Redesigned regional community nursing service showcased nationally
How nurses from Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) are putting community nursing in the spotlight to showcase their work on a national level.
Community nurses from Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) are putting community nursing in the spotlight as part of a national showcase of their work to overhaul the service they offer being presented by NHS Improvement.
The trust began looking at how the community nursing service could be improved in 2014. ‘We felt it was time to change our service and move it forward,’ says RDaSH head of nursing Melanie Gibbons. Main drivers for the nurse-led changes included the increased pressures on district nursing.
‘Staff were a lot busier than they had historically been,’ says Ms Gibbons. There had also been a change in the range of complex needs of patients.
Improving the service
Previously, the community nursing service was divided into three separate services – district nursing, community matrons and community integrated care teams.
‘All were working separately. The nurses in each team were not linking up or liaising with nurses across other teams, which led to duplications,’ explains Ms Gibbons.
The first objective was to merge the three strands into one 24/7 community nursing service. To facilitate this new way of working, a number of initiatives were introduced. In the first instance, a single point of access (SPOA) for all referrals into the service, staffed by trained call handlers, was introduced. In addition, clinical nurse telephone triage was bolted onto the SPOA.
The expected population of the UK by mid-2027
The senior triage nurses are able to quickly determine the appropriate response level and timeframe for patients to be seen by a nurse. They also provide advice and consultations over the telephone if patients require support without the need for a visit.
Split care teams
Community nursing teams were split into unplanned or planned care. The unplanned care community nurses see patients on a reactive basis. Patients can be seen as an emergency (up to two hours response), urgent (four-hour response) or as same-day response. The unplanned care teams have received training in a number of areas to ensure they can provide a wider range of care, says Ms Gibbons.
‘We recognised that we needed the unplanned care nurses to work differently to how they had been. We need staff to be confident and competent in a range of areas such as end of life care – something that had always been the district nurses’ bread and butter.’
More than 1 in 12
of the UK population is projected to be aged 80 or over by mid-2039
The district nurses work seven days a week from 8.30am to 5.00pm as part of the planned care teams. ‘The unplanned rapid response approach prevents the district nurses from seeing any additional patients,’ says Ms Gibbons. ‘We wanted to protect their time.’
Additionally, a caseload case management model was introduced, which aimed to maximise continuity of care between general practices, care homes and the community nursing teams. Complex care practitioners also form part of the planned care teams. Formerly known as community matrons, the practitioners specialise in assessment, diagnosis and treatment. Within the planned care teams, all band 6 nurses and above have received nurse-prescriber training.
Training and support
They have also received risk management training and support the district nurses with case management. Each district nurse has a caseload of approximately 50 patients, although this can vary.
The service’s patient demographic is predominately older people and the main aim of the improved community nursing service is to prevent avoidable hospital admissions. The enhanced community nursing service will celebrate its third year of operation in April. Feedback from patients has been highly favourable.
‘We have received positive feedback from our end of life patients and they were a big driver in making the changes to the service,’ says Ms Gibbons.
‘Patients no longer have to wait for any length of time for anything. Patients’ calls to the SPOA are answered immediately. If it is an emergency, patients will be seen within two hours, although it is often much quicker than that.
‘With end of life patients we only have one chance to get their care right. They are seen in a more timely manner now.’
Other trusts have learned about the revitalised Doncaster community nursing service as part of NHS Improvement’s role in sharing the work across the country.
As Ms Gibbons says, ‘We are proud of what we are doing and are keen to share our work with other community and district nursing services.’
District nursing lead perspective: ‘Quality time with patients’
‘This new way of working enables the district nurses to focus on their patients,’ says RDaSH area clinical manager and service manager for district nursing Chris Eastwood.
‘All referrals that can be seen the next day go to the planned care teams and district nurse visits are scheduled in as required. The aim is to prioritise continuity of care and to have the same nurse (and case manager) visiting a patient.
If a district nurse has 15 home visits scheduled tomorrow, they know they will have no additional visits beyond those planned and they can spend quality time with their patients. The case manager approach is key for the district nurses and they work closely with band 6 nurses when caring for more complex patients.’
District nursing sister perspective: ‘Much better way of working’
‘I look after a caseload of around 300 patients and allocate visits to the district nurses in my team,’ says RDaSH district nursing sister for the east planned care team Natalie Cox. Ms Cox’s team includes four district nurses and two healthcare assistants.
‘Before the change, we may have gone out for morning visits and returned to find there were 20 further visits to allocate for that afternoon. There is no uncertainty now, it is a much better way of working. I see complex patients that require more time.
‘The range of patients the district nurses will see is based on the complexity tool. As a band 6 nurse, I would see complexities that score a 4 or 5.
‘We work closely with the unplanned care team. If they visit a patient overnight, they will notify us to update the patient’s district nurse and case manager. The district nurse can then notify the patient’s GP the following day.
‘We have been able to build better relationships with patients and GP practices as we have continuity of care now. We really get to know our patients and we can quickly spot any changes in their condition.’