About the role
Salary: Negotiable
Totton Primary Care Network is
seeking an experienced and motivated Frailty Nurse to join our
multidisciplinary team, supporting the delivery of proactive, high-quality care
to our frail and elderly population.
Undertake comprehensive frailty assessments, including clinical, functional, psychological, and social aspects of care.
Develop, implement, and regularly review personalised care and support plans in collaboration with patients, carers, and the wider MDT.
Provide clinical reviews and ongoing monitoring for patients identified as moderately or severely frail.
Support admission avoidance through early intervention, escalation planning, and coordination with community and acute services.
Contribute to anticipatory care planning, including end-of-life and advance care planning where appropriate.
Work closely with GPs, ANPs, Care Coordinators, Social Prescribers, pharmacists, and community teams.
Key Responsibilities