Job descriptions for general practice nurse roles

Title: Agenda for Change (AfC) banding: Hours of duty: Responsible to: Accountable to: Senior GPN/Lead GPN Senior GPN/Lead GPN General practice nurse (GPN) 5

Job summary
The post holder is responsible for the delivery of basic practice nursing services care to the practice population. Supported by senior nurses within the practice, they will deliver care within the boundaries of their role, focusing upon supporting patients to be healthy, monitoring of long-term conditions, health prevention and screening activities. They will work collaboratively with the general practice team to meet the needs of patients, supporting the delivery of policy and procedures, and providing nurse leadership as required.

Key responsibilities
Clinical practice
Assess, plan, develop, implement and evaluate programmes to promote health and well-being, and prevent adverse effects on health and well-being Implement and evaluate individual treatment plans for patients with a known long-term condition Identify, and manage as appropriate, treatment plans for patients at risk of developing a long-term condition Prioritise health problems and intervene appropriately to assist the patient in complex, urgent or emergency situations, including initiation of effective emergency care Support patients to adopt health promotion strategies that encourage patients to live healthily, and apply principles of self-care Deliver opportunistic health promotion using opportunities such as new-patient medicals Provide information and advice on prescribed or over-the-counter medication on medication regimens, sideeffects and interactions Support patients to adopt health promotion strategies that promote patients to live healthily, and encourage principles of self-care Assess and care for patients presenting with uncomplicated wounds Support and advise women requesting information relating to family planning needs Support and manage health needs of women presenting for cervical cytology consultations Recognise, assess and refer patients presenting with mental health needs in accordance with the National Service Framework (NSF) for Mental Health Implement and participate in vaccination and immunisation programmes for both adults and children Advise, support and, where appropriate, administer vaccinations for patients travelling abroad Promote and deliver evidence-based care for patients presenting with aural conditions Assist senior practitioners in providing minor-surgery sessions

Crown Copyright September 2006. The text in this document may be reproduced free of charge in any format or medium providing that it is reproduced accurately and not used in a misleading context or used for commercial gain. The material must be acknowledged as Crown Copyright and the title of the document specified. Where others have been referenced on specific documents and tools, the organisation must be acknowledged in full and the title of the document specified. All links to external websites have been provided for your information and the Working in Partnership Programme take no responsibility for any material or content accessed on any such websites

This document is intended as a guide only.

Communication
Utilise and demonstrate sensitive communication styles, to ensure patients are fully informed and consent to treatment Communicate with and support patients who are receiving bad news Communicate effectively with patients and carers, recognising the need for alternative methods of communication to overcome different levels of understanding, cultural background and preferred ways of communicating Utilise communication skills to support patients to adhere to prescribed treatment regimens Anticipate barriers to communication and take action to improve communication Estimate and maintain effective communication with individuals and groups within the practice environment and with external stakeholders Act as an advocate when representing the patients and colleagues viewpoints to others

Delivering a quality service

Recognise and work within own competence and professional code of conduct as regulated by the Nursing and Midwifery Council (NMC) Produce accurate, contemporaneous and complete records of patient consultation, consistent with legislation, policies and procedures Prioritise, organise and manage own workload in a manner that maintains and promotes quality Deliver care according to the NSF and the National Institute for Clinical Excellence (NICE) guidelines and evidence-based care Assess effectiveness of care delivery through self and peer review, benchmarking and formal evaluation Participate in the maintenance of quality governance systems and processes across the organisation and its activities Utilise the audit cycle as a means of evaluating the quality of the work of self and the team, implementing improvements where required In partnership with other clinical teams, collaborate on improving the quality of health care, responding to local and national policies and initiatives as appropriate Evaluate the patients response to health care provision and the effectiveness of care Support and participate in shared learning across the practice and wider organisation Participate in the management, review and identify learning from patient complaints, clinical incidents and near-miss events utilising a structured framework (eg root-cause analysis) Participate in the performance monitoring review of the team, providing feedback as appropriate Understand and apply legal policy that supports the identification of vulnerable and abused children and adults, being aware of statutory child/vulnerable adult health procedure and local guidance Work within policies relating to domestic violence, vulnerable adults, substance abuse and addictive behaviour, and refer as appropriate

Personal and people development

Take responsibility for own development, learning and performance including participating in clinical supervision and acting as a positive role model Support the development of others in order to maximise potential Actively promote the workplace as a learning environment, encouraging everyone to learn from each other and from external good practice Encourage others to make realistic self-assessment of their application of knowledge and skills, challenging complacency and actions that are not in the interest of the public and/or users of services Understand own responsibilities and accountability in the delivery of GPN services to patients, ensuring that the needs of the patient are the priority Participate in planning and implementing changes within the area of care and responsibility Work with other nurses and practice team to ensure sufficient staff of appropriate ability, quality and skillmix are available to meet the needs of patients Contribute and participate in the development of local guidelines, protocols and standards Participate in the engagement of practice-based commissioning or similar initiatives Critically evaluate and review innovations and developments that are relevant to own practice Keep up-to-date with new developments locally and nationally identifying those that will enhance the teams work Ensure awareness of sources of support and guidance (eg patient advice and liaison service PALS) and provide information in an acceptable format to all patients, recognising any difficulties and referring where appropriate Promote the role of the GPN in the provision of care

Team working
Understand own role and scope in the organisation and identify how this may develop over time Work as an effective and responsible team member, supporting others and exploring the mechanisms to develop new ways of working Delegate clearly and appropriately, adopting the principles of safe practice and assessment of competence of those taking on delegated duties Ensure clear understanding and utilisation of referral mechanisms within the practice Accept delegation from other nurses, prioritise own workload and ensure effective time-management strategies are embedded in own practice Work effectively with others to clearly define values, direction and policies impacting upon care delivery Participate in team activities that create opportunities to improve patient care Participate in and support local projects as agreed with the practice management team

Management of risk
Manage and assess risk within the areas of responsibility, ensuring adequate measures are in place to protect staff and patients Monitor work areas and practices to ensure they are safe and free from hazards and conform to health, safety and security legislation, policies, procedures and guidelines Ensure safe storage, rotation and disposal of vaccines and drugs is undertaken. Where appropriate, oversee the monitoring, stock control and documentation of controlled drug usage according to legal requirements Undertake mandatory and statutory training Apply infection control measures within the practice according to local and national guidelines Apply policies that reduce environmental health risks, are culturally sensitive and increase access to health care for all Participate in the local implementation strategies that are aligned to the values and culture of general practice

Utilising information
Use technology as an aid to management in planning, implementation and monitoring, presenting and communicating information Review and process data using accurate Read codes about patients in order to ensure easy and accurate retrieval for monitoring and audit processes Manage information searches using the internet and local library databases, for example, the retrieval of relevant information for patients on their condition Understand own and others responsibility to the individual organisation regarding the Freedom of Information Act Collate, analyse and present clinical data and information to the team using appropriate charts and/or graphs to enhance care

Learning and development

Act as mentor to students, assessing competence against set standards as requested and if appropriately qualified Disseminate learning and information gained to other team members in order to share good practice and inform others about current and future developments Assess own learning needs and undertake learning as appropriate Make effective use of learning opportunities within and outside the workplace, evaluating their effectiveness and feeding back relevant information Provide an educational role to patients, carers, families and colleagues in an environment that facilitates learning

Equality and diversity

Identify patterns of discrimination, take action to overcome this, and promote diversity and quality of opportunity Enable others to promote equality and diversity in a non-discriminatory culture Support people who need assistance in exercising their rights Monitor and evaluate adherence to local chaperoning policies Act as a role model in good practice relating to equality and diversity Accept the rights of individuals to choose their care providers, participate in care and refuse care. Assist patients from marginalised groups to access quality care

Person specification
Criteria Knowledge

Essential
Knowledge of needs of patients with long-term conditions Aware of accountability of own role and other roles in a nurseled service

Desirable
Ability to identify determinants on health in the local area Knowledge of public health issues in the local area Awareness of local and national health policy Awareness of issues within the wider health economy

Knowledge of health promotion strategies Awareness of clinical governance issues in primary care Knowledge of patient group directions and associated policy Clinical skills cervical cytology, immunisation and vaccination, ear care, minor surgery Change-management skills and ability to support patients to change lifestyle Communication skills, both written and verbal Ability to communicate difficult messages to patients and families Negotiation and conflictmanagement skills IT skills Minimum 2 years postregistration experience At least 1 year recent primary and community nursing experience Management of long-term conditions Involvement in implementing and using protocols and clinical guidelines Experience of audit Registered first level nurse Clinical supervision training and experience Self-directed practitioner Highly motivated Flexibility Enthusiasm Team player Ability to work across boundaries

Skills

Experience of teaching and mentorship in a clinical setting

Experience

Participation in quality initiatives such as clinical benchmarking

Qualifications

Relevant nursing/health degree Mentor/teaching qualification

Other

Title: AfC banding: Hours of duty: Responsible to: Accountable to:

Senior general practice nurse (GPN) 6 GP/Lead GPN GP/Lead GPN

Job summary
The post holder is responsible for the delivery of general practice nursing to the whole practice population. The focus of the role is both the delivery of evidence-based practice for patients presenting with a longterm condition, and the provision of preventative health care to the practice population. As an autonomous practitioner the nurse is responsible for the care delivered, demonstrating critical thinking and skills in clinical decision-making in the management of patients. They will work collaboratively within the general practice team to meet the needs of patients, support the delivery of policy and procedures, and provide nurse leadership as required.

Key responsibilities
Clinical practice
Assess, plan, develop, implement and evaluate treatment programmes that promote health and well-being Assess, plan, implement and evaluate individual treatment plans for patients with a known long-term condition Proactively identify, diagnose and manage treatment plans for patients at risk of developing a long-term condition as appropriate Work with other health care professionals to diagnose, monitor, manage and treat long-term conditions, including non-drug-based treatment methods using a management plan, and in line with national and local policies and practice needs Review medication for therapeutic effectiveness, appropriate to patient needs and in accordance with evidence-based practice and national and practice protocols Work with patients in order to support adherence to prescribed treatments Provide information and advice on prescribed or over-the-counter medication on medication regimens, side-effects and interactions Prioritise health problems and intervene appropriately to assist the patient in complex, urgent or emergency situations, including initiation of effective emergency care Support patients to adopt health promotion strategies that promote patients to live healthily, and apply principles of self-care Support and manage health needs of women presenting for family planning and cervical cytology consultations Recognise, assess and refer patients presenting with mental health needs in accordance with the NSF for Mental Health Implement and participate in vaccination and immunisation programmes for both adults and children Advise, support and administer vaccinations where appropriate for patients travelling abroad Promote and deliver evidence-based care for patients presenting with aural conditions Meet the needs of patients presenting for opportunistic wound care

Communication
Demonstrate sensitive communication styles to ensure patients are fully informed and consent to treatment Communicate with and support patients receiving bad news Communicate effectively with patients and carers, recognising the need for alternative methods of communication to overcome different levels of understanding, cultural background and preferred ways of communicating Anticipate barriers to communication and take action to improve communication Estimate and maintain effective communication with individuals and groups within the practice environment and with external stakeholders Act as an advocate when representing patients and colleagues

Delivering a quality service

Recognise and work within own competence and professional code of conduct as regulated by the NMC Produce accurate, contemporaneous and complete records of patient consultation, consistent with legislation, policies and procedures Prioritise, organise and manage own workload in a manner that maintains and promotes quality Deliver care according to NSF, NICE guidelines and evidence-based care Assess effectiveness of care delivery through self and peer review, benchmarking and formal evaluation Participate in the maintenance of quality governance systems and processes across the practice Utilise the audit cycle as a means of evaluating the quality of the work of self and the team, implementing improvements where required Collaborate on improving the quality of health care in partnership with other clinical teams, responding to local and national policies and initiatives as appropriate Evaluate the patients response to health care provision and the effectiveness of care Support and participate in shared learning across the practice and wider organisation Participate in the management and review of patient complaints, and identify learning from clinical incidents and near-miss events using a structured framework (eg root-cause analysis) Assess the impact of policy implementation on care delivery Participate in the performance monitoring review of the team, providing feedback as appropriate Understand and apply legal policy that supports the identification of vulnerable and abused children and adults, being aware of statutory child/vulnerable adult health procedure and local guidance Work within policies regarding family violence, vulnerable adults, substance abuse and addictive behaviour, and refer as appropriate

Leadership personal and people development

Take responsibility for own development learning and performance including participating in clinical supervision and acting as a positive role model Support the development of others in order to maximise potential Actively promote the workplace as a learning environment, encouraging everyone to learn from each other and from external good practice Encourage others to make realistic self-assessment of their application of knowledge and skills, challenging any complacency and actions that are not in the interest of the public and/or users of services Act as a clinical leader in the delivery of GPN services to patients, ensuring that the needs of the patient are the priority Participate in planning and implementing changes within the area of care and responsibility Work with practice management to ensure sufficient staff of appropriate ability, quality and skill-mix are available to meet current and future service delivery Contribute and participate in the development of local guidelines, protocols and standards Participate in the planning and engagement of practice-based commissioning or similar initiatives Ensure awareness of sources of support and guidance (eg PALS), and provide information in an acceptable format to all patients, recognising any difficulties and referring where appropriate Promote the role of the senior GPN in the provision of care

Team working
Understand own role and scope, and identify how this may develop over time Work as an effective and responsible team member, supporting others and exploring the mechanisms to develop new ways of working Delegate clearly and appropriately, adopting the principles of safe practice and assessing competence Ensure clear referral mechanisms are in place to meet patient need Prioritise own workload and ensure effective time-management strategies are embedded within the culture of the team Work effectively with others to clearly define values, direction and policies impacting upon care delivery Participate in team activities that create opportunities to improve patient care Participate in and support local projects as agreed with the practice management team

Management of risk
Manage and assess risk within the areas of responsibility, ensuring adequate measures are in place to protect staff and patients Monitor work areas and practices to ensure they are safe and free from hazards and conform to health, safety and security legislation, policies, procedures and guidelines Ensure safe storage, rotation and disposal of vaccines and drugs. Oversee the monitoring, stock control and documentation of controlled drug usage according to legal requirements Support members of the nursing team to undertake mandatory and statutory training requirements Apply infection-control measures within the practice according to local and national guidelines Apply policies that reduce environmental health risks, are culturally sensitive and increase access to health care for all Participate in the local implementation strategies that are aligned to the values and culture of general practice

Utilising information
Use technology as an aid to management in planning, implementation and monitoring, presenting and communicating information Review and process data using accurate Read codes to ensure easy and accurate retrieval for monitoring and audit processes Manage information searches using the internet and local library databases, for example, the retrieval of relevant information for patients on their condition Understand the responsibility of self and others regarding the Freedom of Information Act Collate, analyse and present clinical data and information to the team using appropriate charts and/or graphs to enhance care

Learning and development

Act as a mentor for more junior staff and students, assessing competence against set standards as requested Disseminate learning and information gained to other team members in order to share good practice and inform others about current and future developments Assess own learning needs and undertake learning as appropriate Provide an educational role to patients, carers, families and colleagues in an environment that facilitates learning

Equality and diversity

Identify patterns of discrimination, take action to overcome this, and promote diversity and quality of opportunity Enable others to promote equality and diversity in a non-discriminatory culture Support people who need assistance in exercising their rights Monitor and evaluate adherence to local chaperoning policies Act as a role model in the observance of equality and diversity good practice Accept the rights of individuals to choose their care providers, participate in care and refuse care. Assist patients from marginalised groups to access quality care

Person specification
Criteria Knowledge

Essential
Knowledge of management of patients with long-term conditions Knowledge of accountability of own role and other roles in a nurse-led service Knowledge of health promotion strategies Knowledge of local and national health policy Wider health economy awareness Knowledge of clinical governance issues in primary care Knowledge of patient group directions and associated policy Clinical leadership skills Clinical skills cervical cytology, immunisation and vaccination, ear care, minor surgery Change-management skills and ability to support patients to change lifestyle Communication skills, both written and verbal Ability to communicate difficult messages to patients and families Negotiation and conflictmanagement skills Ability to provide teaching and mentorship in a clinical setting IT skills

Desirable
Knowledge of public health issues Ability to identify determinants on health in the local area Knowledge of public health issues in the area

Skills

Criteria Experience

Essential
Minimum 3 years postregistration experience At least 2 years recent primary and community nursing experience Experience of nurse-led management of long-term conditions Experience of implementing protocols and clinical guidelines Experience of quality initiatives such as clinical benchmarking Audit experience Registered first level nurse Community nursing specialist qualification or equivalent Relevant nursing/health degree Mentor/teaching qualification Clinical supervision training and experience Self-directed practitioner Highly motivated Flexibility Enthusiasm Team player Ability to work across boundaries

Desirable

Qualifications

Independent/supplementary nurse prescribing qualification

Other

Title: AfC banding: Hours of duty: Responsible to: Accountable to:

Lead general practice nurse (GPN) 7 GP GP

Job summary
The post holder is responsible for ensuring the delivery of safe and effective nursing care to the whole practice population. As the team leader for the GPN team, the post holder is accountable for nursing service delivery. They will lead and manage all the nursing resource, working closely with the practice manager and GPs to deliver the practice priorities. Clinically, the focus of the role is the delivery of evidence-based practice for patients with long-term conditions and management and preventative nursing interventions to all patients. As autonomous practitioners the nurse is responsible for the care delivered, demonstrating critical thinking and skills in clinical decision-making. They will work collaboratively with the whole general practice team to meet the needs of patients, supporting the delivery of policy and procedures, and providing leadership and direction for the nursing team.

Key responsibilities
Clinical practice
Assess, plan, develop, implement and evaluate treatment programmes that promote health and well-being Assess, plan, implement and evaluate individual treatment plans for patients with a known long-term condition Proactively identify, diagnose and manage treatment plans for patients at risk of developing a long-term condition Work with other health care professionals to diagnose, monitor, manage and treat long-term conditions, including using non-drug-based treatment methods, in line with national and local policies and practice needs Review medication for therapeutic effectiveness, appropriate to patient needs and in accordance with evidencebased practice and national and practice protocols Work with patients in order to support adherence to prescribed treatments Provide information and advice on prescribed or over-the-counter medication on medication regimens, side-effects and interactions Prioritise health problems and intervene appropriately to assist the patient in complex, urgent or emergency situations, including initiation of effective emergency care Support patients to adopt health promotion strategies that promote them to live healthily, and apply principles of self-care Support and manage health needs of women presenting for family planning and cervical cytology consultations Assess, identify and refer patients presenting with mental health needs in accordance with the NSF for Mental Health as required Implement and participate in vaccination and immunisation programmes for both adults and children Advise, support and, where appropriate, administer vaccinations for patients travelling abroad Promote and deliver evidence-based care for patients presenting with aural conditions Meet the needs of patients presenting for opportunistic wound care

Communication
Demonstrate sensitive communication styles to ensure patients are fully informed and consent to treatment Communicate with and support patients who are receiving bad news Communicate effectively with patients and carers, recognising the need for alternative methods of communication to overcome different levels of understanding, cultural background and preferred ways of communicating Anticipate barriers to communication and take action to improve communication Estimate and maintain effective communication within the practice environment and with external stakeholders Act as an advocate when representing patients and colleagues Participate in practice team meetings, delivering the nursing agenda Produce written documents that evidence the contribution of the nursing team to the practice priorities Ensure awareness of sources of support and guidance (eg PALS) and provide information in an acceptable format to all patients, recognising any difficulties and referring where appropriate

Delivering a quality service

Recognise and work within own competence and professional code of conduct as regulated by the NMC Produce accurate, contemporaneous and complete records of patient consultation, consistent with legislation, policies and procedures Prioritise, organise and manage own and others workload in a manner that maintains and promotes quality Deliver care as an individual and team according to NSF, NICE guidelines and evidence-based care Assess effectiveness of care delivery for the nursing team through peer review, benchmarking and formal evaluation Lead on the maintenance of quality governance systems for the nursing team Implement and review the application of evidence-based practice in nursing Utilise the audit cycle as a means of evaluating the quality of the work of self and the team, implementing improvements where required Lead the quality agenda in responding to local and national policies and initiatives as appropriate Evaluate patients response to health care provision and the effectiveness of care Lead and participate in shared learning across the practice and wider organisation Lead in the management and review of patient complaints, and identify learning from clinical incidents and near-miss events utilising a structured framework (eg root-cause analysis) Assess the impact of policy implementation on care delivery Monitor the performance of the GPN team in accordance with local policies Understand and apply legal policy that supports the identification of vulnerable and abused children and adults, being aware of statutory child/vulnerable adult health procedure and local guidance Work within policies regarding family violence, vulnerable adults, substance abuse and addictive behaviour, and refer as appropriate Interpret national strategies and policies into local implementation strategies that are aligned to the values and culture of general practice

Management function
Identify the nursing requirement to meet the practice population need, assessing the impact and implementation of skill-mix in the delivery of care Lead the recruitment and selection of nurses into the GPN team Implement induction programmes for new nursing staff, ensuring they are able to function within the practice team Assess competences of nurses within the team Undertake appraisals in line with best practice and local policies Manage and monitor sickness, absence and annual leave requests in line with best practice and local policies Participate in performance-monitoring review of the team, providing feedback as appropriate Instigate and lead performance management and formal disciplinary procedures if required Collate, analyse and present clinical data and information from the team Communicate essential financial restraints with the team and discuss with them ideas for effective and efficient working within these constraints Manage, if agreed, nursing budget within financial principles

Leadership personal and people development

Take responsibility for own development, learning and performance including participating in clinical supervision and acting as a positive role model Support the development of others in order to maximise staff potential Actively promote the workplace as a learning environment, encouraging everyone to learn from each other and from external good practice Lead others to make realistic self-assessment of their knowledge and skills, challenging any complacency and actions that are not in the interest of the public and/or users of service Act as a clinical leader in the delivery of GPN services to patients, ensuring that the needs of the patient are the priority Lead in the planning and implementation of changes within the area of care and responsibility Lead and participate in the development of local guidelines, protocols and standards Lead the nursing team in the planning and engagement of practice-based commissioning or similar initiatives Promote the role of the nursing team in the provision of care

Team working
Understand own role and scope in the practice and identify how this may develop over time Work as an effective and responsible team leader, supporting others and exploring the mechanisms to develop new ways of working Delegate appropriately, adopting the principles of safe practice and assessment of competence of nurses Ensure clear referral mechanisms are in place to meet patient need Prioritise own and others workload and ensure effective time-management strategies are embedded within the culture of the team Work effectively with others to clearly define values, direction and policies impacting upon care delivery Lead nursing team activities that create opportunities to improve patient care Participate in and support local projects as agreed with the practice management team

Management of risk
Manage and assess risk within the areas of responsibility, ensuring adequate measures are in place to protect staff and patients Monitor work areas and practices to ensure they are safe and free from hazards and conform to health, safety and security legislation, policies, procedures and guidelines Ensure the safe storage, rotation and disposal of vaccines and drugs. Oversee the monitoring, stock control and documentation of controlled drug usage according to legal requirements Act as a role model to support members of the nursing team to undertake mandatory and statutory training requirements Apply infection-control measures within the practice according to local and national guidelines Apply policies that reduce environmental health risks, are culturally sensitive and increase access to health care for all Participate in the local implementation strategies that are aligned to the values and culture of general practice

Utilising information
Use technology and appropriate software packages as an aid to the planning, implementation and monitoring of care, presenting and communicating information Review and process data using accurate Read codes in order to ensure easy and accurate information retrieval for monitoring and audit processes Manage information searches using the internet and local library databases Understand the responsibility of self and others regarding the Freedom of Information Act Collate, analyse and present clinical data and information to the team using appropriate charts and/or graphs to enhance care

Learning and development

Act as mentor for more junior staff and students, assessing competence against set standards Disseminate learning and information to other team members in order to share good practice and inform others about current and future developments (eg courses and conferences) Assess own learning needs and undertake learning as appropriate Provide an educational role to patients, carers, families and colleagues in an environment that facilitates learning

Equality and diversity

Identify patterns of discrimination and take action to overcome this and promote diversity and equality of opportunity Enable others to promote equality and diversity in a non-discriminatory culture Support people who need assistance in exercising their rights Monitor and evaluate adherence to local chaperoning policies Act as a role model in the observance of equality and diversity good practice Accept the rights of individuals to choose their care providers, participate in care and refuse care. Assist patients from marginalised groups to access quality care

Person specification
Criteria Knowledge

Essential
Skills in management of patients with long-term conditions Awareness of accountability of own and others roles in a nurseled service Knowledge of health promotion strategies Awareness of local and national health policy Wider health economy awareness Knowledge of clinical governance issues in primary care Knowledge of patient group directions and associated policy Leadership skills Management knowledge Human resources (HR) awareness Clinical leadership skills Skills in management of staff and teams Negotiation skills Clinical skills cervical cytology, immunisation and vaccination, ear care, minor surgery Change-management skills and ability to support patients to change lifestyle Communication skills, both written and verbal Ability to communicate difficult messages to patients and families Negotiation and conflictmanagement skills Teaching and mentorship experience in a clinical setting IT skills

Desirable
Knowledge of public health issues Ability to identify determinants on health in the local area Knowledge of public health issues in the area

Skills

Criteria Experience

Essential
Minimum 5 years postregistration experience At least 2 years recent primary and community nursing experience Experience in nurse-led management of long-term conditions Experience in implementing protocols and clinical guidelines Experience in quality initiatives such as clinical benchmarking Audit skills Registered first level nurse Community nursing specialist qualification or equivalent Relevant nursing/health degree Mentor/teaching qualification Clinical supervision training and experience Self-directed practitioner Highly motivated Flexibility Enthusiasm Team player Ability to work across boundaries

Desirable
Team leader experience

Qualifications

Independent/supplementary nurse prescribing qualification

Other

Title: AfC Banding: Hours of duty: Responsible to: Accountable to:

Advanced nurse practitioner in general practice 8 GP GP

Job summary
The post holder is an experienced nurse who, acting within their professional boundaries, will provide care for the presenting patient from initial history taking, clinical assessment, diagnosis, treatment and evaluation of care. They will demonstrate safe, clinical decision-making and expert care, including assessment and diagnostic skills, for patients within the general practice. The post holder will demonstrate critical thinking in the clinical decision-making process. They will work collaboratively with the general practice team to meet the needs of patients, supporting the delivery of policy and procedures, and providing nurse leadership as required. In order to work at this level NMC requirements for advanced practice must be met.

Key responsibilities
Clinical practice
Assess, diagnose, plan, implement and evaluate treatment/interventions and care for patients presenting with an undifferentiated diagnosis Clinically examine and assess patient needs from a physiological and psychological perspective, and plan clinical care accordingly Assess, diagnosis, plan, implement and evaluate interventions/treatments for patients with complex needs Proactively identify, diagnose and manage treatment plans for patients at risk of developing a long-term condition (as appropriate) Diagnose and manage both acute and chronic conditions, integrating both drug- and non-drug-based treatment methods into a management plan Prescribe and review medication for therapeutic effectiveness, appropriate to patient needs and in accordance with evidence-based practice and national and practice protocols, and within scope of practice Work with patients in order to support compliance with and adherence to prescribed treatments Provide information and advice on prescribed or over-the-counter medication on medication regimens, side-effects and interactions Prioritise health problems and intervene appropriately to assist the patient in complex, urgent or emergency situations, including initiation of effective emergency care Support patients to adopt health promotion strategies that promote healthy lifestyles, and apply principles of self-care Support and manage health needs of women presenting for family planning, cervical cytology or sexual health consultation Assess, identify and refer patients presenting with mental health needs in accordance with the NSF for Mental Health Implement and participate in vaccination and immunisation programmes for both adults and children Advise, support and administer vaccinations for patients travelling abroad, where appropriate Promote and deliver evidence-based care for patients presenting with aural conditions Meet the needs of patients presenting for opportunistic wound care Undertake minor surgery as appropriate to competence

Communication
Utilise and demonstrate sensitive communication styles, to ensure patients are fully informed and consent to treatment Communicate with and support patients who are receiving bad news Communicate effectively with patients and carers, recognising the need for alternative methods of communication to overcome different levels of understanding, cultural background and preferred ways of communicating Anticipate barriers to communication and take action to improve communication Maintain effective communication within the practice environment and with external stakeholders Act as an advocate for patients and colleagues Ensure awareness of sources of support and guidance (eg PALS) and provide information in an acceptable format to all patients, recognising any difficulties and referring where appropriate

Delivering a quality service

Recognise and work within own competence and professional code of conduct as regulated by the NMC Produce accurate, contemporaneous and complete records of patient consultation, consistent with legislation, policies and procedures Prioritise, organise and manage own workload in a manner that maintains and promotes quality Deliver care according to NSF, NICE guidelines and evidence-based care Assess effectiveness of care delivery through self and peer review, benchmarking and formal evaluation Initiate and participate in the maintenance of quality governance systems and processes across the organisation and its activities Utilise the audit cycle as a means of evaluating the quality of the work of self and the team, implementing improvements where required In partnership with other clinical teams, collaborate on improving the quality of health care responding to local and national policies and initiatives as appropriate Evaluate patients response to health care provision and the effectiveness of care Support and participate in shared learning across the practice and wider organisation Use a structured framework (eg root-cause analysis) to manage, review and identify learning from patient complaints, clinical incidents and near-miss events Assess the impact of policy implementation on care delivery Monitor and develop the performance of the GPN team in accordance with local policies Approve the performance of the team, providing feedback as appropriate Understand and apply legal issues that support the identification of vulnerable and abused children and adults, and be aware of statutory child/vulnerable patients health procedures and local guidance Ensure the whole team have skills and knowledge regarding domestic violence, vulnerable adults, substance abuse and addictive behaviour. Provide guidance and support to ensure appropriate referral if required

Leadership personal and people development

Take responsibility for own learning and performance including participating in clinical supervision and acting as a positive role mode Support staff development in order to maximise potential Actively promote the workplace as a learning environment, encouraging everyone to learn from each other and from external good practice Encourage others to make realistic self-assessment of their application of knowledge and skills, challenging any complacency or actions that are not in the interest of the public and/or users of services Critically evaluate and review innovations and developments that are relevant to the area of work Enlist support and influence stakeholders and decision-makers in order to bring about new developments in the provision of services Lead the GPN team and ensure support structures are in place for the smooth running of the practice Take a lead role in planning and implementing changes within the area of care and responsibility Work with practice management to ensure sufficient staff of appropriate ability, quality and skill-mix are available to meet current and future service delivery, that selection and recruitment processes are effective and that equality of treatment of the team incorporates quality HR principles and processes Contribute to the development of local guidelines, protocols and standards Maintain effective communication with those responsible for the overall commissioning and procurement process Maintain active involvement in the planning and processes of practice-based commissioning or similar initiatives Market the role of the advanced nurse practitioner in general practice

Team working
Understand own role and scope and identify how this may develop over time Work as an effective and responsible team member, supporting others and exploring the mechanisms to develop new ways of working Delegate clearly and appropriately, adopting the principles of safe practice and assessment of competence Create clear referral mechanisms to meet patient need Prioritise own workload and ensure effective time-management strategies are embedded within the culture of the team Work effectively with others to clearly define values, direction and policies impacting upon care delivery Discuss, highlight and work with the team to create opportunities to improve patient care Manage and lead on the delivery of specifically identified services or projects as agreed with the practice management team Agree plans and outcomes by which to measure success

Management of risk
Manage and assess risk within the areas of responsibility, ensuring adequate measures are in place to protect staff and patients Monitor work areas and practices to ensure they are safe and free from hazards and conform to health, safety and security legislation, policies, procedures and guidelines Ensure appropriate supervision of safe storage, rotation and disposal of vaccines and drugs. Oversee the monitoring, stock control and documentation of controlled drug usage according to legal requirements where appropriate Ensure the nursing team undertakes mandatory and statutory training requirements Apply infection-control measures within the practice according to local and national guidelines Advocate for policies that reduce environmental health risks, are culturally sensitive and increase access to health care for all Interpret national strategies and policies into local implementation strategies that are aligned to the values and culture of general practice

Managing information
Use technology and appropriate software as an aid to management in planning, implementation and monitoring of care, presenting and communicating information Review and process data using accurate Read codes in order to ensure easy and accurate information retrieval for monitoring and audit processes Manage information searches using the internet and local library databases Understand responsibility of self and others to the practice and primary care trust regarding the Freedom and Information Act Monitor and confirm that the nursing team are receiving and processing data and information in an agreed format Collate, analyse and present clinical data and information to the team Communicate essential financial restraints with the team and discuss with them ideas for effective and efficient working within these constraints Manage, if agreed, the nursing budget within financial principles

Learning and development

Undertake mentorship for more junior staff, assessing competence against set standards Disseminate learning and information gained to other team members in order to share good practice and inform others about current and future developments (eg courses and conferences) Assess own learning needs and undertake learning as appropriate Provide an educational role to patients, carers, families and colleagues in an environment that facilitates learning

Equality and diversity

Identify patterns of discrimination and take action to overcome this and promote diversity and equality of opportunity Enable others to promote equality and diversity in a non-discriminatory culture Support people who need assistance in exercising their rights Monitor and evaluate adherence to local chaperoning policies Act as a role model in the observance of equality and diversity good practice Accept the rights of individuals to choose their care providers, participate in care and refuses care. Assist patients from marginalised groups to access quality care

NB: This list is not exhaustive and may be added to or amended according to the needs of the practice.

Person specification
Criteria Knowledge

Essential
Advanced clinical practice skills Management of patients with long-term conditions Management of patients with complex needs Clinical examination skills Accountability of own role and other roles in a nurse-led service Local and national health policy Wider health economy Clinical governance issues in primary care Patient group directions and associated policy Clinical leadership skills Communication skills, both written and verbal Communication of difficult messages to patients and families Negotiation and conflictmanagement skills Change management Teaching and mentorship in a clinical setting Resource management

Desirable
Knowledge of public health issues Able to identify determinants on health in the area Knowledge of public health issues in the area

Skills

Criteria Experience

Essential
Minimum 5 years postregistration experience At least 2 years recent primary and community nursing experience Nurse-led management of minor illness, minor ailments and injuries Nurse-led triage Compiling protocols and clinical guidelines Leadership in quality initiatives such as clinical benchmarking Leading a team Audit Research Nurse prescribing Registered first level nurse MSc or equivalent Relevant nursing/health degree Mentor/teaching qualification Clinical supervision training and experience Extended/independent nurse prescriber qualification Self-directed practitioner Highly motivated Flexibility Enthusiasm Team player Ability to work across boundaries

Desirable
Project management Working with community development initiatives Health-needs assessment

Qualifications

Community nursing specialist qualification

Other