Community Matron

Job summary

We are seeking a motivated & dynamic Hospital at Home Community Matron to join our Neighbourhood Teams within the Barnsley Physical Health & Wellbeing Care Group

This role is central to delivering Hospital at Home pathways, working alongside Urgent Community Response Crisis & Virtual Ward services, supporting acutely unwell patients in their own homes or place of residence with consultant oversight & MDT support

You will also provide cross-cover to support proactive neighbourhood care for patients with complex co-morbidities, alongside contributing to Ageing Well services & multidisciplinary clinics. This is an exciting opportunity to join a growing service aligned to national priorities and community-based care transformation

You will provide clinical leadership, deliver high-quality holistic care & support admission avoidance through effective assessment, treatment & coordination of care. Working collaboratively across primary, secondary & social care, you will help ensure safe, effective patient pathways from triage to discharge.

Service delivery operates between 08:00 and 18:00, 365 days per year.

All employees of the Trust are strongly encouraged to have their up-to-date flu vaccination to protect staff and patients.

At the time of advertising, this role does meet the minimum requirements set by UK Visas and Immigration to sponsor candidates to work in the UK. We look forward to receiving your application.

Main duties of the job

Key Responsibilities

• Oversee & deliver high-quality, holistic patient care, ensuring individual needs are met within the home environment
• Support admission avoidance initiatives by identifying & implementing effective community-based care strategies
• Provide clinical leadership & expertise to help shape & develop evolving, integrated community services
• Promote innovative, patient-centred approaches that enhance care delivery & outcomes within the community

Main Duties

• Actively contribute to admission avoidance by managing patients safely at home, including assessment, treatment & onboarding to virtual ward pathways where appropriate
• Reduce unnecessary hospital admissions by coordinating timely interventions, linking with Same Day Emergency Care & mobilising the wider multidisciplinary team (MDT).
• Work collaboratively across primary, secondary & community care services, maintaining strong partnership working to deliver seamless patient care
• Utilise non-medical prescribing skills to assess, prescribe & manage treatments, ensuring effective & timely clinical interventions
• Where required, manage a caseload of patients with complex, long-term conditions, ensuring continuity, quality & proactive care delivery

This role requires strong clinical expertise, leadership and a proactive, adaptable approach to support high-quality care & meet the changing needs of the community.

Cherie Webb/Lesley Cooper

cherie.webb@swyt.nhs.uk/Lesley.cooper1@swyt.nhs.uk

01226644387/07833048059

About us

We are a specialist NHS Foundation Trust that provides community, mental health and learning disability services for the people of Barnsley, Calderdale, Kirklees and Wakefield. We also provide low and medium secure services and are the lead for the west Yorkshire secure provider collaborative.

Our mission is to help people reach their potential and live well in their communities, we do this by providing high-quality care in the right place at the right time. We employ staff in both clinical and non-clinical services who work hard to make a difference to the lives of service users, families and carers.

We encourage and welcome applications from all protected characteristic groups, we value diversity and want our workforce to be reflective of our communities.

Being a foundation Trust means were accountable to our members, who can have a say in how were run. Around 14,300 local people (including staff) are members of our Trust.

Join us and you will be one of over 4,500 staff committed to supporting and improving the mental, physical and social needs of the thousands of people we meet and help each year.

We are committed to safeguarding and promoting the welfare of children, young people and vulnerable adults and expects all colleagues and volunteers to share this commitment.

We do reserve to right to close vacancy before the advertised closing date if necessary, so please apply as soon as possible.

Details

• Date posted: 08 June 2026
• Pay scheme: Agenda for change
• Band: Band 8a
• Salary: £57,528 to £64,750 a year
• Contract: Permanent
• Working pattern: Full-time, Flexible working
• Reference number: C9378-B2334
• Job locations: Kendray Hospital, Doncaster Road, Barnsley, S Yorkshire, S70 3RD, United Kingdom

Job responsibilities

JOB SUMMARY

The role of the Case Manager/ Community Matron is:

To provide systems leadership at a neighbourhood level for managers, specialist nurses and staff within a primary care setting.

Work effectively in an integrated partnership way with primary care, secondary care, social care, the independent and voluntary sector

Through patient involvement, brokering care across partnerships, whilst leading and promoting the principles of multidisciplinary team working, to support the achievement of better health outcomes

To provide a high quality, comprehensive and accessible community nursing service to housebound patients

Undertake complex holistic assessments using advanced clinical examination and assessment skills that encompass all aspects of an individuals needs.

Act as keyworker, liaising and working collaboratively with other professionals to co-ordinate care, preventing duplication, fragmentation and ensuring the effective deployment of resources

Undertaken line management responsibilities of the District Nurse and Assistant Community Matron roles.

KEY RESULT AREAS

1.1 Clinical Care

• Proactively manage a caseload of patients with long term conditions who have complex needs, increasing and decreasing input into a patient care as required and discharging from the caseload as appropriate in line with the Community Nursing Service Operating Framework.
• Undertake the keyworker role, liaising and working collaboratively with other professionals to co-ordinate care, preventing duplication, fragmentation and ensuring the effective deployment of resources.
• Actively case find using data bases and risk stratification tools to actively seek out patients who will benefit from clinical case management techniques to avoid unplanned hospital admissions and reduce the length of hospital stays by facilitating a timely discharge
• Undertaken complex holistic assessments using advanced clinical examination and assessment skills that encompass all aspects of an individuals needs in conjunction with the individual and their family.
• Use self-management and joint care planning principles to care delivery that promote the resilience, enhance well-being and maintain independence
• To provide evidence based care plans based on sound clinical decision making using the knowledge of the unique presentation of long term conditions, negotiated with the person.
• To initiate and lead medicines management reviews, independently prescribing medicines and appliances where appropriate and within scope of practice.
• Use expert knowledge to promote healthy lifestyles and self-management of long term conditions
• Prevent unplanned hospital admissions through intensive clinical management and health and social care support at home. Reducing the length of stay of unplanned hospital admissions through communication and coordination of care with secondary and primary care
• To help individuals and their families to plan for and improve end of life care, ensuring their choices are reflected in personalisation care plans.
• Communicate effectively using higher level communication skills at all levels within the organisation, to a variety of health and social care professionals, individuals and their families.
• Challenge practice, systems and policies in an objective and constructive manner
• Use high level communication skills to negotiate care plans and establish collaborative partnerships with patients and carers
• Support the patient to develop a range of self-management strategies to enable them to be independent.

• Actively promote health and self-care, disease prevention and the self- management of acute and/or long term conditions, applying the principles of making every contact count in clinical practice
• Maintain contact with the individual if admitted to hospital, providing information about home circumstances to hospital staff and ensuring that discharge of the patient is rapid, planned and safe
• Utilise nursing metrics to provide high quality advanced nursing care
• Visible role model for the National Nursing Strategy and the values within Compassion in Care and the 10 commitments to nursing

For full job description, please see attached supporting documents.

We are aware that an increasing number of applicants are using AI technology to generate responses on NHS Job application forms. Over reliance on AI-generated content in application forms is strongly discouraged and we will conduct a thorough screening process before selecting candidates to progress to the next stage. If you are using AI to enhance your application, please disclose this in your NHS Jobs application form.