Lancashire and South Cumbria Integrated Care Board (ICB) has been selected to take part in one of four national Fit Note Reform Pilots commissioned by the Department for Work and Pensions, helping to test a new approach that aims to improve support for people whose health affects their ability to work. The pilot is designed to address a recognised challenge within the current system, where fit notes often focus on certifying sickness absence rather than providing practical support to help people remain in work or return to work safely.
MBPCC is delivering one of these pilots taking fit note generation out of practices within the Barrow and Mid Furness PCN areas. Patients will be referred directly from general practice into a new service called Enable where they will be offered a personalised Workability Plan setting out what they can do, the adjustments that would help, and the support available to them to aid them return to work.
The Advanced Nurse Practitioner is the senior clinical decision maker within the Enable service. The post holder carries clinical accountability for decisions, holds the most complex and highest risk caseload, and acts as the definitive point of clinical escalation short of the Clinical Lead.
Undertake advanced, autonomous work and health assessments for patients referred into the pilot, employing an extended scope of practice including advanced consultation, history taking and, where within the post holders assessed competence, physical assessment.
Assess undifferentiated presentations in the context of work, applying systematic clinical reasoning to distinguish between patients whose needs can be met by a Workability Plan, those requiring parallel clinical management, and those requiring urgent escalation.
Formulate and co-produce personalised Workability Plans focused on functional capability, phased return, adjustments and the practical support required to sustain work.
Exercise independent judgement in determining whether a period away from work is clinically appropriate, and articulate that judgement in terms that withstand challenge from patients, employers, referring clinicians and, potentially, an employment tribunal.
Recognise deteriorating or high risk presentations, including physical deterioration, mental health crisis, safeguarding concern and undisclosed serious pathology, and escalate without delay through agreed routes.
Request, review and interpret investigations where clinically indicated and within agreed pilot scope, communicating and acting on findings appropriately.
Morecambe Bay Primary Care Collaborative is the largest employer of Primary Care colleagues in South Cumbria, we are a not-for-profit Community Interest Company, and work to support, guide and underpin primary medical care across Lancashire and South Cumbria.
We deeply value education and learning, hosting the Lancashire and South Cumbria Training Hub. We have a great team on our board that guide our organisation, and you will be supported to excel in your role.
Job description
Job responsibilities
Post: Advanced Nurse Practitioner or Advanced Clinical
Practitioner with relevant experience
Service: MBPCC Enable Service
Accountable to: Service & Clinical Lead
Responsible to: Service
Lead
Hours: 37.5 per week
Salary: £52,000 £65,000 (30% enhanced hourly rate for
Saturday working)
Contract Type Fixed term 12 months.
Secondment applications welcome.
Base: Hybrid and
flexible with home working occasional Barrow and Mid
Furness PCN sites
MAIN DUTIES AND RESPONSIBILITIES
Clinical practice
Advanced assessment
and clinical decision making
Undertake advanced, autonomous work and health
assessments for patients referred into the pilot, employing an extended scope
of practice including advanced consultation, history taking and, where within
the post holders assessed competence, physical assessment.
Assess undifferentiated presentations in the context
of work, applying systematic clinical reasoning to distinguish between patients
whose needs can be met by a Workability Plan, those requiring parallel clinical
management, and those requiring urgent escalation.
Formulate and co-produce personalised Workability
Plans focused on functional capability, phased return, adjustments and the
practical support required to sustain work.
Exercise independent judgement in determining whether
a period away from work is clinically appropriate and articulate that judgement
in terms that withstand challenge from patients, employers, referring
clinicians and, potentially, an employment tribunal.
Recognise deteriorating or high risk presentations,
including physical deterioration, mental health crisis, safeguarding concern
and undisclosed serious pathology, and escalate without delay through agreed
routes.
Issue fit notes for patients
Request, review and interpret investigations where
clinically indicated and within agreed pilot scope, communicating and acting on
findings appropriately.
Complex casework and
clinical consultancy
Hold the most clinically complex, contested and high
risk cases within the service, including multiple comorbidity, mental health
presentations, contested employer relationships and cases with potential legal
exposure.
Act as the definitive clinical point of reference for
colleagues, providing case advice, joint assessment and decision support, and
taking clinical handover of cases beyond their scope.
Provide specialist advice on reasonable adjustments,
graduated return, workplace modification, redeployment and ill health
capability, informed by the Equality Act 2010 and relevant health and safety
legislation.
Assess mental capacity where relevant, obtain and
record valid informed consent, and work within the applicable legal framework.
Acknowledge the limits of personal competence and of
the pilot service, and accept responsibility only for activity where competence
can be assured.
Leadership and management
Provide senior clinical leadership to the assessment
function, setting and modelling the standard of practice for the service.
Own, develop and maintain the clinical assessment
protocols, triage criteria, escalation thresholds, business rules, assessment
templates and standard operating procedures, ensuring they are version
controlled and approved through the agreed governance route in collaboration
with other team members.
Exercise professional judgement to create precedent
and resolve ambiguous or novel clinical problems where no protocol exists, and
ensure those decisions are subsequently reflected in protocol.
Provide clinical supervision to clinical staff within
the service, and clinical oversight to non-clinical work and health coaches,
ensuring they operate within safe boundaries and escalate appropriately.
Deputise for the Clinical Lead in their absence on
clinical matters, escalating to the Clinical Lead where a decision falls
outside delegated authority.
Lead the clinical governance arrangements for the
assessment function, including clinical audit, incident and complaint
investigation, and the clinical risk register.
Advise on the clinical implications of proposed
operational changes, including capacity, appointment length, skill mix and
caseload distribution, and contribute to the workforce model for any successor
service.
Contribute to recruitment, induction, competency
assessment and development planning for clinical members of the team, and
identify and address unwarranted variation in practice.
Support the wellbeing of the clinical team in a
service dealing with distressed patients and emotionally demanding material.
Education
Act as the clinical educational resource for the
service, building capability in workability assessment across clinical and
non-clinical colleagues.
Design and deliver training, briefings and awareness
sessions for primary care colleagues, work and health coaches, employers and
partner organisations.
Provide mentorship, coaching and reflective
supervision, and support the development of any trainee or developmental posts
within the service.
Build constructive relationships with referring GPs,
providing feedback that improves referral quality and sustains clinical
confidence in the pilot model.
Take responsibility for personal continuing
professional development, maintain registration and revalidation requirements,
and arrange personal clinical and professional supervision.
Contribute to the wider dissemination of learning from
the pilot, including written outputs, case studies, presentations and
contributions to professional networks.
Research and evaluation
Design and lead clinical audit and case note review,
report findings and ensure recommendations are implemented and re-audited.
Lead clinical test-and-learn cycles, proposing,
testing and evaluating changes to the assessment model during the pilot period.
Act as a clinical point
of contact for the national evaluation, including interviews, case note review
and data queries, within the limits of patient confidentiality
5. FREEDOM TO ACT
The post holder practises competently and autonomously
without direct clinical supervision, in accordance with the NMC Code and local
policy.
The post holder assumes clinical accountability for
patients referred into a non-medically led pathway.
The post holder exercises professional judgement and
expertise to create precedent and deal with ambiguous or novel problems,
applying evidence-based practice and rigorous analytical judgement in the
absence of specific guidance.
The post holder holds delegated authority to determine
clinical assessment practice within the service, subject to ratification by the
Clinical Lead
Matters with implications for patient safety, service
scope, contractual obligation or the national pilot design are escalated to the
Clinical Lead
WORKING ARRANGEMENTS
This is a fixed term post for 12 months, funded
through the national pilot. Continuation beyond the pilot period cannot be
guaranteed and is subject to national decisions on the future of the model.
A flexible and agile approach to working is expected.
The service operates a blended model of face to face clinics, remote
consultation and home working, and the balance between these will vary with
service demand and patient need.
Home working is supported for remote assessment,
report writing, supervision and administrative activity, subject to a suitable,
confidential home working environment and compliance with information
governance requirements. Home working is an operational arrangement, not a
contractual entitlement, and does not remove the requirement to attend sites.
The leadership, supervisory and educational elements
of the role require a regular on-site presence sufficient to maintain
visibility, support the team and sustain relationships with referring
practices.
Regular travel across Barrow and Mid Furness is
required. Access to a vehicle and a full UK driving licence, or an equivalent
means of meeting the travel requirements of the post, is necessary.
Some flexibility over working hours may be needed to
accommodate patients who are in work and employers who are only available
outside core hours such as Saturday working.
The post holder will be expected to work in a rapidly
evolving service where processes, systems and documentation change during the
pilot period, and to lead others through that change.
Please see full Job Description and Person Specification
