General Practitioner (GP) - Frailty Services

Job overview

We’re building a new Hub at Newton Abbot Hospital to deliver integrated acute care closer to home for people living with frailty. The service will grow capacity and build on existing links between the Urgent Community Response team, Frailty Virtual Ward and HOP department, and add a new Same Day Emergency Care (SDEC)/ambulatory pathway. You’ll provide senior clinical decision-making at the community–acute interface—triaging referrals, streaming patients to the right part of the service, and supporting the wider MDT to assess and manage patients in community settings as a safe and effective alternative to inpatient care.

Day to day, you’ll provide and enable “hospital-level” interventions at home or in ambulatory settings (e.g. arranging timely diagnostics, IV fluids/antibiotics/treatments, therapy reviews, medicines optimisation and deprescribing, advance care planning), use point-of-care testing/digital monitoring to support timely decisions where appropriate, and provide the medical aspects of the Comprehensive Geriatric Assessment (CGA. You’ll work within and through a strong MDT—UCR, Intermediate Care, Primary Care, ward teams and HOP colleagues—respecting and enabling collective MDT decision-making to deliver patient-centred care. You’ll model professional standards in documentation, governance and supervision, and contribute to service development, QI and teaching.

Main duties of the job

• Hold clinical risk in community settings: provide senior decision-making to patients living with frailty and complex care needs at home, in intermediate care beds or within the virtual ward; balance escalation vs admission, and making and documenting clear management plans.
• Lead clinical triage and streaming: deliver telephone clinical triage for referrers (e.g. Primary Care, community teams, SWASFT) and stream patients to the right part of the service (Virtual Ward, SDEC, community teams).
• Enable “hospital-level” care at home: arrange/oversee appropriate community interventions (e.g., monitoring, IV fluids/antibiotics, therapy reviews) and use point-of-care testing/digital monitoring to support timely decisions.
• Deliver CGA-led care: undertake specialist assessment and interventions following the principles of comprehensive geriatric assessment, including medicines review and deprescribing.
• Respect and strengthen MDT decisions: work with Urgent Care Response, Intermediate Care, Primary Care and ward MDTs; contribute to anticipatory care planning and ensure up-to-date TEPs representing patient wishes.
• Model professional standards: maintain accurate contemporaneous records; adhere to Trust policies and GMC standards; champion governance, audit and service improvement.
• Provide leadership and teaching: act as senior clinical voice for the Hub (deputising for Lead GP as required), supervise ACPs/trainees, and contribute to QI and service development.

Detailed job description and main responsibilities

Full Vacancy details can be found on the attached Job Description/Person Specification. Please refer to your suitability to the post in your supporting information from the role requirements or person specification.