QEHKL Development of the ACP Service at QEHKL Challenges and Triumphs Suzie Robinson Southey Consultant Nurse Emergency

The idea of the ACP in a small DGH How we have developed our ACP role The ACP and ECP rotational workforce project

QEHKL My Background Consultant Nurse in various ED UK/Australia since 2003 DGH Large Teaching Hospital Overseas Different challenges in ACP

Existing Service Small DGH Increasing attendances and ambulance conveyances Increasing major and major ambulatory conditions 7 WTE ENP hours cover the hours of 0800-0200 Five band 7 2 band 6 (not prescribers) PGD 1 Consultant Nurse QI indicators for ENP service Patient experience Staff development Efficiency improvements

Challenge No increased financial support to develop the ACP program Comfort zones of staff Skill sets Recruitment Activity Owning the service

ENP Reporting/Owning the service Monthly stats Case mix expansion Numbers seen per service and per person Shift Patterns Time off the floor Training Audit (RCGP Notes audit) January 2016   Total Hours 1000.15 Supernumary 59.2 5.90% Study 135 13.50% Admin 16.5 1.60% Sick 29 3.00% Annual Leave 151.5 15%

Setting Expectations Regular peer audit Numbers per hour minor/major ENP/ACP Review and support staff to achieve quality and activity Clinical competency development program 360 feed back Communications with staff and trust

Heat Map – Matching the hours 4am - 4pm 4pm - 4am Date 4 5 6 7 8 9 10 11 12 13 14 15   16 17 18 19 20 21 22 23 1 2 3 Grand Total 30/03/2016 87 85 172 29/03/2016 89 92 181 28/03/2016 103 84 187 27/03/2016 171 26/03/2016 106 195 25/03/2016 93 97 190 24/03/2016 90 79 169 23/03/2016 80 159 22/03/2016 88 21/03/2016 177 20/03/2016 102 78 180 19/03/2016 109 91 200 18/03/2016 77 179 17/03/2016 156 16/03/2016 74 152 15/03/2016 164 14/03/2016 96 174 13/03/2016 184 12/03/2016 176 11/03/2016 99 178 10/03/2016 76 166 09/03/2016 161 08/03/2016 173 07/03/2016 175 06/03/2016 188 05/03/2016 98 82 04/03/2016 71 142 03/03/2016 02/03/2016 01/03/2016 73 158

Review Major Minor Split Increasing attendance Split 60 % major 40 % minor Frailty , conversion to admission and increased ambulance conveyance

Faced with A challenge to get investment Major minor split changing ENP recruitment ENP not happy to expand to majors Seeing from the EDIS booking in condition Over lap of ENP not productive Wider trust financial challenges Reduction in CPD

NAM & SUZIE –Plan We recognised qualities in our band 6 team wanting to develop into the clinical senior role not management roles Shining stars keen for knowledge and development We had some good minor injury focussed ENP happy in role not wanting to change We had some staffing gaps had 2 ENP ready for ACP role We had 1 band 6 ready for ACP role

Considered Structure of potential new system envisaged by NHS England Urgent and Emergency Care Review Local context

Super Plan We developed a 5 year academic profile for CPD requirements and submitted it We focussed on the Keough actions and matched this to the local improvement and development plans We developed a CPD plan that would match the needs of our work force and our vision Focus on retain our staff and recruit more We developed a locally based clinical competency program and portfolio Set out a 5 year vision to our teams

CPD The 5 year vision We mapped the RCEM outline and considered individuals in our team: Non medical prescribing Master program and single Modules – Advanced Practice – full MSC – Post Grad Certification – Emergency Focus – Paediatric My previous project at ERI on competency portfolios

Actions We kept a vacancy on the ENP line Set up trainee ACP post Set 12.5 hours per week supernumerary for the ACP Expected competency program and portfolio Self driven and motivated person Accessed academic program mapped to the ACP trainee Set out the number and case mix expectations Split ANP /ENP team roster 2 ENP wanted to develop ACP skills moved to ACP roster 1 ENP 1 Charge nurse access masters program ENP focus on minors ACP to develop to all areas

ACP Local competency Clinical skills Consultant Reg/middle grade support Slow and steady Convince the critics Professional politics Case mix focus

ANP 4.6 ENP 0800-0030 2.4 ANP 1000-2300 Work together but a focus on major minor What do patients need Trust perspective ED perspective Challenges ‘same old’

Split New roster Not all happy Change ……………….. People Comfort zones Perception

Now ANP 10-2300 Activity and case mix expanding Feed back +++++ Refer to all specialty Specialty acceptance Academic MSc program accessed Staff challenges ….Dr/Nurse ..keeping roles separated

ANP/ENP Cases Presentation profile Changes Minor to Major

Recent Activity

Next Steps Rotation with ECP ACP A shared work force An emergency practitioner in ED or in the community Acute enduring care for ECP First response for ACP Admission prevention Prescribing added value Nursing /paramedical rotational

Program - NP /ECP HR PGD/NMP matching PGD for ECP in ED Prescribing for ACP in community Contracts Scene management Enduring care A role that interfaces and develops patient experiences Organisational skills and understanding Adaptation Skills and education Recruitment Total journey

Education Requirements The Acute Practitioner Role (ACP) is based on working towards and achieving a master’s level of decision making, competency and underpinning education. The sharing of acute and emergency primary care experiences and understanding

Assumptions 1. Standards and competencies are built on those that a ACP/ECP brings from his/her generalist nurse preparation and experience 2. Standards and competencies are focused on advanced clinical practice

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