Mainstreaming
How have you tried to tackle this issue?
PCTs have explored alternate sources of funding e.g. Neighbourhood Renewal Funding and gaining access to reimbursement money. Some PCTs had approached mainstreaming by linking the project to other local work such as around service redesign, skill mix analysis, building into the LDP and using nGMS/PMS.
Making educational and training links to develop work based learning programme, at different levels up to masters, and building into pre registration training.
Other approaches have included:
- Highlighting success to enhance mainstreaming prospects.
- Developing inter professional working.
- Securing high-level support.
- Enforced radical redesign of services.
- Making links with workforce confederations.
- Raised awareness through other national programmes.
- Stimulating change in community nursing.
- Attracting the right people.
- Redistributing funding.
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To what extent have you succeeded in overcoming barriers and difficulties?
PCTs have been able to maintain the existing numbers of APNs planned and in many case have planned increases despite that hard results are still not available and that some distrust remains.
PCTs have been streamlining services and using this experience to inform reviews on the structure and function of community nursing.
This model has contributed towards a range of other activity, such as the ‘Single Assessment Process’, similar work for other client groups and ‘Agenda for change’/knowledge & skills framework.
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What resources have you used or developed to help you?
PCTs have developed documentation in order to retain corporate memory on implementing the proactive model.
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What has been the key learning in tackling this issue?
If the model is to be successfully embedded within the system it is imperative to:
- Communicate with stakeholders – particularly informing them of success and drawing out the benefits for individual stakeholders.
- Develop permanent systems in order to make the new approach a permanent feature of the local system.
- Provide vision and enthusiasm
- Engaging and partnership working with staff and other stakeholders.
- Address this as a question of mainstreaming into community nursing – not just district nursing.
- Put in place dedicated time and project management.
- Plan to build in residential and nursing homes. Though most high-risk elderly live in there own homes there are significant numbers in these settings.
- Develop services at home.
- Develop quality markers to ensure standards.
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Clinical Skills
To what extent have you succeeded in overcoming barriers and difficulties?
What resources have you used or developed to help you?
What has been the key learning in tackling this issue?
To what extent have you succeeded in overcoming barriers and difficulties?
By looking at the following issues:
- Examining the need for a nurse practitioner course
- Resolving the question of where the APN role stands in relation to other roles and services.
- Securing additional training to that provided by Evercare sometimes with nurse practitioners support
- Attempting to create time to learn older persons diagnostic skills
- Incorporating specialist training as part of a generic role
- Securing specialist support for the generalist role e.g. mentorship by GPs
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What resources have you used or developed to help you?
- Gaining access to geriatricians as mentors and coaches
- Making use of specialist nurses in primary care
- COPD service able to make referrals
- Cardiac rehab services used as training resource
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What has been the key learning in tackling this issue?
- Formal education input can vary
- Needs input from other clinicians
- Diagnostics are a key challenge for the APN role
- Clinical mentorship and an academic background helps
- Developing robust coverage processes for when an APN is not working is important – if not possible to cover for each other, should care return to GP?
- Resolving the issue of where the APN sits is important e.g. should they be in DN team when only a handful of their patients are on DN caseloads.
- APN visits are not always required – many contacts with the caseload could be through a Healthcare Assistant or via a telephone call
- 24hr care in the community needs to be delivered by a multi-disciplinary/multi-agency team.
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