PCN Nursing Associate @ Canalside PCN

Job summary

As a Nursing Associate within our PCN Frailty Team, you will play an important role in supporting the delivery of proactive, personalised care to patients with frailty and complex health needs. Working alongside GPs, Advanced Clinical Practitioners, Registered Nurses, Community Nurses, Care Coordinators and wider multidisciplinary colleagues, you will help identify patients at risk of deterioration, support holistic assessments and promote independence, wellbeing and quality of life. Your role will involve community work, including home visits and care home support.

We are looking for someone who

• Is a Registered Nursing Associate with current NMC registration.
• Has a genuine passion for caring for older people and people living with frailty.
• Has excellent communication and interpersonal skills.
• Can work independently within their scope of practice while recognising when to seek support.
• Is organised, flexible and able to prioritise their workload.
• Enjoys working as part of a multidisciplinary team.
• Is compassionate, approachable and committed to delivering high-quality, person-centred care.
• Is motivated to develop their knowledge and skills within frailty and community-based care.

Main duties of the job

• Supporting the assessment and ongoing monitoring of patients living with frailty.
• Undertaking clinical observations and delegated clinical procedures within your competence.
• Supporting Comprehensive Geriatric Assessment (CGA) and personalised care planning.
• Identifying early signs of deterioration and escalating concerns appropriately.
• Supporting falls prevention, nutritional and hydration assessments and monitoring functional decline.
• Undertaking proactive home visits and supporting care home residents.
• Supporting patients following hospital discharge to promote safe recovery and prevent avoidable readmissions.
• Working collaboratively with the multidisciplinary team to coordinate care and improve patient outcomes.
• Providing advice and support to patients and carers, promoting independence and self-management.
• Maintaining accurate clinical records and contributing to service development.

About us

Canalside Primary Care Network brings together local GP practices and healthcare professionals to deliver more joined-up, personalised care for our population. Our Frailty Team is committed to supporting people to live well for longer, maintaining independence, preventing avoidable deterioration and ensuring that patients receive the right care, in the right place, at the right time.

The role is based across our 7 GP practices within Rochdale and Middleton, they include:

• Wellfield Health Centre
• Castleton Health Centre
• Kirkholt Medical Practice
• The Kingsway Practice
• Dr Hamid's Practice
• Middleton Health Centre
• The Hive Health Centre

The role is 37.5 hours worked over 5 days, with the flexibility to travel across the PCN footprint.

This is an exciting opportunity to:

• Be part of a supportive and PCN Frailty Team.
• Make a meaningful difference to the lives of older people within our community.
• Develop specialist knowledge and skills in frailty and proactive care.
• Work alongside a range of experienced healthcare professionals
• Contribute to innovative approaches to preventing hospital admissions and supporting people to remain independent.

Interviews to take place on Tuesday 15th December 2026.

Job description

Job responsibilities

The Nursing Associate will work as an integral member of the Primary Care Network (PCN) Frailty Team, supporting the delivery of high-quality, person-centered care to older people and individuals living with frailty. The post holder will work collaboratively with GPs, Advanced Clinical Practitioners, Practice Nurses, Community Nurses, Social Prescribers, Care Coordinators, therapists and wider health and social care professionals to support the identification, assessment and ongoing management of people living with frailty. The role will focus on promoting independence, preventing avoidable hospital admissions, supporting early intervention, reducing health inequalities and improving the quality of life for people living with frailty.

Working within their scope of competence and under appropriate clinical supervision, the Nursing Associate will undertake delegated clinical activities, contribute to holistic assessments, support care planning and provide proactive care in practice and community settings, including patients own homes and care homes.

Key Responsibilities

Clinical Responsibilities

• Undertake delegated clinical tasks within the Nursing Associate scope of practice and demonstrated competence.
• Support the holistic assessment and ongoing monitoring of patients living with frailty.
• Undertake clinical observations, including blood pressure, pulse, respiratory rate, oxygen saturations, temperature and blood glucose monitoring where appropriate.
• Recognise and respond appropriately to deterioration in patients physical or mental health, escalating concerns promptly to the appropriate registered clinician.
• Support the management of long-term conditions and contribute to routine health reviews.
• Undertake clinical procedures within competence, including wound care, dressings, ECG recording, urinalysis and venepuncture where trained and assessed as competent.
• Support medication-related monitoring and adherence, escalating concerns regarding polypharmacy or potential adverse effects to the appropriate prescriber.
• Contribute to falls risk assessment and support falls prevention strategies.
• Support nutritional and hydration assessments and identify concerns relating to weight loss, malnutrition or dehydration.
• Recognise signs of delirium, cognitive impairment, depression and social isolation and escalate concerns appropriately.
• Support the monitoring and management of patients following hospital discharge.
• Undertake home and care home visits as required, in accordance with lone-working policies and risk assessments.

Frailty and Proactive Care

• Support the identification of patients with frailty using appropriate clinical tools and the PCN frailty register.
• Contribute to Comprehensive Geriatric Assessment (CGA) processes under the direction of the Advanced Clinical Practitioner.
• Support the development, implementation and review of personalised care and support plans.
• Promote a proactive approach to care, identifying patients who may benefit from additional support or intervention.
• Support early identification of changes in patients health, function, mobility or social circumstances.
• Promote independence, self-management and supported decision-making.
• Identify patients at risk of falls, functional decline, avoidable admission or deterioration and escalate concerns.
• Support anticipatory care planning and contribute to discussions around ReSPECT and advance care planning within the boundaries of the role and appropriate supervision.
• Support end-of-life care through compassionate communication, monitoring and escalation of patient and carer needs.

Care Coordination and Multidisciplinary Working

• Work collaboratively with the PCN multidisciplinary team to ensure coordinated and joined-up care.
• Attend and contribute to multidisciplinary team (MDT) meetings, frailty meetings and complex patient discussions.
• Communicate effectively with patients, relatives, carers and professionals across health and social care services.
• Support referrals to appropriate services, following agreed pathways and delegated responsibilities.
• Liaise with community nursing, occupational therapy, physiotherapy, social care, mental health and voluntary sector services.
• Identify unmet health and social care needs and escalate these to the relevant team members.
• Support timely communication and continuity of care following hospital discharge or changes in care arrangements.

Patient and Carer Support

• Provide compassionate, respectful and individualised care, maintaining dignity and promoting choice.
• Support patients and carers to understand their health conditions and treatment plans.
• Provide health promotion and prevention advice within the scope of the role.
• Encourage physical activity, mobility, appropriate nutrition and hydration, and social engagement.
• Identify carer strain and concerns relating to safeguarding, neglect or abuse, escalating in accordance with organisational policies.
• Demonstrate sensitivity when supporting people with dementia, cognitive impairment, communication difficulties and complex needs.
• Promote equality, diversity and inclusion in all aspects of patient care.

Documentation and Clinical Governance

• Maintain accurate, contemporaneous and confidential clinical records using the PCNs clinical systems.
• Record clinical observations, interventions, assessments and escalation of concerns.
• Follow relevant clinical policies, procedures and evidence-based guidance.
• Maintain patient confidentiality and comply with GDPR and information governance requirements.
• Participate in clinical audit, service evaluation and quality improvement activities.
• Report incidents, near misses and safeguarding concerns in accordance with local policy.
• Maintain awareness of professional responsibilities and work within the Nursing Associate Code of Conduct and scope of practice.

Professional Development

• Maintain registration with the Nursing and Midwifery Council (NMC).
• Participate in regular clinical supervision, appraisal and performance reviews.
• Maintain a personal development portfolio and evidence of continuing professional development.
• Undertake additional training and competency assessments relevant to the frailty role.
• Maintain knowledge of frailty pathways, long-term conditions and best practice in older peoples care.
• Support the development of a positive learning culture within the PCN team.

The post holder will work within the professional standards and scope of practice of a Registered Nursing Associate. They will undertake clinical activities for which they have received appropriate training and been assessed as competent. The Nursing Associate will work under the direction and delegation of an appropriately registered healthcare professional. They will recognise the limitations of their competence, seek advice when required and escalate clinical concerns promptly. The post holder will not independently diagnose, prescribe medication or make clinical decisions outside their scope of practice.

Key Outcomes and Measures of Success

• The post holder will contribute to the following service outcomes: Improved proactive identification and monitoring of patients living with frailty.
• Improved access to appropriate community-based assessment and intervention.
• Reduced avoidable hospital admissions and unnecessary escalation to emergency services.
• Improved continuity and coordination of care across primary, community and social care.
• Increased completion of appropriate frailty reviews and personalised care plans.
• Improved identification and management of falls risk, nutritional concerns and functional decline.
• Improved patient and carer experience.
• Promotion of independence, dignity and quality of life for older people.

General Responsibilities

• Adhere to all relevant PCN and employing organisation policies and procedures.
• Maintain confidentiality and uphold professional standards at all times.
• Participate in mandatory training and ongoing professional development.
• Work flexibly across the PCN footprint in response to service requirements.
• Undertake other duties appropriate to the role and level of competence, as agreed with the line manager.

Safeguarding

All employees have a responsibility to protect and safeguard vulnerable individuals at risk (whether children or adults). They must be aware of local child and adult protection procedures and who to contact within the ICB for further advice. All employees are required to attend safeguarding awareness training and undertake additional training appropriate to their role.

This job description is not exhaustive and may be adjusted periodically after review and consultation. You will be expected to carry out any reasonable duties which may be requested from time-to time.

Person Specification

Registration

Essential

• Current NMC registration as a Nursing
• Associate.

Desirable

• Evidence of relevant additional clinical
• competencies.

Experience

Essential

• Experience of working within a healthcare
• setting.

Desirable

• Experience in primary care, community
• nursing, care homes or older peoples
• services.

Qualifications

Essential

• Registered Nursing Associate qualification
• (Foundation Degree or equivalent).

Desirable

• Additional training in frailty, older peoples
• care or long-term conditions.

Knowledge and skills

Essential

• Competent in undertaking clinical observations and recognising deterioration.
• Understanding of the Nursing Associate role, professional accountability and scope of practice.
• Excellent verbal and written communication skills.
• Ability to work effectively within a multidisciplinary team.
• Ability to prioritise workload and manage competing demands
• Compassionate, empathetic, flexible and patient-focused.
• Ability to use electronic clinical record systems
• Full UK driving licence and access to a vehicle

Desirable

• Experience of venepuncture, ECGs, wound care and long-term condition monitoring.
• Understanding of frailty, Comprehensive Geriatric Assessment and proactive care.
• Experience communicating with people living with dementia or cognitive impairment.
• Experience working across health and social care services.
• Experience coordinating care for patients with complex needs.
• Experience supporting service development or quality improvement.
• Experience of EMIS, SystmOne or other primary care clinical systems.

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

Canalside PCN

Address

Wellfield Health Centre

116 Oldham Road

Rochdale

Lancashire

OL11 1AD

United Kingdom

Employer's website

https://www.wellfieldhealthcentre.co.uk/ (Opens in a new tab)