Developing a vision and service framework for general practice nurses Supporting care closer to home and improving population health needs Wendy Nicholson Professional Officer - School and community nursing DH Crystal Oldman CE Queen’s Nursing Institute Michelle Mello Head of Commissioning NHS England November 2013 DH – Leading the nation’s health and care

2 Context To be able to move care from hospital settings to home requires commissioners to have robust plans for community and primary care services that will be able to meet the challenges and demands of an ageing population and the associated increase in the prevalence of long term conditions and especially the needs of the frail elderly and those with dementia. In addition the health protection role is increasing with the expanded immunisation and vaccine schedule being introduced There has been a 10% reduction (HC & FTE) of practice nurses since 2006 Care in local communities published in Jan 2013 From May 2012 we consulted with 2,000 GPNs

3 Challenges for GPNs – you said…. Scoping work with practice nurses identified a number of challenges which were associated with the terms and conditions of their employment, these included: Lack of clarity regarding the role of general practice nursing and no consistent approach to service delivery Lack of profile nationally for the role and the role not being promoted as a career option Disparity and lack of consistency in training, there are a range of courses to support preparation and updates with each practice determining the best route Limited access to CPD and an agreed career framework – access and support for CPD varies between practices Limited access to protected time and commitment from employer for supervision

4 Transforming care…………

5 Using core values and behaviours to support delivery Care Compassion Commitment Competence Communication Courage Leadership at all levels Maximising health and wellbeing. Helping people to stay independent Delivering care and measuring impact Supporting a positive experience Building and strengthening leadership Ensuring we have the right staff, with the right skills in the right place Supporting a positive staff experience National Nursing, Midwifery and Care Staff Strategy we have undertaken a similar scoping with GPNs, both build on a wide range of recommended programmes and initiatives for local areas to consider including the Carers Strategy and End of Life Strategy. The unique role of the General Practice Nurse: Practice nurses co-ordinating and supporting a health team to deliver care and support in primary care settings Optimising the health of the practice population within the community Mental health and wellbeing Contraceptive and sexual health advice Education and delivery of public health programmes Screening and immunisation provision Managing and supporting long term conditions Positive lifestyle changes Health promotion, protection and screening Travel advice Management of risks (drugs, alcohol, weight management, smoking cessation) Managing acute events Long term conditions including exacerbations and continuing care Medicines management Triage Minor illness and minor injury management Management of emergencies (acute asthma attach, chest pain etc.) Preventing premature death

6 Wider determinants of health Health improvement Health protection HCPH and MECC Supporting health wellbeing and independence Celebrating Personalised care

7 Components of Public Health Nursing and Minnesota Wheel Model Public Health Nursing and Midwifery Public Health Outcomes Framework Improving wider determinants of health Health Improvement Health Protection Healthcare Public Health Public Health Outcomes Framework Improving wider determinants of health Health Improvement Health Protection Healthcare Public Health Underpinned by Evidence including NICE Research Education Professional Engagement Impact on Public Health Consultants and Practitioners/Specialist Community Public Health Nurses and Midwives Nurses and midwives with specific primary and secondary prevention roles: practice nurses, mental health, community nurses, sexual health nurses All nurses and midwives maximising their role in health and well being through making Every Contact Count

8 What have we achieved? Supporting asset based delivery – community settings Patients and carers at the heart of delivery

9 Department of Health Community Nursing Advisory Group

10 Vision Statement Strengthening innovation, supporting the workforce and improving commissioning practice for community, district and general practice nursing A commitment to supporting carers through the carers work stream linking to the Dementia challenge and supporting people with long term conditions

11 5 Work Streams Commissioning Development - NHS England Integration - NHS England Public Health - Department of Health/Public Health England Technology & Innovation - Health & Social Care Information Centre/NHSE Workforce – Health Education England

12 Commissioning Development

13 Integration Vertical Integration Horizontal Integration 175 definitions of integrated care Patient outcomes at the centre

14 The scale of the challenge - demand More than 2.6 million people receive care from district nurses in England (and Wales )2 1 in 4 people over 75yrs and 1 in 2 people over 85 will receive care from a district nurse 2 ; 3.6 million emergency admissions to England’s hospitals in 2011/ million people in England have a long term condition with LTCs accounting for some: 1.Around 70% of the total health and care spend in England o 64% of all outpatient appointments o 70% of all inpatient bed days o 50% of all GP appointments More than 300 million GP consultations in 2008/9 3 ; End of life care – in the national bereavement survey (VOICES) 4, 2012 – for those who expressed a preference, the majority preferred to die at home (81%), but only half of these actually died at home (49%). The most commonly reported place of death was a hospital (52%).

15 Public Health Helping People to stay independent, maximising well-being and improving health outcomes. Every contact counts

16 Technology and Innovation

17 Workforce Planning Fewer qualified District Nurses than 5 years ago: 5 in London in summer 2013 ↓ Practice Nurses: 21,634 ↑ School Nurses: 1,510 ↓ Ref: NHS Information Centre 2012

18 Workforce Planning GPN workforce profile & retirements Careers options in community nursing Student nurse placements with GPNs Mentorship for GPNs GPN visible career pathway Recognition of specialist skills Recognition of contribution

19 Next steps…… Publication Call to action Links to CNSG Products Dissemination DH – Leading the nation’s health and care