* Independent prescriber
Desirable
* Teaching qualification
* Additional clinical qualifications in Frailty/Older Persons Care
Experience
Essential
* Proven relevant post registration experience
* Experience of the management of patients living with frailty (predominantly older people)
* Experience of cross system and Multi Disciplinary Team working
* Experience in managing teams.
* Experience in designing training packages relevant to role
* Previous experience/delivery of formal/informal teaching of patients and staff
Employer details
Employer name
Livewell Southwest
Address
200 Mount Gould Road
Mount Gould
Plymouth
Devon
PL4 7PY
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