SYMPOSIUM

ON
NURSING IN THE COMMUNITY
Presenters:
Collis Rochester-Peart
Service Manager / Clinical Lead (Haemoglobinpathies)
Lambeth Primary Care Trust
and
Dr. Lorna Bennett
Clinical Services Manager (Haemoglobinpathies)
Islington Primary Care Trust
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Nursing In The Community

Collis Rochester-Peart
Service Manager / Clinical Lead
(Haemoglobinpathies)

Lambeth Primary Care Trust

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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Introduction
• Objectives
• Context
• Models of community nursing care in the
haemoglobinopathies
• Description of local models of community
nursing
• Benefits of case management
• Challenges of case management
• Summary
• Reference list
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Objectives

• To present two community nursing care models for

the haemoglobinopathies

• To assist the understanding of different care

models delivering patient outcomes

• To provide an exploration of the benefits and

challenges of the models in the current political
environment
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Context (1)
• “Ninety percent of all patients journey begin and end in
primary care. For most people primary care is the
National Health Service” (DH 2002)

• “The philosophy underpinning community care relates to

a client – controlled environment which demands
expertise in health surveillance, risk analysis, good
communication skills and social action to meet the needs
of the individual, families and communities”.
(UKCC1994)
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Context (2)
Haemoglobinopathies
• Screening programmes and clinical care:
◦ Standards for caring for children
◦ Standards for caring for adult
◦ Standards for caring for individuals with thalassaemia

• The case for care in the community has been steadily made:
◦ Thomas and Westerdale (1996) discussed the problems
arose from inadequate and poorly functioning community care and
suggested immeasurable benefits can accrue from developing sickle
services similar to other acute on chronic diseases;
◦ Smith-Wynter and van den Akker (1999) feasibility study showed it was
possible to manage non-complicated crises within the home with
increased input from primary care, especially community and specialist
haemoglobinopathy nurses
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Context (3)
• Governmental Directives - Lord Darzi’s new foundation
for health service - The NHS Next Stage Review

The vision for Primary and Community Care provides:

◦ Shifting from organisational and process outcome
measurement to Patient Reported Outcome
Measurements (PROMs)
◦ Support to the NHS and community clinicians to transfer
services
◦ Promote development of transformed new vibrant
provider organisations
◦ Promotion of integrated care between agencies
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Service Model and Design
• Different models of service design:
◦ Community-based locations -: Sickle Cell and
Thalassaemia Centre – free standing entities with
potential for bridging hospital –community
interface (Rochester-Peart 2004)
◦ Sickle Cell and Thalassaemia Services
co-located with other health services
• Managed as nurse-led services
• Service design is interdependent on services
delivered and funding arrangements e.g partnership
arrangements between health and local boroughs.
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
A Local Model (1)
• Case management model used to manage
individuals in Lambeth, Southwark and
Lewisham
• The triangle of Long Term Condition approach

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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
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Local Model (2)

• The model – closer case co-ordination and

monitoring to deliver high quality service with
better patient outcomes and best value for money.

• Delivered by specialist nurses as case managers

to individuals / families with complex needs since
September 2006

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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
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Local Model (3)

Features of the Model

• Case finding / referrals
• Care pathways, protocols and care plans
• Closer communication between caregivers
• Nurse-led clinics

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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
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A Local Model (4)

Expected Outcomes of Case Management

• Improved quality of life through better control of the
condition
• Improved quality of life through long term health
improvement
• Reduction in A&E attendances and unplanned
hospital admissions

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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
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Benefits of the model
Stakeholders’ Benefits
• Clients:-
Individualised care plans
◦ Care co-ordination from a named professional
◦ Increased time and attention from names professional
◦ Named professional with increased/full knowledge of case
◦ Shortened care pathway
◦ Closer work with young people
• Nurses:-
◦ More defined case-load
◦ Increased specialist knowledge
◦ Increased autonomy of care
◦ Delivering more focused care.
◦ Delivering nurse-led clinical intervention
• Organisation (PCT):-
◦ Increase targeting of complex clients
◦ Value for money service (Evaluation pending)
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community

• Challenges / Barriers
◦ Drivers for change agenda
◦ Maintaining continuity of care
◦ Maintaining patient focused care
◦ Sharing of care in the emerging competitive environment
◦ Measuring Outcomes – whose and what outcomes?
◦ Reporting Outcomes – linked technological systems
◦ Competences and training issues
◦ Recruitment and retention of staff

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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Reference List(1)
• DH (2002), Liberating the Talents. Helping Primary Care
Trusts and Nursing to deliver the NHS Plan, London DoH
• UKCC (1994), The Future of Professional Practice – The
Councils Standards for Education and Practice Following
Registration. London UKCC
• NHS Next Stage Review. www.dh.gov.uk
• Sickle Cell Society (2008) Standards for the Clinical Care of
Adults with Sickle Cell Disease in the UK
www.sicklecellsociety.org.uk
• NCEPOD (2008) A Sickle Crisis? A Report of the National
Confidential Enquiry into Patient Outcome and Death.
www.ncepod.org.uk
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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008
 Nursing In The Community
Reference List (2)
• Rochester-Peart C.(2004) The roles and function of a community
sickle cell and thalassaemia centre In Practical Management of
Haemoglobinopathies Edited Okpala I. London: Blackwell Science.
• Thomas V N, Westerdale N. Managing sickle cell disease: the
hospital –community interface British Journal of Community
Nursing, Vol.1, Iss.8 16 Dec 1996 pp 466-471
• Smith-Wynter L, van den Akker O. The feasibility of nursing patients
with sickle cell crisis at home British Journal of Community
Nursing, Vol.4, Iss. 10 08 Nov 1999, pp531-537

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© South East London Sickle Cell and Thalasseamia Centre – Lambeth PCT September 2008