About this role
Job summary
Lancashire and South Cumbria Integrated Care Board (ICB) has been selected to take part in one of four national Fit Note Reform Pilots commissioned by the Department for Work and Pensions, helping to test a new approach that aims to improve support for people whose health affects their ability to work. The pilot is designed to address a recognised challenge within the current system, where fit notes often focus on certifying sickness absence rather than providing practical support to help people remain in work or return to work safely.
MBPCC is delivering one of these pilots taking fit note generation out of practices within the Barrow and Mid Furness PCN areas. Patients will be referred directly from general practice into a new service called Enable where they will be offered a personalised Workability Plan setting out what they can do, the adjustments that would help, and the support available to them to aid them return to work.
The Advanced Nurse Practitioner is the senior clinical decision maker within the Enable service. The post holder carries clinical accountability for decisions, holds the most complex and highest risk caseload, and acts as the definitive point of clinical escalation short of the Clinical Lead.
Main duties of the job
Undertake advanced, autonomous work and health assessments for patients referred into the pilot, employing an extended scope of practice including advanced consultation, history taking and, where within the post holders assessed competence, physical assessment.
Assess undifferentiated presentations in the context of work, applying systematic clinical reasoning to distinguish between patients whose needs can be met by a Workability Plan, those requiring parallel clinical management, and those requiring urgent escalation.
Formulate and co-produce personalised Workability Plans focused on functional capability, phased return, adjustments and the practical support required to sustain work.
Exercise independent judgement in determining whether a period away from work is clinically appropriate, and articulate that judgement in terms that withstand challenge from patients, employers, referring clinicians and, potentially, an employment tribunal.
Recognise deteriorating or high risk presentations, including physical deterioration, mental health crisis, safeguarding concern and undisclosed serious pathology, and escalate without delay through agreed routes.
Issue fit notes for patients
Request, review and interpret investigations where clinically indicated and within agreed pilot scope, communicating and acting on findings appropriately.
About us
Morecambe Bay Primary Care Collaborative is the largest employer of Primary Care colleagues in South Cumbria, we are a not-for-profit Community Interest Company, and work to support, guide and underpin primary medical care across Lancashire and South Cumbria.
We deeply value education and learning, hosting the Lancashire and South Cumbria Training Hub. We have a great team on our board that guide our organisation, and you will be supported to excel in your role.
Job description Job responsibilities
Post: Advanced Nurse Practitioner or Advanced Clinical Practitioner with relevant experience
Service: MBPCC Enable Service
Accountable to: Service & Clinical Lead
Responsible to: Service Lead
Hours: 37.5 per week
Salary: £52,000 £65,000 (30% enhanced hourly rate for Saturday working)
Contract Type Fixed term 12 months. Secondment applications welcome.
Base: Hybrid and flexible with home working occasional Barrow and Mid Furness PCN sites
MAIN DUTIES AND RESPONSIBILITIES
Clinical practice
Advanced assessment and clinical decision making
Undertake advanced, autonomous work and health assessments for patients referred into the pilot, employing an extended scope of practice including advanced consultation, history taking and, where within the post holders assessed competence, physical assessment.
Assess undifferentiated presentations in the context of work, applying systematic clinical reasoning to distinguish between patients whose needs can be met by a Workability Plan, those requiring parallel clinical management, and those requiring urgent escalation.
Formulate and co-produce personalised Workability Plans focused on functional capability, phased return, adjustments and the practical support required to sustain work.
Exercise independent judgement in determining whether a period away from work is clinically appropriate and articulate that judgement in terms that withstand challenge from patients, employers, referring clinicians and, potentially, an employment tribunal.
Recognise deteriorating or high risk presentations, including physical deterioration, mental health crisis, safeguarding concern and undisclosed serious pathology, and escalate without delay through agreed routes.
Issue fit notes for patients
Request, review and interpret investigations where clinically indicated and within agreed pilot scope, communicating and acting on findings appropriately.
Complex casework and clinical consultancy
Hold the most clinically complex, contested and high risk cases within the service, including multiple comorbidity, mental health presentations, contested employer relationships and cases with potential legal exposure.
Act as the definitive clinical point of reference for colleagues, providing case advice, joint assessment and decision support, and taking clinical handover of cases beyond their scope.
Provide specialist advice on reasonable adjustments, graduated return, workplace modification, redeployment and ill health capability, informed by the Equality Act 2010 and relevant health and safety legislation.
Assess mental capacity where relevant, obtain and record valid informed consent, and work within the applicable legal framework.
Acknowledge the limits of personal competence and of the pilot service, and accept responsibility only for activity where competence can be assured.
Leadership and management
Provide senior clinical leadership to the assessment function, setting and modelling the standard of practice for the service.
Own, develop and maintain the clinical assessment protocols, triage criteria, escalation thresholds, business rules, assessment templates and standard operating procedures, ensuring they are version controlled and approved through the agreed governance route in collaboration with other team members.
Exercise professional judgement to create precedent and resolve ambiguous or novel clinical problems where no protocol exists, and ensure those decisions are subsequently reflected in protocol.
Provide clinical supervision to clinical staff within the service, and clinical oversight to non-clinical work and health coaches, ensuring they operate within safe boundaries and escalate appropriately.
Deputise for the Clinical Lead in their absence on clinical matters, escalating to the Clinical Lead where a decision falls outside delegated authority.
Lead the clinical governance arrangements for the assessment function, including clinical audit, incident and complaint investigation, and the clinical risk register.
Advise on the clinical implications of proposed operational changes, including capacity, appointment length, skill mix and caseload distribution, and contribute to the workforce model for any successor service.
Contribute to recruitment, induction, competency assessment and development planning for clinical members of the team, and identify and address unwarranted variation in practice.
Support the wellbeing of the clinical team in a service dealing with distressed patients and emotionally demanding material.
Education
Act as the clinical educational resource for the service, building capability in workability assessment across clinical and non-clinical colleagues.
Design and deliver training, briefings and awareness sessions for primary care colleagues, work and health coaches, employers and partner organisations.
Provide mentorship, coaching and reflective supervision, and support the development of any trainee or developmental posts within the service.
Build constructive relationships with referring GPs, providing feedback that improves referral quality and sustains clinical confidence in the pilot model.
Take responsibility for personal continuing professional development, maintain registration and revalidation requirements, and arrange personal clinical and professional supervision.
Contribute to the wider dissemination of learning from the pilot, including written outputs, case studies, presentations and contributions to professional networks.
Research and evaluation
Design and lead clinical audit and case note review, report findings and ensure recommendations are implemented and re-audited.
Lead clinical test-and-learn cycles, proposing, testing and evaluating changes to the assessment model during the pilot period.
Act as a clinical point of contact for the national evaluation, including interviews, case note review and data queries, within the limits of patient confidentiality
5. FREEDOM TO ACT
The post holder practises competently and autonomously without direct clinical supervision, in accordance with the NMC Code and local policy.
The post holder assumes clinical accountability for patients referred into a non-medically led pathway.
The post holder exercises professional judgement and expertise to create precedent and deal with ambiguous or novel problems, applying evidence-based practice and rigorous analytical judgement in the absence of specific guidance.
The post holder holds delegated authority to determine clinical assessment practice within the service, subject to ratification by the Clinical Lead
Matters with implications for patient safety, service scope, contractual obligation or the national pilot design are escalated to the Clinical Lead
WORKING ARRANGEMENTS
This is a fixed term post for 12 months, funded through the national pilot. Continuation beyond the pilot period cannot be guaranteed and is subject to national decisions on the future of the model.
A flexible and agile approach to working is expected. The service operates a blended model of face to face clinics, remote consultation and home working, and the balance between these will vary with service demand and patient need.
Home working is supported for remote assessment, report writing, supervision and administrative activity, subject to a suitable, confidential home working environment and compliance with information governance requirements. Home working is an operational arrangement, not a contractual entitlement, and does not remove the requirement to attend sites.
The leadership, supervisory and educational elements of the role require a regular on-site presence sufficient to maintain visibility, support the team and sustain relationships with referring practices.
Regular travel across Barrow and Mid Furness is required. Access to a vehicle and a full UK driving licence, or an equivalent means of meeting the travel requirements of the post, is necessary.
Some flexibility over working hours may be needed to accommodate patients who are in work and employers who are only available outside core hours such as Saturday working.
The post holder will be expected to work in a rapidly evolving service where processes, systems and documentation change during the pilot period, and to lead others through that change.
Please see full Job Description and Person Specification
Person Specification
Experience Essential
-Substantial post registration experience, including significant experience at an advanced or senior autonomous level. -Experience of assessing undifferentiated presentations and managing the associated clinical uncertainty and risk. -Experience of holding clinical accountability for a complex caseload without direct supervision. -Experience of providing clinical supervision, mentoring or case advice to other practitioners. -Experience of writing or owning clinical protocols, pathways or standard operating procedures. -Experience of leading clinical audit, service evaluation or quality improvement, including implementing and re-auditing findings. -Experience of service development, transformation or working within a new or pilot service. -Experience of producing clear written advice or reports for non-clinical audiences. -Experience of working across organisational boundaries and building networks with external stakeholders.
Desirable
-Experience of working within Occupational Health services, or a demonstrable interest in occupational health, workplace wellbeing, health surveillance, and supporting employees to remain healthy and productive at work OR -Previous Occupational Health experience or a strong interest in employee health and wellbeing, including supporting attendance, rehabilitation, and workplace health initiatives. -Practical experience of issuing, advising on or contributing to fit notes. -Experience of sickness absence management, vocational rehabilitation or return to work planning. -Experience of advising employers, HR or line managers directly, including where views differ. -Experience of working in primary care, community services or a WorkWell service. -Experience of deputising for a senior clinician or service lead. -Experience of investigating incidents or complaints. -Experience of presenting to boards, commissioners or at regional or national level. -Experience of remote or telephone consultation.
Qualifications Essential
-Current registration as a Registered Nurse on Part 1 of the NMC register (Adult, Mental Health or Learning Disability), unrestricted, and compliance with NMC revalidation requirements. -MSc in Advanced Clinical Practice, or an equivalent masters level award encompassing the four pillars, or demonstrable equivalence agreed through portfolio review at the application stage. -Postgraduate module or equivalent evidenced competence in advanced health assessment and clinical reasoning. -Portfolio of accredited continuing professional development relevant to the role. -Willingness to undertake pilot specific training in workability assessment, fit note practice and work and health conversations.
Desirable
-Occupational health qualification, or SCPHN (Occupational Health) registration. -Training in fit note completion -Teaching, assessing or clinical supervision qualification. -Leadership, quality improvement or project management qualification. -Motivational interviewing, health coaching or case management training
Knowledge and skills Essential
-Advanced clinical reasoning and the ability to reach and defend a clinical judgement on limited information and in the absence of precedent. -Advanced ability to assess functional capacity and relate health conditions to the demands of work. -Understanding of the principles of fitness for work assessment and the health benefits of good work. -Knowledge of the Equality Act 2010 as it applies to reasonable adjustments and ill health capability. -Sound understanding of consent, capacity, confidentiality, disclosure and information governance, and the ability to advise others on them. -Knowledge of clinical governance and risk management, with the ability to lead their application within a small service. -Knowledge of safeguarding responsibilities for children and adults at risk. -Highly developed communication skills, including the ability to convey complex clinical information clearly and sensitively to patients, employers, clinicians and non-clinical colleagues. -Negotiation, influencing, motivational and de-escalation skills, including where professional opinions differ. -Ability to critically appraise evidence and translate it into practice. -Ability to interpret and critically analyse service data. -Competent use of clinical record systems and Microsoft 365, including Teams for virtual consultation and meetings.
Desirable
-Knowledge of relevant health and safety legislation. -Understanding of the national fit note reform policy context and the Workability Plan model. -Familiarity with EMIS -Knowledge of local employment support, WorkWell and VCFSE provision. -Presentation and facilitation skills for clinical and non-clinical audiences.
Disclosure and Barring Service Check This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.
UK Registration
Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).
Employer details Employer name Morecambe Bay Primary Care Collaborative
Address The Strand
Barrow in Furness
Cumbria
LA14 2HG
United Kingdom
Employer's website https://mbpcc.co.uk/ (Opens in a new tab)