Assistant practitioners ap s our story kate howard deputy director of nursing ahp s and quality
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Assistant Practitioners (AP’s) Our story….. Kate Howard Deputy Director of Nursing, AHP’s and Quality. Background. What does NHFT do: 4,500 staff 1800 health professionals 800 Bands 2 – 4 clinical staff

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Assistant practitioners ap s our story kate howard deputy director of nursing ahp s and quality

Assistant Practitioners (AP’s)Our story…..Kate HowardDeputy Director of Nursing, AHP’s and Quality


  • What does NHFT do:

  • 4,500 staff

  • 1800 health professionals

  • 800 Bands 2 – 4 clinical staff

  • Multi functional sites across the county delivering the following services under 3 pathways: child, adult and specialist



Adult and Children


District Nursing

Community Beds

Palliative care in-patient and


Frail and older persons hub


Child mental health in-

patient and community

Children’s community


Looked After Children

  • Mental Health in-patient and

  • community

  • Learning disability in-patient and

  • community

  • Forensic in-patient and

  • community

  • Crisis (MH)

  • Early intervention in psychosis….

  • Prison health

  • Rehabilitation


  • Current Assistant Practitioner Workforce:

  • 3 x community hca’s (qualified in 2013); one now accepted

  • onto pre registration

  • 3 x hcas’s (1 x Mental Health, 1 x support worker: schools, 1

  • x community nurse) just about to qualify

  • 5 x hca’s (1 x mental health, 1 x community, 2 x Learning

  • disability, 1 x specialist services) commenced in 2014


  • This AP process was not without its challenges (or chaos)

  • the key ones for NHFT :

  • Staff buy in

  • Concern that band 5’s will be at risk

  • Accountability

  • Safety

  • Role and responsibility

  • Training support – difference in ability

  • Band 4 job availability

Role and responsibility
Role and Responsibility



- A robust job description

based on RCN guidance

and examples from other


- Clear identification of

what a band 3, 4 and 5 does, what skills are needed (what is the difference)

- Educating those supporting/ employing band 4’s around accountability, skill maintenance and accountability

  • -What does a band 4 do?

  • -Competence in the

  • community work force (band

  • 3’s currently doing a hugh

  • amount of independent,

  • advanced work)

  • -Who’s responsible for the practice? (linked to accountability)

Staff buy in
Staff Buy In



- Education, discussion and

regular bullet in’s

- Looking at developing the

workforce via transformation

and consultation

- Job descriptions which

give distinct responsibilities to bands 4 and 5

  • - Why do we need band 4’s

  • - What will they do?

  • - Are we going back to the

  • old enrolled nurse programme?

  • - We have no posts available

  • - Will they replace band 5’s?

How it works in practice
How it works in practice…

  • John was a 62 year old ex warehouse man whom over

  • the past 30 years had a series of cardiac events. However

  • 18 months ago at his appointment with a specialist

  • ‘heart’ hospital they had told him in no uncertain terms that

  • his heart could fail at any time. Because of the way this was

  • communicated John was anxious, and suspicious of health

  • professionals.

  • However John went home and carried on!

  • At home as John deteriorated it was obvious

  • that he needed District Nurse support – he refused, until it

  • got to a point where his wife was really struggling!

How it works in practice1
How it works in practice….

  • The District Nurse went to assess him, he was hostile and

  • refused to answer any questions.. John stated he didn’t want

  • female nurses coming to see him!

  • However John’s need was so great in terms of blood tests,

  • vaccinations, equipment ordering, skin assessment, pain

  • assessment etc that he required someone with the skills and

  • experiences to visit as he could no longer get to the GP’s!

How it works in practice2
How it works in practice…

  • Luckily, we had a male trainee assistant practitioner

  • associated with the District Nurse Team.

  • Visit 1: TAP visit discussed rugby, football, and the TV from

  • last night! Engagement meant that without knowing it the

  • TAP was able to observe; how dry was the mouth? how

  • breathless was John when talking/ resting? How tired was

  • John? Skin integrity on hands and visible skin…What was

  • the social/ environmental situation?

How it works in practice3
How it works in practice….

  • Visit 2: Discuss England football results, favourite films..

  • Able to steer conversation into an assessment of need –

  • TAP able to find out about equipment needs, ADL’s and

  • Undertake SSKIN. Bloods taken…

  • Visit 3: Join John in the garden for a glass of juice, comment on the

  • cricket John is listening to on the radio, talk about the garden (picking up

  • some tips as John is a keen gardener!) Raise the issue of equipment

  • delivery dates – reduce John’s distress, try to reassure him that the

  • equipment is there to help him and not because he is deteriorating and is

  • losing his independence (a key anxiety).. John feels able to raise an issue

  • around incontinence.. TAP able to undertake an incontinence assessment and

  • referral…

How it works in practice4
How it works in practice….

  • I hope you see the picture – the male to male engagement is

  • paramount, but the skills the TAP was learning/ had

  • learnt maximised the visits whilst maintaining John’s comfort

  • around only having a male practitioner.. I think this is a real

  • success story and I know it was a positive patient

  • experience for John and his wife.

  • Name and key details have been changed to protect confidentiality

What next
What next…

  • Integration of more band 4 posts within the services.

  • Promotion of this pathway to our AHP colleagues.

  • Continued support of our current Trainee AP’s – providing

  • them with an optimal education experience.

  • On going development of the bands 1 – 8 education

  • pathway.

  • Evaluating how this fits with the DH Trailblazer programmes.