News and Notices

Update on District Nursing Specification work - letter to GPs/PNs and District Nursing teams


Derbyshire Community Health Services NHS Foundation Trust and
Derby and Derbyshire Clinical Commissioning Group

Dear Colleagues

Update on District Nursing Specification work

This letter aims to update GP practices and District Nursing teams on the new District Nursing Specification.  This specification has now been approved by both DCHS and the CCG, and DCHS have been awarded the contract for the coming year (2019/20).  The full specification is available here and this letter aims to summarise the process, key changes and next steps. 

Context

As you are aware, there are current variations in the provision of District Nursing (DN) services across Derbyshire, reflected by the recent concerns around wound care. This variation is more apparent with the merging of the four CCGs. At the same time, there are emerging Derbyshire-wide shared principles and a focus on joint clinical outcomes with integrated working across MDTs within a Primary Care Network footprint. This has been the context for the steering group that has worked on the new District Nursing Specification.

Who’s been involved?

The steering group comprised commissioning & quality representatives from the CCG & DCHS, Clinical Leads including GPs and District Nurses, and incorporated a Professional and Patient Reference Group. The December 2018 stakeholder survey of all Derbyshire practices included feedback from GPs, PNs, Practice Managers and DNs and identified some common themes which were key in agreeing a remodelled DN specification.

What principles did the steering group follow?

  • Delivery of high quality and consistent standard services
  • Equitable distribution of resources and services for patients based on clinical need
  • Maximise efficiency, including recognition of the need to develop skill mix and new validated models and pathways of care within a challenging environment of increasing patient demand and a primary care and community workforce under increasing pressure
  • Delivery model in line with long term plan and the establishment of primary care networks
  • Recognition of the principle of collaborative working with the patient at the heart of the discussions and a move away from the traditional provider/commissioner/patient divisions
  • Recognition of the value of the DNs/Primary Care relationship and collaborative MDT working which enables the delivery of high quality of care for patients

How is the new specification different?

The new DN Specification gives helpful clarification of ‘who does what’, being much clearer about what DN teams do and don’t do. There are a number of key changes:

  • DN teams will provide all complex wound care - with wound care clinics for non-housebound patients in order to maximise efficiency and skill-mix opportunities. Most of the wound care sites are now established and wound care is in the process of safely transitioning based on clinical priority.
  • DCHS has been asked to start development of a separate ‘hot’ (urgent/unscheduled) and ‘cold’ (scheduled) DN team service which will improve patient continuity. Recruitment to new roles is progressing well.
  • A better communication protocol - such as a named DN team link for each practice, with attendance at practice MDT meetings supported by internal DCHS/PCN named leads. Practices will also be expected to have a named DN clinical lead as a point of contact for the DN team.
  • An increased focus on Primary Care Networks: with DN teams becoming aligned to Primary Care Networks (PCN) as they develop

How much local flexibility will there be?

In developing the specification we took the view that what is provided should be consistent and fair county-wide, but how it is delivered should be determined by local General Practices and District Nursing teams working together.  Over the next few months practices will begin to work in Primary Care Networks, with District Nursing teams aligned, and we see this as the way for local teams to develop and agree how services will be delivered on the ground.

What are the next steps?

We recognise that all this will take some time.  With that in mind there will need to be a period of transition over the coming months so with the exception of wound care, DN services will not feel different until the autumn.

There is still some work to do on the specification itself.  This includes activity that the steering group believe DN teams should or should not provide, but we need to plan and in some cases commission alternatives for. This includes:

  • The planning for DN teams in the south of the county to set up syringe driver pumps to deliver EoL medications as the teams in the north do
  • Agreeing who does which CHC assessments for patients with potential health needs
  • Training and competencies for DN teams to be able to  verify the death of patients they may have found on a visit
  • Agreeing the appropriate care provision for a range of specific care for non-housebound patients currently cared for by DN teams e.g. PICC lines, catheterisation
  • Agreeing the appropriate care provision for a range of specific care that is not provided by DN teams in most of the county, but is in some localities e.g. medication prompts, PEG feeding.

The steering group will continue to work through these areas with an intention to have a plan for each of these by October 2019.

Getting involved in further work on the specification

If you have any questions or comments about the specification or would like to get involved in the further work that needs to be done could you please contact Clare Walker, CCG Commissioning Manager – Joint and Community Commissioning (clare.walker16@nhs.net).  We have several areas where we would be grateful for further clinical input.  These are:

  • Areas for non-housebound patients: catheter insertion; care of PICC /Hickman lines and bowel management. medication delivery for patients unable to self-administer,
  • Provision of medication prompts,
  • Set up and care of enteral feeding regimes,
  • Delivery of PEG medication and non-cancer lymphedema

If you are interested in providing input in these areas please contact Laura Moore (CCG Deputy Chief Nurse - laura.moore10@nhs.net)

Delivering the specification locally

In order to shape a future DN specification that embraces the opportunities that arise from the NHS Long Term Plan we would ask that you support a steady transition over the coming year and work in partnership within your PCN footprints to develop a strengthened MDT collaborative pattern of working which recognises the importance of the DN/Practice relationship.

Key to this will be a series of CCG and DCHS led forums which will be taking place over the coming months within the PCN footprints as they take shape. Your feedback will be important and we encourage you to take part.  Ahead of this if you would like to discuss this further as a group and would like support from the steering group with this then please contact Clare Walker (clare.walker16@nhs.net).

Yours

 

Dr.Ian Lawrence (Clinical Director, DCHS)

 

Dr.Kath Bagshaw (Assistant Medical Director, NHS Derby and Derbyshire CCG)