About this role
Job summary
We are looking to recruit a Registered Nurse- Long Term Conditions, on a permanent basis, within our Collaborative Care Team.
This role is full time for 37.5hrs per week and has a starting salary of £36,000 for the full time equivalent per annum.
Main duties of the job
The Long-Term Conditions (LTC) Registered Nurse will provide high-quality, patient-centred nursing care to adults living with one or more long-term health conditions within the community setting. The post holder will support patients to optimise self-management, improve health outcomes, reduce unnecessary hospital admissions, and enhance quality of life through proactive assessment, care planning, education, and clinical intervention.
About us
PML is a successful not-for-profit, GP-led organisation providing various NHS community and primary care clinical services to patients across Oxfordshire and Northamptonshire. We have evolved as a NHS healthcare provider since 2004 and in the last few years have grown significantly, now employing around 300 staff with a turnover of circa £16m. PML holds GMS contracts, as well as being a GP Federation representing circa 50 GP practices covering approximately 650,000 patients.
We welcome applicants from a diverse range of backgrounds and circumstances and people with protected characteristics under the Equality Act 2010
Job description
Job responsibilities
Role Purpose
The Collaborative Care team (CCT) is a multi-disciplinary team which provides proactive assessment and support to people living with Frailty and long-term conditions, promoting independence at home and preventing unplanned admissions to hospital. The team coordinate services across the local health and care economy within Northants for people who have complex care needs.
The role involves working collaboratively with multidisciplinary teams, primary care providers, social care, voluntary sector organisations, and family carers to deliver coordinated care that meets the physical, psychological, and social needs of patients.
Accountable to: Collaborative Care Team Clinical Lead
Role Responsibilities
- Undertake comprehensive physical, psychological, and social assessments of patients with long-term conditions and develop person centred care plans through shared decision making.
- Conduct routine and specialist reviews for patients with long-term conditions including Chronic Obstructive Pulmonary Disease (COPD), Asthma, Diabetes, Heart Failure, Hypertension, Coronary Heart Disease, Chronic Kidney Disease, Frailty and multi-morbidity.
- Undertake clinical procedures including Venepuncture, Blood pressure monitoring, ECG recording, Wound assessment and care, Urinalysis, Point-of-care testing where appropriate. Diabetic foot screening
- Coordinate care across multiple services and providers and participate in multidisciplinary team meetings and case discussions.
- Promote healthy lifestyles and preventative healthcare measures by providing education and coaching to enable patients to self-manage their conditions effectively. This includes encouraging the uptake of screening, immunisation, and health checks.
- Identify barriers to self-management and develop strategies to overcome them.
- Undertake risk assessments relating to health, wellbeing, mobility, nutrition, and environmental factors and implement risk management plans to maintain patient safety.
- Provide clinical leadership for Nursing Practice and support and supervise junior staff including healthcare support workers and students.
- Contribute to service development and quality improvement initiatives and participate in clinical audit, research, and evaluation activities.
- Maintain professional competence through continuing professional development and participate in clinical supervision, appraisal, and professional revalidation.
Person Specification
Experience
Essential
- Experience of community, primary care, or integrated care services.
Desirable
- Frailty and complex care management.
Qualifications
Essential
- Registered Nurse (Adult) with current NMC Registration
- Recognised qualification or considerable experience in management of long-term conditions.
Desirable
- Mentorship or Practice Assessor qualification
Skills & Knowledge
Essential
- Sound clinical knowledge of long-term condition management.
- Excellent assessment and clinical decision-making skills.
- Strong communication and interpersonal skills.
- Ability to work independently and manage workload effectively.
- Competence in clinical record keeping and IT systems.
- Understanding of safeguarding legislation and procedures.
- Full UK driving licence and access to a vehicle for work purposes (where required).
- Ability to travel across community locations.
Desirable
- Knowledge of national healthcare priorities and integrated care pathways
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
Principal Medical Limited
Address
Principal Medical Ltd
3 Barberry Place
Bicester
Oxfordshire
OX26 3HA
United Kingdom
Employer's website
https://www.principal-medical.co.uk (Opens in a new tab)