wales study tour july 2008 - southern dhbimms co-ord imms outreach phc nurses provider arm nir...
TRANSCRIPT
Wales Study TourWales Study Tour
July 2008July 2008
Wendy FindlayWendy Findlay
Purpose of the TourPurpose of the Tour
�� To expose NZ Practice Nurse leaders to To expose NZ Practice Nurse leaders to
different and innovative models of PHC different and innovative models of PHC
nursingnursing
�� To facilitate the spread of these To facilitate the spread of these
innovations within the New Zealand innovations within the New Zealand
Primary Health Care environmentPrimary Health Care environment
Tour OutlineTour Outline��RCN Practice Nurse ConferenceRCN Practice Nurse Conference
��Welsh AssemblyWelsh Assembly��Wales Chief Nurse Wales Chief Nurse –– Rosemary CookRosemary Cook
��LTC Strategy Implementation LTC Strategy Implementation –– Helen HausmanHelen Hausman
��University of GlamorganUniversity of Glamorgan
��Practice VisitsPractice Visits��Lampter Local Health Board, CerdigionLampter Local Health Board, Cerdigion
��Lampter SurgeryLampter Surgery
��Primary Care Support Unit Primary Care Support Unit –– Rhondda Valley LHBRhondda Valley LHB
��St Johns Medical PracticeSt Johns Medical Practice
��Greenfield SurgeryGreenfield Surgery
��Ashgrove Surgery Ashgrove Surgery
��Gloucestershire Primary Care TrustGloucestershire Primary Care Trust
Positive Key FindingsPositive Key Findings
�� Nurse PrescribingNurse Prescribing
�� LTC Management Strategy and Implementation LTC Management Strategy and Implementation
-- nurse led as care conurse led as care co--ordinatorsordinators
-- use of demonstration sites use of demonstration sites –– 3 across Wales3 across Wales
�� Advanced nursing roles are integral to the Advanced nursing roles are integral to the
provision of Primary Health Care provision of Primary Health Care
�� Practice Nurse Career Framework supported by Practice Nurse Career Framework supported by
education pathwayeducation pathway
�� LHBLHB’’s are able to improve General Practice s are able to improve General Practice
quality through education and supportquality through education and support
Positive Findings contPositive Findings cont……
�� Patient/consumer engagement in General Patient/consumer engagement in General
Practice and LHBPractice and LHB’’ss
�� Business Model General Practice can Business Model General Practice can
work alongside LHB Managed Practiceswork alongside LHB Managed Practices
�� CoCo--location of nurses in General Practice location of nurses in General Practice
�� Innovative nursing practice to reach males Innovative nursing practice to reach males
not engaged in any health service not engaged in any health service
�� Lots of great resources and contactsLots of great resources and contacts
Negative Key FindingsNegative Key Findings
�� Nursing roles were driven and Nursing roles were driven and
developed around Quality Outcomes developed around Quality Outcomes Framework (QoF)Framework (QoF)
�� PN education funding has been devolved to PN education funding has been devolved to General Practice General Practice
�� Lack of progress regarding a shared clinical Lack of progress regarding a shared clinical electronic recordelectronic record
�� Practice Nursing roles are largely defined by Practice Nursing roles are largely defined by the employing General Practitionerthe employing General Practitioner
What could this mean for What could this mean for
SouthlandSouthland……
�� Supporting the development of a nursing Supporting the development of a nursing service to support general practice and service to support general practice and assist the PHO to reach population health assist the PHO to reach population health objectivesobjectives
�� LTC management needs to be done in a LTC management needs to be done in a coco--ordinated, planned and multiordinated, planned and multi--disciplined way that is client centred. disciplined way that is client centred.
Opportunities Opportunities
Continued..Continued..
�� Providing support and working alongside Providing support and working alongside
General Practices to improve quality General Practices to improve quality
�� The development of LHB managed practices The development of LHB managed practices
enhance the districtenhance the district’’s ability to attract both s ability to attract both
General Practitioners and nursing staff.General Practitioners and nursing staff.
�� As a community we need to support, advocate As a community we need to support, advocate
and politically drive nurse prescribingand politically drive nurse prescribing
�� Nursing leadership is crucial to nursing Nursing leadership is crucial to nursing
developmentdevelopment
The Lighter Side of the TourThe Lighter Side of the Tour
Southland Southland
Primary Nursing Primary Nursing
ProjectProject
A collaboration between A collaboration between
the SDHB and the 4 the SDHB and the 4
Southland PHOsSouthland PHOs
Why this strategy?Why this strategy?
�� Current nursing leadership infrastructure is Current nursing leadership infrastructure is
under resourcedunder resourced
�� PHCNs are largely disconnected from SDHB, PHCNs are largely disconnected from SDHB,
PHO & PHC strategies that are vital to the PHO & PHC strategies that are vital to the
implementation of the Primary Health strategy implementation of the Primary Health strategy
�� Nursing roles within primary health environment Nursing roles within primary health environment
are rapidly expanding and demonstrating are rapidly expanding and demonstrating
efficacyefficacy
�� PHCN workforce is very fragmentedPHCN workforce is very fragmented
Current Southland Nursing StructuresCurrent Southland Nursing Structures
SDHB
DON
Women &
ChildrenPublic Health
Plunket
Iwi Providers
Family Planning
PACT
Hospice
Home Health Care
Pacific Island Nurses
DON
Surgical
28 Aged Care
Facilities – 170 +
nursesCNO SDHB Provider Arm
DON
Med
DON
Mental
Health
PNA PHO
PHO Mgmt
Services
Nurse Ed
Comm Nurse
MH BI Nurse
PH
C N
rse
4 P
HO
’s
12
0 n
urs
es
Provider Arm
District Nurses
Well Child
Rural Specialists
PH Educator
Kaupapa Maori
Specialists – Wound Care
Diabetes, Respiratory, Oncology,
Sexual Health
Imms outreach
Immunisation
Co-ordinator
Approx 6-700 plus nurses Approx 4-500 plus nurses
All PHO enrolled
patients, when
they are not in
hospital, can be
receiving care
from any one of a
number of 500
PHC Nurses
Occ Health
ACC
Corrections
Youth health
The project represents an initiative The project represents an initiative
from nursing tofrom nursing to…………
�� Build nursing leadership infrastructure in Build nursing leadership infrastructure in
primary care primary care
�� Model collaboration across the sectorModel collaboration across the sector
�� Grow SouthlandGrow Southland’’s nursing potential to s nursing potential to
improve the communityimprove the community’’s health outcomess health outcomes
Nursing Leadership Structure Nursing Leadership Structure
DON
Women & Children
Non DHB
funded orgs
with PHCNs
DON
Surgical
DHB funded
NGOs + Aged
Care Providers
CNO SDHB Provider Arm
DON
Med
CEO
SDHB
CNO SDHB Primary Health Care
DON
Mental Health
DON
PHOs
CEO PHO
Mgmt Services
Nurse Ed
Comm Nurse
MH BI Nurse
PH
C N
rse
4 P
HO
’s
Well Child
Imms Co-ord
Imms outreach
PHC Nurses
Provider Arm
NIRApprox 6-700 plus nurses
Approx 4-500 plus nurses
How?How?
�� Strategic plan agreed by PHO Boards and Strategic plan agreed by PHO Boards and
SDHBSDHB
�� Appoint to the key positionsAppoint to the key positions
�� Activate the implementation planActivate the implementation plan
�� Primary Nursing Advisory Council Primary Nursing Advisory Council
establishedestablished
2. 2. Primary Nursing Workforce Primary Nursing Workforce
Development is given high priority by Development is given high priority by
SDHBSDHB
How?How?
�� Nursing workforce planning group initiatedNursing workforce planning group initiated
�� Profiling current workforce status and planning Profiling current workforce status and planning for future needfor future need
�� Develop and enhance communication across Develop and enhance communication across the sectorthe sector
�� Align PHCN roles to improve integration/reduce Align PHCN roles to improve integration/reduce fragmentationfragmentation
�� PHCN voice is assured when PHC service PHCN voice is assured when PHC service delivery decisions are madedelivery decisions are made
3. Adopt CREAM framework3. Adopt CREAM framework
How?How?
Utilise professional practice framework Utilise professional practice framework incorporating:incorporating:
�� CLINICAL PRACTICECLINICAL PRACTICE
�� RESEARCHRESEARCH
�� EDUCATIONEDUCATION
�� ADVISORY/LEADERSHIPADVISORY/LEADERSHIP
�� MANAGEMENTMANAGEMENT
Impacts of Plan ImplementationImpacts of Plan Implementation
�� All nurses can articulate the SDHB, PHO All nurses can articulate the SDHB, PHO and NZPHC strategies and the part they and NZPHC strategies and the part they are playing in achieving the goalsare playing in achieving the goals
�� Improved collaboration between primary Improved collaboration between primary and secondary nursing servicesand secondary nursing services
�� Increased nurseIncreased nurse--led services which are led services which are demonstrably improving service deliverydemonstrably improving service delivery
�� Increasing consistency in health promotion Increasing consistency in health promotion activitiesactivities
�� Some New Graduates are employed in PHC Some New Graduates are employed in PHC
each yeareach year
�� Recruitment into PHCN is enhancedRecruitment into PHCN is enhanced
�� Southland people are better able to access Southland people are better able to access
PHCN expertisePHCN expertise
�� A survey of PHCN workforce reflects a high level A survey of PHCN workforce reflects a high level
of job satisfactionof job satisfaction
�� All PHCNs can identify local resources for All PHCNs can identify local resources for
leadership, advice, education and developmentleadership, advice, education and development
�� Planning for PHC projects and contracts Planning for PHC projects and contracts includes PHC Nursing input includes PHC Nursing input
�� A climate of increasing mutual respect and A climate of increasing mutual respect and collaboration exists between Planning and collaboration exists between Planning and Funding Team and PHC service providersFunding Team and PHC service providers
�� All nurses providing PHC services are working All nurses providing PHC services are working for PHC providersfor PHC providers
�� There is a demonstrable move towards There is a demonstrable move towards increased patient/family/whanau focus for increased patient/family/whanau focus for service configurationservice configuration