‘Now More Than Ever’An International

Perspective

Professor Barbara Parfitt CBE PhD MSc

MCommH RGN RM FNP

Inverse Care Impoverishing Care Fragmented Care Unsafe care Misdirected care

Service Delivery Reforms

Leadership Reforms

Universal coverage Reforms

Public Policy Reforms

Family Physician

Family Health

Nurses / Midwives

Public health

approaches to

protecting the public

Multi-disciplinar

y and multi-

agency team

working

Integrated care approach

Community participation

Meeting the health needs of communities

Supporting anticipatory care

Working directly with individuals and their carers

Supporting self care

Co-ordinating services

Guided by:• WHO Europe

definition• NHS Education

Scotland Competency framework

• learning from all pilot countries

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

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NHS WesternIsles

NHS Highland

NHSOrkney

StirlingUniversity

Robert GordonUniversity

NHS Argyll & Clyde

NHS Glasgow

Glasgow CaledonianUniversity

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Varsob

Medical CollegePost graduate Institute

Qurghonteppe

Kulob

Tajikistan site locations

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

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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

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 pre-qualifying 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

• 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

Interface with other services Workforce modelling Change management Generic vs specialist model

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INPUTS CARE CONTEXT OUTPUTS

Education,training culture

Integrated team network

Advanced nursing Expertise

•Country specific Primary Health Care Model

•Accessibility

•Tackling MDG’s

•Cost effective

Family centred health care

Measurable outcomes

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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Individuals, carers, families and communities

Individuals, carers, families and communities

Community Health Nurse(CHN)

Clinical Team Leader/Advanced PractitionerNurse Consultant

Community staff nurseHealth care support worker

Primary Health Care Team, including GP.

practice nurses, pharmacists,

maternity services etc

Acute SectorCommunity Hospitals Local AuthorityTeams

Nursing Service Model

Nurses working in the community

Working directly with people

Meeting health needs

Public health / Protecting the public

Supporting Anticipatory

care

Multi disciplinary Team working

Supportingself 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

Educational transition taking place

Base Line Study Completed

New teams in place

Full evaluation commencing July 2009

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

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

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

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?

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.