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