Download JOB TITLE: Advanced Nurse Practitioner

MARLBOROUGH MEDICAL PRACTICE
JOB DESCRIPTION
JOB TITLE:
ADVANCED NURSE PRACTITIONER
REPORTS TO:
GP PARTNERS
Job Summary:
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To act as an autonomous practitioner working independently and in conjunction with other health care
professionals to assess, diagnose and treat the conditions of all registered patients, initiating direct
referrals as appropriate.
In conjunction with the doctors, managing minor ailments and provide face-to-face and telephone triage /
assessment and treatment of patients in line with business need and patient demand.
You will assess and respond to requests for home visiting with the support of the GP team.
To develop new and innovative concepts, models, methods and practices to deliver new and improved
primary care services to meet the needs of the practice, including education and training to other staff
members and patients.
Duties will also include all tasks normally undertaken by an experience RGN and in addition any roles
agreed between the nurse and the doctors as appropriate, having regard to current training.
KEY RESPONSIBILITIES
AUTONOMOUS PRACTITIONER SKILLS
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To act as an autonomous practitioner, accountable for own professional actions, providing clinical
assessment, diagnosis (where possible), and treatment (where appropriate) for all registered patients adults & paediatrics.
Evaluate clinical information from examination & history taking and assesses, diagnoses and treat
patients in surgery, residential or nursing homes or within their own home with a range of acute, nonacute and chronic medical conditions.
To liaise with clinical colleagues to provide the most appropriate package of care for each individual
recognising his/her own scope of competence.
Directly admits patients to secondary care hospital in acute medical need.
Refers patients to other medical specialities for assessment if deemed appropriate.
Refers patients as appropriate to other members of the multidisciplinary team, secondary care and to
other statutory and voluntary organisations including referral for x-ray.
Makes critical judgements of the highest order to satisfy the expectations and demands of the job eg first
contact with patients presenting acutely and manages care in the presence and absence of protocols.
Makes decisions where precedents do not exist, where appropriate without recourse to others eg direct
referral of patients to Hospital Consultants without prior reference to other medical colleagues.
Accurately triage & prioritise all patients demonstrating the use of a variety of techniques to elicit the
history of an event / illness including past medical and drug history.
To respond to requests for home visits and provide clinical expertise to patients by assessing and treating
their medical condition.
As an Independent Nurse Prescriber, prescribe, supply and / or administer medication and treatments
according to agreed protocols, within scope of competence.
NURSING HOME MANAGEMENT
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The jobholder will be responsible for managing the care for the patients registered in residential and
nursing homes covered by the practice boundary.
Duties will include, but are not limited to:
o Reviewing new residents within 7 days of arrival at the home or on return from hospital
o Medications are reviewed at least 6-monthly
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In conjunction with GPs, undertake a weekly ward round by GP
Generate and keep up to date advanced care planning and care co-ordination information
Ensure each resident has Treatment Escalation Plan (TEP) completed once they have settled into the
home
LONG TERM CONDITIONS MANAGEMENT
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Develops and manages highly specialised programmes of care and care packages and provides highly
specialised advice concerning care normally beyond the scope of normal Nursing practice eg establishes
differential diagnoses, management/treatment plans and makes referrals as appropriate. Makes fast track
referrals.
Initiates the process of diagnosis with patients suspected to have a chronic disease eg. diabetes, COPD,
asthma, IHD referring to other clinical staff as appropriate.
Contribute to practice targets both local and national within the disease management agenda eg QOF,
prescribing incentive scheme, etc.
Contributes to disease registers.
Undertakes annual review of patients’ understanding and ability to self-manage.
Works at the forefront of practice innovation. Determines how to deal with ambiguous or unique
problems to develop and advance primary care services for the benefit of patients, carers and
communities.
MANAGEMENT & LEADERSHIP
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To take clinical responsibility for themselves and to provide assistance and supervision to other health
professionals as required.
In partnership with others, challenge and critically evaluate the boundaries of autonomous practice, such
that patient access, choice and outcomes will improve.
Assist in the maintenance of clinical standards to ensure the efficient running of the practice.
Help in the development and evaluation of clinical guidelines, and competency tools to support the
clinical team in the delivery of best practice.
To be aware of local, regional and national policies which affect the delivery of health and social care.
Audits outcomes of care against standards and initiate changes as necessary.
Regularly communicates service related information to Partners and salaried GPs, Practice Management,
Nursing and Administrative staff, patients, relatives and carers.
To empower service users to access the service through the most appropriate means and to encourage
self-care where clinically appropriate.
Continue to develop, expand and role model own personal clinical expertise as an autonomous /
independent practitioner.
Advises and supports others where standard protocols do not apply.
TELEPHONE TRIAGE
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The jobholder will be responsible for triaging all requests for emergency appointments (including
emergency visits), by undertaking the following:
o obtain a brief telephone history;
o assess and classify emergent conditions;
o assign level of triage;
o decide relevant management plan (either appointment with relevant clinician, visit, telephone
appointment, advice, attend A&E, phone 999, etc) for the patient;
o Prescribe as needed;
o decide which member of the medical team is best suited to handle the case and notify this person,
and book patients appointments in according with agreed protocol
MANAGING MINOR AILMENTS
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Manage minor ailments either by providing telephone advice or running clinics within surgery opening
hours. by undertaking the following:
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Obtain a medical history and perform physical examinations
Order, perform, and interpret diagnostic studies (i.e. blood, x-rays) as per agreed protocols.
Initiate treatments as per agreed protocols
Prescribe as needed
Provide advice to patients as per their medical condition.
CLINICAL SKILLS
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Undertakes Clinical Nursing Practice at an advanced level using expert knowledge and clinical skills to
deliver holistic care to people accessing primary health care services.
Take a management role in the delivery of care for patients with Long Term Conditions.
Providing assessment, screening and treatment services and health education advice:
Provide nursing treatments to patients in participation with GPs or independently to agreed protocols.
Provide general and specific health screenings to the Practice patients with referral to other members of
the primary and secondary health care team as necessary
Advise patients on general health care and minor ailments with referral to GPs as necessary.
Assist in and perform routine tasks related to patient, including but not limited to:
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Blood pressure checks and hypertension management
Venepuncture
Anticoagulation clinics (to include interpretation of blood tests and dosing)
ABPM 24 hour
24 hour ECGs and cardiocall
Dietary advice
Cervical Cytology - participate in national screening programme
Urinalysis
Ear syringing
Eye washing
Cryotherapy
Spirometry
Wound care / ulcer care:
o Dressings
o Dopplers
o Removal of sutures / clips
14. Provide directly and assist GPs with contraception and Sexual Health services:
o Insertion and removal of Contraceptive implants
o IUCDs - Assisting GPs with the fitting of IUCD
o Offer contraceptive counselling and advice
o Provide the contraceptive injection as required
o Issue repeat contraceptive pills as required
15. Routine Vaccinations and Immunisations:
o Administer in line with national guidelines
o Offer advice about routine adult and childhood vaccinations
o ensure vaccines are administered under Patient Group Directives
o Undertake Flu vaccinations in the community
16. Chronic Disease Management (including but not limited to including hypertension management,
asthma, COPD, diabetes etc) and contraception services
o following specialist training, be in charge of running specific clinic sessions
o maintain robust call and recall systems
o READ code all interaction so that the necessary data is available for claims, etc
17. Offer a holistic approach to travel health by providing comprehensive advice to patients
prior to travel including:
o Administration of necessary travel vaccinations and medicines as required under a
Patient Group Directive (PGD)
o Provide malarial advice, including the use of antimalarial medication when needed
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o Other advice relevant to the travel including but not limited to safe sex, food hygiene,
sun protection, etc.
18. Health promotion – as required, running well person clinics and health promotion programmes by
providing lifestyle advice on diet, smoking, alcohol intake and exercise to help educate patients
19. Minor Surgery / Operations:
o Assisting GPs with minor surgical procedures
o management of the treatment room for minor operations including maintenance of equipment
and stock
o Ensure adequate staffing and ensuring appropriate items of service claims are made
20. Mental health checks
21. New patient medicals and other health surveillance as required
22. Other clinics as defined by the partners
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Following appropriate training, undertake the collection, storage and despatch of pathological specimens
including intravenous blood samples, swabs, smears etc and ensure the cleanliness of any equipment so
used. Perform any investigatory procedures requested by the GPs.
Requesting pathology tests (eg urine culture swabs) and subsequent interpretation of test results
Interest in Diabetes or Coronary Heart Disease and Contraception.
Chaperone – to act as chaperone when required
See patients referred by other members of the nursing team.
SUPPLIES AND EQUIPMENT – TREATMENT ROOM AND OTHER AREAS
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Maintaining and cleaning equipment used by the nurses and GPs
Correct cleaning of equipment used for near patient testing such as blood glucose monitoring equipment
and smokelysers, using manufacturer’s instructions as appropriate
Undertake housekeeping duties including general tidiness and cleanliness of nurse and treatment rooms
Maintaining GP and nurses rooms, stocking and rotating items as required
Maintain general tidiness and cleanliness of nurses and treatment rooms
Ordering of vaccinations to maintain stock levels
ADMINISTRATIVE AND PROFESSIONAL RESPONSIBILITIES
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Able to obtain and document informed consent (either verbal or written)
Ensure accurate notes of all consultations and treatments are recorded in the patients’ notes on the
clinical computer system as appropriate.
To maintain accurate patient records and enter onto the computer using agreed Read Codes
Ensure accurate completion of all necessary documentation associated with patient health care and
registration with the Practice.
Dealing with telephone enquiries appropriately and according to Practice policy
Able to perform Cardio-pulmonary resuscitation according to current UK guidelines.
Ensure collection and maintenance of statistical information required for regular and ad hoc reports.
Co-operate and participate as required in any research projects within the Practice.
Maintain effective liaison with other agencies and staff concerned with patient care and with all other
disciplines within the Practice, with appropriate regard to confidentiality.
Ability to recognise signs and symptoms of child abuse.
Ensure awareness of statutory and local clinical protection procedures, including systems of referral.
Liaise with other Team Leaders and Patients as necessary following clinical staff sickness or
unauthorised absence to ensure clinics are either covered or cancelled.
In conjunction with the team leader, offer a leadership role to the team to ensure it provides an efficient
and clinically safe service to patients and employees. This will include the supervision and management
of the team, ensuring all functions are carried out in accordance with Practice policies and protocols.
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ADDITIONAL RESPONSIBILITIES
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Work as an effective and responsible team member, supporting others and exploring the mechanisms to
develop new ways of working, including having an understanding of your own role and scope and
identify how this may develop over time
Assessing problems presented opportunistically by patients, dealing with minor illness.
Contribute to the assessment of service needs
Assist patients to identify their health needs
Contribute a nursing perspective to the practice development plan
Manage and organise individual patient consultations
Identify changes to clinical practice that are required to implement evidence-based guidelines
Participate in clinical supervision
Offer innovative ways of working and opportunities to facilitate learning
Facilitates a learning environment within the team
Maintains a caring environment through the support of colleagues
A duty to advise senior nurses of potential problems or errors within a range of assigned tasks
On occasion there may be a requirement to undertake home visits
Any other delegated duties appropriate to the post
Conduct clinical audits of unit as determined from time to time:
o prepare audit reports and recommend corrective action;
o review medical records and patient assessments to determine compliance with policies and
procedures.
INFORMATION PROCESSES
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Record information and activities undertaken with patients and carers in an accurate and timely fashion
using manual or computer systems as appropriate
Maintain confidentiality or information relating to patients, relatives, staff and the practice
Take the necessary precautions when transmitting information
Understand basic legal and communication issues regarding child abuse, family violence, vulnerable
adults, substance abuse and addictive behaviour
SAFETY AND SECURITY
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Use the personal security systems within the workplace according to practice guidelines
Identify the risks involved in work activities and undertake them in a way that manages the risks
Use appropriate infection control procedures and maintain work areas in each clinical room so that they
are clean, safe and free from hazards reporting of any potential risks identified, including:
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hand washing
universal hygiene procedures
collection and handling of laboratory specimens
segregation and disposal of waste materials
decontamination of instruments and clinical equipment
reporting and treatment of sharps injuries
dealing with blood and body fluid spillages
Assist patients and colleagues in adopting sound infection control measures
Understand and apply the principles of the cold chain
Ensure safe storage, rotation and disposal of vaccines and drugs within area of responsibility
Know the general principles of first aid and resuscitation to be able to undertake initial actions as
appropriate
Be aware of statutory child health procedures and statutory local guidance and referral criteria
Know the health and safety policies and procedures within the workplace, including fire procedures,
maintaining documentation, monitoring and maintaining of equipment and furniture within your area of
responsibility
Use the computer monitor safely
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Be able to identify the risks to health of microbiological and chemical hazards within the working
environment according to the Control of Substances Hazardous to Health
Act as a chaperone as required
Ensure own actions are consistent with clinical governance systems
Practice in accordance with agreed standards of care
Enable patients to access appropriate professionals in the team
Ensure stock items under your control are ordered and available in the treatment and consulting rooms
Know how clinical governance affects the HCA role and bring to the attention of more senior staff any
specific risk situation
Know the practice's policies, especially the whistle-blowing policy, available in the practice staff
handbook
Be able to manage your own time effectively
SERVICE IMPROVEMENT
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Be aware of and, if appropriate, assist in current clinical audit
Work with colleagues in the team on the development of current and new services and other initiatives
Maintain the notice board in the waiting room and promote good health with educational material
Deal with requests from patients and clinical staff for health information leaflets
ONGOING PROFESSIONAL DEVELOPMENT
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To maintain own annual registration with the NMC and adhere to Code of Professional Conduct.
To maintain membership of the RCN or equivalent body.
To promote a professional approach at all times by attire and attitude to patients and staff both in and out
of the Practice
To be accountable to the GP Partners of Marlborough Medical Practice.
Take responsibility for own developmental learning and performance, including participating in
supervision
Take responsibility for maintaining a record of own personal development
Work with management on any new training requirements
To recognise and understand the roles and responsibilities of individuals working in the primary health
care team
Be aware of the legal issues pertinent to the role of all members of the nursing team
Support others with the training and development needs.
PERSONAL AND PEOPLE DEVELOPMENT
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Take responsibility for own development learning and performance including participating in clinical
supervision and acting as a positive role model
Participate in and oversee the administrative and professional responsibilities of the team.
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
Participate in planning and implementing changes within the area of care and responsibility
Work with the team leader and 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
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
Attend external and in-house mandatory and clinical training sessions
GENERAL DUTIES
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Input and extract information from the Practice’s clinical system
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Participate in overtime rota to cover sickness and holidays
Attend and participate in Team and Practice meetings as required
Undertake any training as necessary to ensure continued safe and efficient performance
Attend external and in house mandatory training
Any other tasks allocated by the Team Leaders, Practice Manager or GPs
Photocopying and faxing
To undertake specific assigned tasks, project support, or development work which may arise from time
to time
OTHER
This Job Description is neither exhaustive nor exclusive and will be reviewed periodically in conjunction
with the post holder. The post holder is required to carry out any duties that may reasonably be requested by
the Partners or the Practice Manager. Some of the above duties may be delegated. The Practice reserves the
right to make changes to the Job Description and Personal Specification.
CONFIDENTIALITY
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In the course of seeking treatment, patients entrust us with, or allow us to gather, sensitive information in
relation to their health and other matters. They do so in confidence and have the right to expect that
staff will respect their privacy and act appropriately
In the performance of the duties outlined in this Job Description, the post-holder may have access to
confidential information relating to patients and their carers, Practice staff and other healthcare workers.
They may also have access to information relating to the Practice as a business organisation. All such
information from any source is to be regarded as strictly confidential
Information relating to patients, carers, colleagues, other healthcare workers or the business of the
Practice may only be divulged to authorised persons in accordance with the Practice policies and
procedures relating to confidentiality and the protection of personal and sensitive data
HEALTH & SAFETY
The post-holder will assist in promoting and maintaining their own and other’s health, safety and security as
defined in the Practice Health and Safety Policy, the practice Health & Safety Manual, and the practice
Infection Control policy and published procedures. This will include:
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Using personal security systems within the workplace according to Practice guidelines
Identifying the risks involved in work activities and undertaking such activities in a way that manages
those risks across clinical and patient process
Making effective use of training to update knowledge and skills
Responsible for correct hand hygiene of self and others
Always using appropriate infection control procedures, maintaining work areas in a tidy clean and sterile
and safe way, and free from hazards
Actively identifying, reporting, and correction of health and safety hazards and infection hazards
immediately when recognised
Keeping own work areas and general/patient areas generally clean, sterile, identifying such hazards/risks
in relation to other work areas within the practice and assisting in the maintenance of general standards
of cleanliness consistent with the scope of the job holder’s role
Correct use of Personal Protective Equipment (PPE) when appropriate
Waste management including collection, handling, segregation, container management, storage and
collection
Undertaking periodic infection control training
Reporting potential risks identified
INFECTION CONTROL
The post-holder will assist in promoting and maintaining their own and other’s infection control as defined in
the practice Infection Control policy and published procedures. This will include (but will not be limited to):
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Active observation of current working practices across the team in relation to infection control,
cleanliness and related activities, ensuring that procedures are followed and weaknesses / training needs
are identified, escalating issues as appropriate
Identifying the risks involved in work activities and undertaking such activities in a way that manages
those risks across clinical and patient process
Monitoring practice facilities and equipment in relation to infection control, ensuring that provision of
hand cleansing facilities, wipes etc are sufficient to ensure a good clinical working environment. Lack of
facilities to be escalated as appropriate.
Safe management of sharps procedures including training, use, storage and disposal
Keeping own work areas and general / patient areas generally clean, sterile, identifying issues and
hazards / risks in relation to other work areas within the Practice
Routine management of own team areas, and maintenance of work space standards
Spillage control procedures, management and training
Decontamination control procedures, management and training, and equipment maintenance
Maintenance of sterile environments
Awareness of national standards of infection control and cleanliness and regulatory / contractual /
professional requirements, and good practice guideline
Ownership of infection control and clinically based patient care protocols, and implementation of those
protocols within the team
EQUALITY AND DIVERSITY
The post-holder will support the equality, diversity and rights of patients, carers and colleagues, behave in a
manner which is welcoming, non-judgmental, and respectful to the privacy, dignity and needs and beliefs of
patients, carers and colleagues. This includes, but is not limited to:
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Acting in a way that recognizes the importance of people’s rights, interpreting them in a way that is
consistent with Practice procedures and policies, and current legislation
Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues
Behaving in a manner which is welcoming to and of the individual, is non-judgmental and respects their
circumstances, feelings priorities and rights.
PERSONAL/PROFESSIONAL DEVELOPMENT
The post-holder will participate in any training programme implemented by the Practice as part of this
employment, such training to include:
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Participation in an annual individual performance review, including taking responsibility for maintaining
a record of own personal and/or professional development
Taking responsibility for own development, learning and performance and demonstrating skills and
activities to others who are undertaking similar work
Participate in the education and training of students of all disciplines and the introduction of all members
of the Practice staff where appropriate
Develop and maintain an in house nurse-training programme reporting to the Practice Management.
Maintain continued education by attendance at courses and study days as deemed useful or necessary for
professional development ensuring PREP requirements are met.
Develop and maintain a Personal Learning Plan
QUALITY
The post-holder will strive to maintain quality within the Practice, and will:
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Alert other team members to issues of quality and risk
Assess own performance and take accountability for own actions, either directly or under supervision
Contribute to the effectiveness of the team by reflecting on own and team activities and making
suggestions on ways to improve and enhance the team’s performance
Work effectively with individuals in other agencies to meet patients’ needs
Effectively manage own time, workload and resources
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COMMUNICATION
The post-holder should recognize the importance of effective communication within the team and will strive
to:
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Communicate effectively with other team members
Communicate effectively with patients and carers
Recognize people’s needs for alternative methods of communication and respond accordingly
CONTRIBUTION TO THE IMPLEMENTATION OF SERVICES
The post-holder will:
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Apply Practice policies, standards and guidance
Discuss with other members of the team how the policies, standards and guidelines will affect own work
Participate in audit where appropriate
DOCUMENT DETAILS
Author and Role:
Organisation:
Reviewed By
Current Version Number:
Date Approved:
Next Review
Amy Lacey, Patient Services Manager
Marlborough Medical Practice
Ralph Rosalie, Senior Partner
1
November 2016
April 2017
Declaration
I accept the roles and responsibilities of my job as set out in this document
Job Holder:
Signature: _____________________________ Date: ______________
Practice Management:
Signature: _____________________________ Date: ______________
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Job Title:
Recruiter:
Date:
Marlborough Medical Practice
Person Specification – Advanced Nurse Practitioner (ANP)
Advanced Nurse Practitioner (ANP)
Partners / Patient Services Manager
November 2016
Qualifications
RGN qualification
Current NMC registration
Independent Nurse Prescribing qualification
Membership of the RCN or equivalent body
Membership of a recognised medical defence organisation
Accredited training in chronic disease management
Accredited training in anticoagulation management
Cervical cytology qualification
Experience
2 years post-registration at E grade
Experience of working in a General Practice environment
Experience of nurse prescribing in a General Practice environment
Evidence of recent updating in primary care
Health promotion
Family planning
Smoking cessation
Evidence of continuing professional development
Autonomous practitioner working independently and with other health care professionals.
Experience of Telephone Triage role in a General Practice environment
Working with TPP SystmOne clinical system
Up-to-date training in childhood immunisations
Skills
Able to demonstrate a depth and breadth of current issues and policies within the NHS and
have the ability to translate into practice
Excellent communication skills (Written and Oral)
IT skills including Microsoft Office to at a good level
Time Management and the ability to work to deadlines
Problem solving skills using diplomacy and tact
Evidence of Excellent Interpersonal skills
Accuracy and attention to detail
Be able to manage clinical uncertainty
Able to plan and organise own time and workload and cope with last minute changes.
Behaviours
Smart, polite and confident
An organised approach to work with the ability to plan, prioritise and balance conflicting
demands
Performing under pressure
Adaptability
Ability to use own initiative, judgement, resourcefulness and common sense
Ability to work as part of a team and autonomously
Self motivated
Ability to work flexibly
Understanding, acceptance and adherence to the need for strict confidentiality
Knowledge
Knowledge of clinical governance
Knowledge of clinical audits
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