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

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

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

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

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

8. 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
Supernumary
59.2
5.90%
Study
135
13.50%
Admin
16.5
1.60%
Sick 29
3.00%
Annual Leave
151.5
15%

10. 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

11. 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

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

13. 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

14. 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

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

17. 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

18. 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

19. 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

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

21. ANP
4.6 ENP
2.4 ANP
Work together but a focus on major minor
What do patients need
Trust perspective
ED perspective
Challenges ‘same old’

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

23. 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

24. ANP/ENP
Cases
Presentation profile
Changes Minor to Major

28. Recent Activity

29. 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

30. 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

31. 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

32. 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

33. ?