Assistant Practitioners (AP’s)Our story…..

Kate HowardDeputy Director of Nursing, AHP’s and

Quality

Background

What does NHFT do:

• 4,500 staff• 1800 health professionals• 800 Bands 2 – 4 clinical staff

• Multi functional sites across the county delivering the following services under 3 pathways: child, adult and specialist

Background

SpecialistMental Health in-patient and

community

Learning disability in-patient and

community

Forensic in-patient and

community

Crisis (MH)

Early intervention in psychosis….

Prison health

Rehabilitation

Adult and ChildrenICT

District Nursing

Community Beds

Palliative care in-patient and

Community

Frail and older persons hub

Rehabilitation

Child mental health in-

patient and community

Children’s community

Service

Looked After Children

Background

Current Assistant Practitioner Workforce:

• 3 x community hca’s (qualified in 2013); one now accepted

onto pre registration

• 3 x hcas’s (1 x Mental Health, 1 x support worker: schools, 1

x community nurse) just about to qualify

• 5 x hca’s (1 x mental health, 1 x community, 2 x Learning

disability, 1 x specialist services) commenced in 2014

The AP journey - starting point

Chaos…

Challenges…

This AP process was not without its challenges (or chaos)

the key ones for NHFT :• Staff buy in • Concern that band 5’s will be at risk• Accountability• Safety• Role and responsibility• Training support – difference in ability• Band 4 job availability

Role and Responsibility

Issues

-What does a band 4 do?

-Competence in the

community work force (band

3’s currently doing a hugh

amount of independent,

advanced work)

-Who’s responsible for the practice? (linked to accountability)

Outcome- A robust job description

based on RCN guidance

and examples from other

Trusts

- Clear identification of

what a band 3, 4 and 5 does, what skills are needed (what is the difference)

- Educating those supporting/ employing band 4’s around accountability, skill maintenance and accountability

Staff Buy In

Issue

- Why do we need band 4’s

- What will they do?

- Are we going back to the

old enrolled nurse programme?

- We have no posts available

- Will they replace band 5’s?

Outcome

- Education, discussion and

regular bullet in’s

- Looking at developing the

workforce via transformation

and consultation

- Job descriptions which

give distinct responsibilities to bands 4 and 5

Where we are now…

How it works in practice…

John was a 62 year old ex warehouse man whom over

the past 30 years had a series of cardiac events. However

18 months ago at his appointment with a specialist

‘heart’ hospital they had told him in no uncertain terms that

his heart could fail at any time. Because of the way this was

communicated John was anxious, and suspicious of health

professionals.

However John went home and carried on!

At home as John deteriorated it was obvious

that he needed District Nurse support – he refused, until it

got to a point where his wife was really struggling!

How it works in practice….

The District Nurse went to assess him, he was hostile and

refused to answer any questions.. John stated he didn’t want

female nurses coming to see him!

However John’s need was so great in terms of blood tests,

vaccinations, equipment ordering, skin assessment, pain

assessment etc that he required someone with the skills and

experiences to visit as he could no longer get to the GP’s!

How it works in practice…

Luckily, we had a male trainee assistant practitioner

associated with the District Nurse Team.

Visit 1: TAP visit discussed rugby, football, and the TV from

last night! Engagement meant that without knowing it the

TAP was able to observe; how dry was the mouth? how

breathless was John when talking/ resting? How tired was

John? Skin integrity on hands and visible skin…What was

the social/ environmental situation?

How it works in practice….

Visit 2: Discuss England football results, favourite films..

Able to steer conversation into an assessment of need –

TAP able to find out about equipment needs, ADL’s and

Undertake SSKIN. Bloods taken…

Visit 3: Join John in the garden for a glass of juice, comment on the

cricket John is listening to on the radio, talk about the garden (picking up

some tips as John is a keen gardener!) Raise the issue of equipment

delivery dates – reduce John’s distress, try to reassure him that the

equipment is there to help him and not because he is deteriorating and is

losing his independence (a key anxiety).. John feels able to raise an issue

around incontinence.. TAP able to undertake an incontinence assessment and

referral…

How it works in practice….

I hope you see the picture – the male to male engagement is

paramount, but the skills the TAP was learning/ had

learnt maximised the visits whilst maintaining John’s comfort

around only having a male practitioner.. I think this is a real

success story and I know it was a positive patient

experience for John and his wife.

Name and key details have been changed to protect confidentiality

Where I would like to be…

What next…

Integration of more band 4 posts within the services.

Promotion of this pathway to our AHP colleagues.

Continued support of our current Trainee AP’s – providing

them with an optimal education experience.

On going development of the bands 1 – 8 education

pathway.

Evaluating how this fits with the DH Trailblazer programmes.

Many thanks for listening..

Any Questions?