PCN Advanced Practitioner

Job description

Job responsibilities

Home Visiting and Clinical Assessment

• Undertake planned and urgent home visits to patients who have been clinically assessed as requiring care at home.

• Independently assess patients presenting with undifferentiated and potentially complex clinical conditions, within the postholder's agreed scope of competence.

• Obtain comprehensive clinical histories and undertake appropriate physical examinations.

• Use advanced clinical reasoning and diagnostic skills to identify potential diagnoses and formulate appropriate management plans.

• Recognise and respond promptly to signs of serious illness, acute deterioration and medical emergencies.

• Assess and manage a range of acute presentations, including respiratory infections, urinary tract infections, exacerbations of chronic conditions, dehydration and other common presentations encountered in primary care.

• Assess frail and elderly patients with multiple comorbidities and complex health or social care needs.

• Assess patients following falls, considering injuries, underlying causes, mobility, medication and environmental risks.

• Request and interpret appropriate diagnostic investigations where authorised and clinically indicated.

• Initiate appropriate treatment, including medicines, within prescribing qualifications and professional competence.

• Arrange timely follow-up, onward referral or escalation to a GP, community service or secondary care provider when required.

• Provide clear clinical safety-netting advice to patients, relatives and carers.Urgent Care and Admission Avoidance

Urgent Care and Admission Avoidance

• Assess patients with acute illness or deterioration to determine the appropriate level and setting of care.

• Identify opportunities to provide safe treatment and monitoring at home rather than arranging hospital admission.

• Liaise with urgent community response teams, hospital services, community nursing teams and other healthcare providers.

• Recognise situations requiring urgent hospital assessment or emergency ambulance attendance and arrange escalation without delay.

• Support appropriate discharge planning and follow-up for patients recently discharged from hospital.

• Ensure admission avoidance decisions are based on individual clinical need, patient safety and informed decision-making.

Frailty, Long-Term Conditions and Palliative Care

• Undertake holistic assessments of patients with frailty, multiple long-term conditions or declining functional ability.

• Identify changes in physical, cognitive or functional health that may require further intervention.

• Review clinical needs and contribute to personalised care plans.

• Support the identification and management of patients requiring enhanced community support.

• Contribute to anticipatory care planning and appropriate discussions regarding future care preferences.

• Support patients receiving palliative or end-of-life care, including symptom assessment, treatment review and liaison with specialist services.

• Work collaboratively with community nursing, social care, palliative care and other relevant professionals.

• Recognise and respond appropriately to concerns relating to mental capacity, consent, safeguarding and carer wellbeing.

Care Coordination and Multidisciplinary Working

• Maintain effective communication with the duty GP and wider clinical team regarding home visiting outcomes and identified risks.

• Participate in relevant multidisciplinary team discussions and clinical meetings.

• Liaise with care home staff, district nurses, social workers, pharmacists and other healthcare professionals to coordinate patient care.

• Facilitate appropriate referrals and ensure responsibility for follow-up is clearly documented.

• Promote continuity of care, particularly for patients with complex or recurring healthcare needs.

• Support collaborative working across the wider Primary Care Network where required.

Clinical Documentation and Information Governance

• Maintain comprehensive, contemporaneous and accurate patient records using SystmOne.

• Record clinical assessment findings, differential diagnoses, clinical reasoning, management plans and safety-netting advice.

• Ensure appropriate SNOMED CT coding and accurate recording of relevant clinical information.

• Communicate significant clinical findings or concerns promptly to the responsible GP or appropriate healthcare professional.

• Maintain patient confidentiality and comply with UK GDPR, the Data Protection Act 2018 and practice information governance policies.

• Ensure clinical documentation supports continuity of care and appropriate clinical accountability.

Job responsibilities

Home Visiting and Clinical Assessment

• Undertake planned and urgent home visits to patients who have been clinically assessed as requiring care at home.

• Independently assess patients presenting with undifferentiated and potentially complex clinical conditions, within the postholder's agreed scope of competence.

• Obtain comprehensive clinical histories and undertake appropriate physical examinations.

• Use advanced clinical reasoning and diagnostic skills to identify potential diagnoses and formulate appropriate management plans.

• Recognise and respond promptly to signs of serious illness, acute deterioration and medical emergencies.

• Assess and manage a range of acute presentations, including respiratory infections, urinary tract infections, exacerbations of chronic conditions, dehydration and other common presentations encountered in primary care.

• Assess frail and elderly patients with multiple comorbidities and complex health or social care needs.

• Assess patients following falls, considering injuries, underlying causes, mobility, medication and environmental risks.

• Request and interpret appropriate diagnostic investigations where authorised and clinically indicated.

• Initiate appropriate treatment, including medicines, within prescribing qualifications and professional competence.

• Arrange timely follow-up, onward referral or escalation to a GP, community service or secondary care provider when required.

• Provide clear clinical safety-netting advice to patients, relatives and carers.Urgent Care and Admission Avoidance

Urgent Care and Admission Avoidance

• Assess patients with acute illness or deterioration to determine the appropriate level and setting of care.

• Identify opportunities to provide safe treatment and monitoring at home rather than arranging hospital admission.

• Liaise with urgent community response teams, hospital services, community nursing teams and other healthcare providers.

• Recognise situations requiring urgent hospital assessment or emergency ambulance attendance and arrange escalation without delay.

• Support appropriate discharge planning and follow-up for patients recently discharged from hospital.

• Ensure admission avoidance decisions are based on individual clinical need, patient safety and informed decision-making.

Frailty, Long-Term Conditions and Palliative Care

• Undertake holistic assessments of patients with frailty, multiple long-term conditions or declining functional ability.

• Identify changes in physical, cognitive or functional health that may require further intervention.

• Review clinical needs and contribute to personalised care plans.

• Support the identification and management of patients requiring enhanced community support.

• Contribute to anticipatory care planning and appropriate discussions regarding future care preferences.

• Support patients receiving palliative or end-of-life care, including symptom assessment, treatment review and liaison with specialist services.

• Work collaboratively with community nursing, social care, palliative care and other relevant professionals.

• Recognise and respond appropriately to concerns relating to mental capacity, consent, safeguarding and carer wellbeing.

Care Coordination and Multidisciplinary Working

• Maintain effective communication with the duty GP and wider clinical team regarding home visiting outcomes and identified risks.

• Participate in relevant multidisciplinary team discussions and clinical meetings.

• Liaise with care home staff, district nurses, social workers, pharmacists and other healthcare professionals to coordinate patient care.

• Facilitate appropriate referrals and ensure responsibility for follow-up is clearly documented.

• Promote continuity of care, particularly for patients with complex or recurring healthcare needs.

• Support collaborative working across the wider Primary Care Network where required.

Clinical Documentation and Information Governance

• Maintain comprehensive, contemporaneous and accurate patient records using SystmOne.

• Record clinical assessment findings, differential diagnoses, clinical reasoning, management plans and safety-netting advice.

• Ensure appropriate SNOMED CT coding and accurate recording of relevant clinical information.

• Communicate significant clinical findings or concerns promptly to the responsible GP or appropriate healthcare professional.

• Maintain patient confidentiality and comply with UK GDPR, the Data Protection Act 2018 and practice information governance policies.

• Ensure clinical documentation supports continuity of care and appropriate clinical accountability.