DGSPCT 1

District Nursing Renaissance

Towards role re-design to meet changing demand – a local

health economy solution

Janice Owen Adult Health Nursing Lead and Lead for Renaissance Project Gillie Lewis Practice Nurse Lead and Nurse Practitioner

Dartford, Gravesham & Swanley PCT

DGSPCT 2

Demand ManagementWork Streams

• Nursing Renaissance (DNs, PNs, acute sector nurses and others)

• Non- elective services

• Elective services

• Practice Resource Utilisation

DGSPCT 3

Purpose

• Building on closer to home strategies

• Resource effectiveness

• Improving access

• Service improvements

• Appropriate professional

• Agenda for Change and implications for DNs

DGSPCT 4

Why now?

• Opportunities Building on primary/community care

development Building on the DGSPCT step up model Shifting resources• Benefits Closer to home Effectiveness• Drivers Payment by Results Financial Recovery Plan nGMS Agenda for Change

Improving Chronic Illness Care Model (after Wagner et al 2000)

1. Community

Resources & Policies

2. Health System

NHS organisation

3. Self Management

4. Delivery Systems design

5. Decision support

6.Clinical Information Systems

Informed, Activated Patient

Prepared, Proactive Practice TeamProductive Interactions

DGSPCT 6

Primary and Community HealthCare

Provision Health Surveillance

Access to health care

Health AdviceHealth

Promotion

Elective

/ episodic careIntermediate/ rehabilitative

care

Long term, chronic sickCare of older

peoplePalliative/

terminal care

Independent(well)

Dependent(ill)

Care continuum -delivering the service improvement

agenda

Requirement for improved Nursing interventions through role and

service redesign

Chronic Disease

Management/ self care

NHS Service demands and pressures

DGSPCT 7

Key Components of Renaissance

• Role redesign

• Activity and caseload classifications

• Working patterns

• Image

• Skills Escalator

DGSPCT 8

Elements of how we will do this

• Extended nursing skills

• Intensive mentorship programme

• Developing core competencies

• Devising comprehensive tools

• Identifying high risk caseloads

Dartford, Gravesham & Swanley Primary Care Dartford, Gravesham & Swanley Primary Care TrustTrust

- The 4 R’s Workforce Redesign Model 2001/02- The 4 R’s Workforce Redesign Model 2001/02

STEP 2Refocus

the workforce skill mix through consultation with

team

STEP 1Review

reconsider vacant post/s in the light of

emerging patient needs and local HimP priorities

STEP 4Reskill

in collaboration with education providers offer appropriate

training to meet skills deficit

STEP 3Redesign

by identifying skills required within the team to meet needs

PILLAR ONE

Health Improvement

& Clinically effective care

PILLAR TWO

Trans-formational/

emotionally intelligent nurse

leadership

PILLAR THREE

Whole systems /integrated

working

1. Health Care Assistants

2, Registered Primary Care Practitioners (generic role)

current staff nurses

3, Senior Registered Practitioners

(Specialist /Advanced practitioners)

4. GPs with Special interestsFirst Contact Practitioners

and Nurse Consultants

DGS PCT Rethinking provision & preparation for future care delivery 2001

Socio-Economic &

DemographicTrends

PolicyImperatives

Patient /Client needsThe Expert

Patient

DGSPCT 11

Our goals and Aspirations

1. The maintenance and palliative care functions of community nursing teams will continue however the service will become more focussed and utilise better all team member skills more appropriately

2. Based on the release of 6 / 8 renaissance nurses as key worker to 50 – 60 ‘frequent flier’ patients with chronic diseases we anticipate:

• An overall reduction of admissions to hospital in the region of 30%

• An overall reduction in the number of in-patient beds

• More satisfied patients and PCT teams

DGSPCT 12

In DGS PCT ----

We have :

• A District Nursing workforce enthusiastic and committed to improving health of the local community where the need is greatest – eg: chronic disease management

• A keen group of staff nurses and health care assistants willing to support the new modus operandi

• Education providers ready to experiment and introduce new programmes to skill up nurses to respond

• Team leaders and managers seeking evidence / good practice and ensuring risk issues were addressed

• Experienced the benefits of introducing skills escalator approaches over the last three years

DGSPCT 13

Some Risk Factors within the Renaissance project in

DGS PCT

• No new resource therefore reviewing existing roles and practices and introducing change

• Assessing capacity and team readiness

• Role redesign and skills acquisition

• GP and acute sector buy in

• Resource impact measurement

DGSPCT 14

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DN Renaissance Project

Determine contribution to the demand management project

Identify target population / disease groups

Caseload Classification –team readiness

PEC GP ‘buy in’

Identify and Review range of acute sector services for collaborative ventures

Obtain DN team buy in

MapGMS2 implications

Visit out to selected practices to secure commitment and

active team support

Develop classificati

on tool

Determine nurse / team capacity

Implementation / set realistic targets for each renaissance nurse

Pilot classification tool across teams

GP reps on steering group

Establish steering group

Project launch

Revised DN structure

Role re-design

Call for expressions of interest / select 6 DNs

Training secured and accessed

Targeted work on caseloads commence / peer support establishedStaff Nurses and HCAs implement new ways of working in selected teams

General Practice Contribution

Referral criteria and protocols agreed within each practice

Recruitment for further renaissance nurses commence

Acute Sector Contribution

Resource impact

Acute sector out reach models agreed

4 /5 Practice Nurse renaissance schemes commence

Identify how base line data will be collected

Bench mark data against Evercare informationRevisit data collection methods

report to steering group and demand management project

Monitor renaissance impact on caseload maintenance / GP and patient satisfaction

Mid Project report

DN team staff nurses and HCAs agree role and responsibility areas

Ensure enhanced roles of staff nurses and HCAs are reflected in job descriptions

DGSPCT 15

The Nursing contribution – seeking renaissance!

‘It is not about making the balloon fly better it is making the balloon into an aeroplane’

Gavin Davis Economics Editor BBC

on the 2004 Spending Review