Transforming Community Services Priority 1 A Better Quality Community Nursing Service Service Model (Daytime and Weekend) 1 1 Background Rotherham CCG and Rotherham FT have now completed their joint review of community nursing services. The Review has been coordinated by a multi-agency team consisting of the following members; Jon Miles Dawn Thomas Tracey Craggs Chris Sandwell Dominic Blaydon Janet Sinclair-Pinder Clinical Director Medicine Head of Medicine Business & Service Manager Medicine Community Transformation Project Manager Head of Long Term Conditions and Urgent Care Care Pathways Manager Rotherham FT Rotherham FT Rotherham FT Rotherham FT Rotherham CCG Rotherham CCG The Review Team recognise the commitment and dedication shown by staff within the community nursing service. Despite working in a difficult environment, the service is delivering high quality care to patients. The Review Team has identified a range of issues which need to be addressed to ensure that service can support an increasing number of vulnerable patients in the community. The community nursing service will be at the sharp end of the transfer of care from hospital to the community so it is important to develop a service model which is safe and sustainable. 2 Summary of New Service Model Figure 1 sets out the structure for the new service model. Key features of the new model include; 7 Local Area Teams (LATs) co-terminus with GP localities Local Area Teams serving GP practice populations Named allied health professionals for each team Single point of access into local community health services Clear clinical supervision and line management arrangements Distribution of resources based on weighted population Recruitment and retention programme There will be an increase in capacity within the service of the following groups of staff; Role Band Number Clinical Team Leaders District Nurses Administrative Assistants 7 5 2 7 7 3.27 The new service model will ensure that there are more nurses doing direct work with patients. These nurses will receive appropriate levels of clinical support and clear direction on what they should be doing. The alignment with GP practice populations will support better partnership arrangements. The new model will deliver a clear feedback loop for GPs into local community health services. Finally, the introduction of a local single point of access will simplify the referral process for GPs. 2 FIGURE 1: Central North Greasbro MC Greenside Surgery Woodstock Bower Broom Lane Surgery/Kimberworth Park Chantry Bridge Weighted: 38,747.50 Clinical Supervision Band 7 Team Leader Weighted: 58,232.66 Weighted: 28,856.41 Clinical Supervision Clinical Supervision Managerial Supervision Clinical Supervision Staff Nurses Current Est: 11.12 WTE Clinical Support Current Est: 2.60 WTE 1.6 Band 8a Community Matrons Managerial Supervision Clinical Supervision Band 2 Admin Support Clinical Supervision Band 2 Admin Support Staff Nurses Current Est: 8.60 WTE Clinical Support Current Est: 1.80 WTE NAMED: Physiotherapist, Occupational Therapist, Speech & Language Therapist, Palliative Specialist Nurse NAMED: Hospice at Home, Social Services, Community Pharmacist, REWS Band 7 Team Leader Managerial Supervision Clinical Supervision Weighted 35,949.57 Weighted: 37,464.75 Staff Nurses Current Est: 17.01 WTE Clinical Support Current Est: 3.62 WTE Clinical Supervision Clinical Supervision Clinical Supervision Band 8a Community Matron Band 7 Team Leader Band 8a/7 Community Matron Band 7 Team Leader Band 8a Community Matron Band 7 Team Leader Clinical Supervision Managerial Supervision Clinical Supervision Managerial Supervision Clinical Supervision Managerial Supervision District Nurses CPTs Current Est: 2.93 WTE Band 2 Admin Support Clinical Supervision Wentworth South Wath & Swinton Market Surgery Crown St Surgery York Rd Surgery Parkgate Surgery Rawmarsh Surgery/TH Thorpe Hesley Surgery/RS Weighted: 50,352.88 Maltby & Wickersley Manorfield Surgery Blyth Road Surgery Queens Surgery Maltby Morthern Road/ Ravenfield Wickersley HC Health Village St Ann’s Surgery/ Kimberworth Park Clifton Lane Surgery/ Wickersley Clinical Supervision District Nurses CPTs Current Est: 4.67 WTE District Nurses CPTs Current Est: 2 WTE District Nurses CPTs Current Est: 3.20 WTE Clinical Supervision Band 7 Team Leader Band 8a Community Matron NB: Weighted Figures take into consideration out of area GP surgeries Rother Valley North Brinsworth Surgery Treeton Surgery Stag MC/Rose Ct Surgery of Light Canklow Surgery Broom Valley Rosehill Surgery The Gate Weighted: 35,956.92 Rother Valley South Dinnington GP Kiveton Surgery Swallownest Surgery The Village Surgery Central 2 Shakespeare Rd High St Surgery Dalton Surgery Magna/Kilnhurst /Dalton Thrybergh Clinical Supervision Band 8a/7 Community Matron COMMUNITY NURSING STRUCTURE District Nurses CPTs Current Est: 2.91 WTE Band 2 Admin Support Staff Nurses Current Est: 10.71 WTE Clinical Support Current Est: 2.49 WTE NAMED: Physiotherapist, Occupational Therapist, Speech & Language Therapist, Palliative Specialist Nurse Clinical Supervision Staff Nurses Current Est: 10.69 WTE Clinical Support Current Est: 2.47 WTE Band 8a/7 Community Matron Clinical Supervision District Nurses CPTs Current Est: 2.96 WTE Band 2 Admin Support Clinical Supervision Staff Nurses Current Est: 10.82 WTE Clinical Support Current Est: 2.47 WTE Band 7 Team Leader Managerial Supervision District Nurses CPTs Current Est: 4.00 WTE Band 2 Admin Support Clinical Supervision Staff Nurses Current Est: 15.55 WTE Clinical Support Current Est: 2.84 WTE NAMED: Physiotherapist, Occupational Therapist Speech & Language Therapist, Palliative Specialist Nurse NAMED: Care Homes Service/ANPs, Specialist Nurses, Continence Service, Falls Service, Community Physicians, Fast Response 3 Service, Intermediate Care Service, Oakwood Community Unit, Breathing Space, Lymphoedema Service, Stroke Service, NAMED: Voluntary Services Band Admi Suppo 3 Financial Model for New Service The new model is affordable within the current contracting envelope for the community services provided by RFT. Savings made in other RFT services have been ring-fenced as part of the 2014-15 plans and the costs of the new model will be commissioned using these funds. Quality Impact Assessments for savings plans have been reviewed by the Trust’s executive committee and have been signed off by the Contract Quality Group. 4 Summary of Feedback from GP Localities and District Nurses The new service model has broad support from GPs and community nurses. There was an almost unanimous view from GPs that there was no robust managerial structure in the community nursing service. GPs believed that the service was fragmented and inconsistent. GPs felt strongly that there was poor morale amongst the district nursing teams and this was having an impact on performance and quality. They said that the new service model must deal with the issue of communication between community and primary care. There was support for the concept of a feedback loop into community teams. A number of GP practices supported the concept of community nurses being back within the GP surgeries. They were all willing to offer room at their surgeries. The Review Team coordinated several community nursing focus groups, which considered the impact of the new service model. Community nurses supported the concept of a single point of access. They highlighted the need to reduce the burden of bureaucracy and increase the amount of time they could spend with patients. There was unanimous support for getting the service to full capacity. There was a recognition that more patients are going to be cared for out of hospital and that this would require more capacity in community. They were positive about community nurses receiving training on APACS and Independent Prescribing. Community nurses and GPs expressed concern about the role of the team leader within the new structure. The Review Team has subsequently amended the specification for this post. The team leader will have a background in community nursing. They will continue to be a practitioner and they will be responsible for working with other locality teams to ensure consistency. GPs believed that co-locating community nurses with GPs would facilitate better communication and patient care. The Review Team has considered this and recommends that, where possible, community nurses should be located at GP practices. The team leader will be responsible for ensuring that there are close working relationships between GPs and their locality teams. RFT have confirmed that there are no outstanding HR issues. There has been a full internal consultation process on the new service model and broad support for the changes within the service. 5. Next Steps The new service model is a significant step towards making the community nursing service fit for purpose. It responds to changing priorities within the health service and addresses some of the issues that have been having an effect on performance and quality. The Review Team recognises that the service model does not currently cover all aspects of the community nursing service. Over the next 6 months further reviews will be carried out to consider; 4 6. Service model for the out-of-hours community nursing service The role of specialist community nursing services Discharge to assess Interface between community nursing services and the Rotherham Hospice Interface between community nursing services and Social Care Recommendations It is recommended that The Community Transformation Board; Approve the service model set out in this report Direct the Performance and Service Development Group for Community Nursing to oversee implementation of the new model Direct the Performance and Service Development Group to amend the Community Nursing service specification so that it reflects the new service model 5
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