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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
March04March04
April 04April 04
May 04May 04
June 04June 04
July 04July 04
August 04August 04
Sept 04Sept 04
Oct 04Oct 04
Nov 04Nov 04
Dec 04Dec 04
Jan 05Jan 05
Feb 05Feb 05
March05March05
April 05April 05
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