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Community Nursing 2008 Lambeth PCT

Learn about the current model of community nursing, which focuses on delivering care to housebound patients through qualified nurse-led teams. Discover the challenges faced by the service and the actions required to enhance the delivery of high-quality care.

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Community Nursing 2008 Lambeth PCT

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  1. Community Nursing2008Lambeth PCT Catherine Caulfield Senior Practitioner Team Leader South West Locality

  2. Service overview • Current model structured around housebound patients with very limited clinic based activities • Care delivered by teams of qualified nurses and non qualified staff. • Teams are linked to GP Practices and work in partnership • Each team is led by a qualified district nurse

  3. Service overview • Operates 7 days a week & 365 days a year. • Service offered from 8.00am to 11.00pm with staff working over three shifts • Open referral, reactive service, demand led. • Operates no waiting list. • Increasingly managing more complex patients. • Five large teams across the PCT with subdivisions of between 3 and five teams in each locality.

  4. A community team • Senior practitioners are Specialist practitioners with a recordable degree level professional qualification in addition to their nursing qualification. They manage a caseload of patients and lead team of qualified and non qualified staff • Skill mix • Band 7 – Senior practitioner Team leaders • Band 7 - Community Matron • Band 7 - Specialist Practice Teachers • Band 6 - Senior Practitioners • Band 5 – Community staff nurses • Band 4 – Primary Care assistant practitioners • Band 3 – Health care assistant • Band 3 – Admin support

  5. Current issues • On an average Monday approx 350 patients will receive home visits from approx 60 staff. Very complex to manage this efficiently • Planning can be difficult as we have little control over referrals and patients conditions can change rapidly • Practices taking on increasing numbers of patients not local to the surgery. • Community nursing often seen as a catch all service • Poor sickness and morale issues. Band 6 vacancies hard to fill. PCT not sponsoring nurses to undertake the course

  6. Current issues • Poor data collection systems resulting in inaccurate and ad hoc data collection and no standardisation of systems across the trust. • SAP is not shared with social services • IT systems implemented which not compatible with DN work (Rio) • With increasing workload more unskilled practitioners being used and difficulties found in embedding these new roles.

  7. The future • People living longer. Burden of long term illness rising. More complex and acute patients. • Increasing number of people wishing to die at home • Demand management will remain a priority • Greater need for technical intervention with patients requiring complicated IV’s, drains, ventilators etc • Practice based commissioning • Greater need for health promotion and surveillance- whose responsibility will this be? • Development of new roles and skill mix • Workforce issues-Older staff/less qualified • Movement of staff and budgets from acute to community

  8. Action required • Develop a more focused service with clear service description and stricter referral guidelines • Identify data that proves that the service delivered meets local needs and is of high quality • Develop data collection systems and processes • Develop clear quality indicators that will support this • Identify training and development around future workforce needs • Build on existing working relationships with GPs, social workers, local mental health teams

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