Symposium Nursing in the Community 2008.V2ppt

8/14/2019 Symposium Nursing in the Community 2008.V2ppt

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SYMPOSIUM

ONNURSING IN THE COMMUNITY

Presenters: Collis Rochester-Peart

Service Manager / Clinical Lead (Haemoglobinpathies)

Lambeth Primary Care Trust

andDr. Lorna Bennett

Clinical Services Manager (Haemoglobinpathies)

Islington Primary Care Trust



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Nursing In The Community

Collis Rochester-Peart

Service Manager / Clinical Lead

(Haemoglobinpathies)

Lambeth Primary Care Trust

© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008



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• Objectives• Context

• Models of community nursing care in thehaemoglobinopathies• Description of local models of community

nursing

• Benefits of case management• Challenges of case management• Summary• Reference list


Introduction




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• To present two community nursing care models for

the haemoglobinopathies

• To assist the understanding of different care

models delivering patient outcomes

• To provide an exploration of the benefits and

challenges of the models in the current political

environment

Nursing In The CommunityObjectives




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• “Ninety percent of all patients journey begin and end in

primary care. For most people primary care is the

National Health Service” (DH 2002)

• “The philosophy underpinning community care relates to

a client – controlled environment which demands

expertise in health surveillance, risk analysis, goodcommunication skills and social action to meet the needs

of the individual, families and communities”.

(UKCC1994)


Context (1)




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Haemoglobinopathies• Screening programmes and clinical care:

◦ Standards for caring for children

◦ Standards for caring for adult

◦ Standards for caring for individuals with thalassaemia

• The case for care in the community has been steadily made:

◦ Thomas and Westerdale (1996) discussed the problems

arose from inadequate and poorly functioning community care and

suggested immeasurable benefits can accrue from developing sickle

services similar to other acute on chronic diseases;◦ Smith-Wynter and van den Akker (1999) feasibility study showed it was

possible to manage non-complicated crises within the home with

increased input from primary care, especially community and specialist

haemoglobinopathy nurses

Nursing In The CommunityContext (2)




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Nursing In The CommunityContext (3)

• Governmental Directives - Lord Darzi’s new foundationfor health service - The NHS Next Stage Review

The vision for Primary and Community Care provides:

◦ Shifting from organisational and process outcome

measurement to Patient Reported Outcome

Measurements (PROMs)

◦ Support to the NHS and community clinicians to transfer

services◦ Promote development of transformed new vibrant

provider organisations

◦ Promotion of integrated care between agencies




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• Different models of service design:

◦ Community-based locations -: Sickle Cell and

Thalassaemia Centre – free standing entities with

potential for bridging hospital –communityinterface (Rochester-Peart 2004)

◦ Sickle Cell and Thalassaemia Services

co-located with other health services

• Managed as nurse-led services• Service design is interdependent on services

delivered and funding arrangements e.g partnershiparrangements between health and local boroughs.

Nursing In The CommunityService Model and Design




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Nursing In The CommunityA Local Model (1)

• Case management model used to manage

individuals in Lambeth, Southwark and

Lewisham

• The triangle of Long Term Condition approach




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• The model – closer case co-ordination and

monitoring to deliver high quality service with

better patient outcomes and best value for money.

• Delivered by specialist nurses as case managers

to individuals / families with complex needs sinceSeptember 2006





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Features of the Model

• Case finding / referrals• Care pathways, protocols and care plans

• Closer communication between caregivers

• Nurse-led clinics





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Expected Outcomes of Case Management

• Improved quality of life through better control of the

condition• Improved quality of life through long term health

improvement

•Reduction in A&E attendances and unplannedhospital admissions

Nursing In The CommunityNursing In The CommunityA Local Model (4)




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Stakeholders’ Benefits• Clients:-

Individualised care plans

◦ Care co-ordination from a named professional

◦ Increased time and attention from names professional

◦ Named professional with increased/full knowledge of case

◦ Shortened care pathway◦ Closer work with young people

• Nurses:-

◦ More defined case-load

◦ Increased specialist knowledge

◦ Increased autonomy of care

◦ Delivering more focused care.

◦ Delivering nurse-led clinical intervention• Organisation (PCT):-

◦ Increase targeting of complex clients

◦ Value for money service (Evaluation pending)

Nursing In The CommunityBenefits of the model




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• Challenges / Barriers

◦ Drivers for change agenda

◦ Maintaining continuity of care

◦ Maintaining patient focused care

◦ Sharing of care in the emerging competitive environment

◦ Measuring Outcomes – whose and what outcomes?

◦ Reporting Outcomes – linked technological systems

◦ Competences and training issues

◦ Recruitment and retention of staff





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Reference List(1)• DH (2002), Liberating the Talents. Helping Primary Care

Trusts and Nursing to deliver the NHS Plan, London DoH• UKCC (1994), The Future of Professional Practice – The

Councils Standards for Education and Practice FollowingRegistration. London UKCC

• NHS Next Stage Review. www.dh.gov.uk• Sickle Cell Society (2008) Standards for the Clinical Care of

Adults with Sickle Cell Disease in the UK

www.sicklecellsociety.org.uk• NCEPOD (2008) A Sickle Crisis? A Report of the National

Confidential Enquiry into Patient Outcome and Death.www.ncepod.org.uk


http://www.dh.gov.uk/

http://www.sicklecellsociety.org.uk/

http://www.ncepod.org.uk/

http://www.ncepod.org.uk/

http://www.sicklecellsociety.org.uk/

http://www.dh.gov.uk/



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Reference List (2)• Rochester-Peart C.(2004) The roles and function of a community

sickle cell and thalassaemia centre In Practical Management of

Haemoglobinopathies Edited Okpala I. London: Blackwell Science.

• Thomas V N, Westerdale N. Managing sickle cell disease: the

hospital –community interface British Journal of Community

Nursing, Vol.1, Iss.8 16 Dec 1996 pp 466-471

• Smith-Wynter L, van den Akker O. The feasibility of nursing patients

with sickle cell crisis at home British Journal of Community

Nursing, Vol.4, Iss. 10 08 Nov 1999, pp531-537

© South East London Sickle Cell and Thalasseamia Centre Lambeth PCT September 2008

Documents

Symposium Nursing in the Community 2008.V2ppt