Enhanced Nurse Primary Care Network (PCN)

Deliver high-quality assessment, intervention, early detection and management of patients at risk of CVD Management of patients with a known Long-term condition who may be at higher risk, do not attend and or have a requirement for personal care adjustment. Using population health tools to proactively identify gaps in care and inequalities in health outcomes. Using risk stratification tools to prioritise and identify eligible patient cohorts. Identify and engage with hard-to-reach and marginalised groups through outreach and partnership with community organisations. Promote self-care and provide education to patients, carers, and community groups. Work closely with a range of management and clinical roles across the PCN and wider allied health professionals to deliver integrated care. Contribute to service development, audits, and quality improvement projects. Act as a clinical leader and mentor for other nursing and support staff across the PCN. Actively partake in a multidisciplinary team meeting Membership and contribution to the PCN Exec Team. Provide and present outcome and evidenced based reports within board meetings. (This role will evolve over time, and the job description may be updated to reflect service developments or organisational priorities) Job description Job responsibilities Deliver high-quality assessment, intervention, early detection and management of patients at risk of CVD Management of patients with a known Long-term condition who may be at higher risk, do not attend and or have a requirement for personal care adjustment. Using population health tools to proactively identify gaps in care and inequalities in health outcomes. Using risk stratification tools to prioritise and identify eligible patient cohorts. Identify and engage with hard-to-reach and marginalised groups through outreach and partnership with community organisations. Promote self-care and provide education to patients, carers, and community groups. Work closely with a range of management and clinical roles across the PCN and wider allied health professionals to deliver integrated care. Contribute to service development, audits, and quality improvement projects. Act as a clinical leader and mentor for other nursing and support staff across the PCN. Actively partake in a multidisciplinary team meeting Membership and contribution to the PCN Exec Team. Provide and present outcome and evidenced based reports within board meetings. (This role will evolve over time, and the job description may be updated to reflect service developments or organisational priorities)