Transcript New Initiatives in Primary Health Care

‘Now More Than Ever’
An International
Perspective
Professor
Barbara Parfitt CBE PhD MSc
MCommH RGN RM FNP
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Inverse Care
Impoverishing Care
Fragmented Care
Unsafe care
Misdirected care
Service Delivery Reforms
Universal coverage
Reforms
Leadership Reforms
Public Policy Reforms
Public health
approaches
to protecting
the public
Meeting the
health needs
of
communities
Supporting
anticipatory
care
Multidisciplinary
and multiagency team
working
Integrated
care
approach
Family
Physician
Family
Health
Nurses /
Midwives
Co-ordinating
services
Community
participation
Supporting
self care
Working directly
with individuals
and their carers
Guided by:
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WHO Europe definition
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NHS Education
Scotland Competency
framework
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learning from all pilot
countries
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Characteristics:
based on a generalist
model
Advanced nursing
practice
combines clinical care
with health improvement
works at 3 levels
individual, family &
community
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Family Health Nurse
(WHO Euro model
Scotland & Tajikistan)
Community Health
Nurse (RoNIC model
Scotland)
Different
 Geographies
 Health needs
 Different support
systems
NHS
Orkney
NHS Western
Isles
NHS Highland
Robert Gordon
University
Stirling
University
NHS Argyll & Clyde
NHS Glasgow
Glasgow Caledonian
University
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Tajikistan site locations
Varsob
Medical College
Post graduate Institute
Kulob
Qurghon
teppe
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To test the FHN model
as a way of delivering
community nursing
services to remote &
rural areas (phase1)
and urban areas (phase
2)
To develop and test
the educational
preparation of FHN
Scottish Executive (2006) The WHO Europe Family Health Nursing
Pilot in Scotland, Final Report. Edinburgh: Scottish Executive.
http://www.scotland.gov.uk/Publications/2006/10/31141146/0
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To evaluate the contribution of Family Health
Nurses towards the National Health Reform
Programme
To review the learning outcomes achieved by
community nurses following completion of the four
year curriculum and the six month re training
programme.
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Improved patient and family experience
Identification of problems at an early stage
Reduced need for hospitalisation
Improving outcomes of care
Increasing organisational efficiency
Larger pilot required, implementation of
development sites and full evaluation to test a
generic advanced community nursing role
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Community based curriculum
for all nurse education prequalifying programmes (4 Med
colleges & 9 Schools)
Reduction in infant deaths and
childhood malaria cases
Timely interventions
Improved access to health
services
1000 new Family Health Nurses
300 community nursing bags
supplied
Raised self esteem of nurses
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Benefits
– Intervention for those who might
‘fall through the cracks’
– First point of contact and
accessibility
– Early detection and prevention of
high risk health threats
– Integrated team approach at
community level
– Empowerment and role modeling
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Community Dependency
– Possible time issues / 24 hour on call
– Financial un-sustainability
– Change of status and position for
nurses (HV’s, DN,s)
– Non engagement by the team
– Focus on acute intervention rather than
public health
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Interface with other services
Workforce modelling
Change management
Generic vs specialist model
INPUTS
Education,
training
culture
Integrated
team network
CARE CONTEXT
•Country
specific
Primary Health
Care Model
•Accessibility
OUTPUTS
Family centred
health care
Measurable outcomes
•Tackling MDG’s
Advanced nursing
Expertise
•Cost effective
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Data from 8 countries using
questionnaires
Similar concepts in role across Europe
Improved communication in team when
shared focus
Move towards clinical disease & public
health
Further work on role clarity and
sustainability
Education programmes differed due to
in-country system & resources
WHO Europe (2006) Report on the Evaluation of the WHO
Multi-country Family Health Nurse Pilot Study, Copenhagen:
WHO Europe http://www.euro.who.int/document/e88841.pdf
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Patient and carer needs
Scotland’s population profile and health
care needs
Health and social policy
Nursing, health and social care workforce
issues
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Increasing numbers of older people
Health is worse than either the rest of Great
Britain or Europe on a range of indicators,
from premature deaths to dental health
among children
Within this, substantial inequalities between
different parts of Scotland and between
different groups within the population
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Diminishing number of work-age adults
The age profile of community nurses different
from nurses in the acute sector
Increasing demand on health care services
– Modernisation agenda with increased
delivery of health care in primary care.
– Maintenance of current levels of service in
the face of recruitment and retention
problems
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Nursing Service Model
Individuals, carers, families and communities
Nurse Consultant
Clinical Team Leader/Advanced Practitioner
Acute Sector
Community
Hospitals
Local Authority
Teams
Community Health
Nurse
(CHN)
Primary Health Care
Team, including GP.
practice nurses,
pharmacists,
maternity services
etc
Community staff nurse
Health care support worker
Individuals, carers, families and communities
Meeting health
needs
Supporting
Anticipatory
care
Working directly
with people
Public health /
Protecting the public
Nurses working in the
community
Multi disciplinary
Team working
Supporting
self care
Co-ordinating
services
Four development sites identified
• Project Director appointed
• Four Project leads in each
development site appointed
• Competencies identified for the new
Role
• Educational programmes developed
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Educational transition taking place
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Base Line Study Completed
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New teams in place
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Full evaluation commencing July
2009
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Experienced workforce
Community Nursing teams with varied
organisation
Engagement = confidence
The ‘invisible nurse’
Mid range levels of satisfaction
Mixed views about proposed changes
Rural areas seen to fit the new model
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Staff, patient, client, carers perceptions and
satisfaction levels
Time and cost of the implementation (value for
money)
Team working / roles responsibilities
Patient outcomes
Impact measures
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Short time span for implementation prior to
evaluation. Possible distortion of results
Variance between different development sites
Difficulty in separating net versus gross
outcomes
Number of variables within each situation
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Does everyone understand what we are trying to
do?
Did we manage the implementation effectively?
Have we achieved our objectives?
Have we made any impact on the problems that
gave rise to the implementation of the project in
the first place?
Do we understand the contribution that
Community Health Nurses and the RoNIC model
can make towards improving the health of our
communities?
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Health systems that maximise the skills and
expertise of nurses are more likely to achieve
the Millennium Development Goals.
Nurses are key players in providing an
effective primary health service for our
communities.
Appropriate community based education and
advanced levels of competence are necessary
for nurses to undertake this role.