PRIMARY CARE: THE FUTURE

In the context of the Role of the Nurse LO4 :A paradigm Shift

The aim of this session is to

◦Analyse key NHS and Nursing Policy in relation to supporting care provision for people living with long term conditions

◦Address LO 4 "Analyse the role of the professional nurse in promoting self care and management of adults with long term conditions"

◦

By the end of the session

◦ List core Health Policy that is shaping the care of patients with long term conditions

◦ Define paradigm shift

◦ List the models of care being introduced in order to support patients with long term conditions

◦ Reflect upon the role of the nurse and list the skills required to coordinate care for patients with long term conditions

Content mapped with the Module LO 4 and can be used to underpin and inform discussion related to the role of the nurse

Reminder from yesterday

◦ 15 Million people have a long term condition

◦ 58% of over 60’s have a long term condition (increased in lower socio-economic groups)

◦ 50% of all GP appointments

◦ 64% of all Outpatient appointments

◦ 70% all in patient bed days

◦ £7 of every £10 of total health and social care budget is spent on patients with a long term condition. NHS Budget 2017/18 = £124.7 billion

First complete the following

Reflection (5mins)◦ Reflect upon the NHS and highlight 3 areas

that concern you from each of the following perspectives:

◦ One as a member of the public

◦ Two as a student nurse

◦ Three as an advocate for a patient who has co morbitities and living on their own

Consider◦ Political climate

◦ Media reports

◦ Experience

When construction your responses

Look at your responses

Consider

◦ The responses from each perspective

◦ Do they differ?

◦ Is there a common area across each of the perspectives

◦ Your sources

◦ What do you conclude from your responses?

Self Assessment

Using a scale 1-10 1 being none

5 being good 10 being excellent

◦ Your knowledge

◦ Your understanding

◦ Your confidence on the topic

◦ Conclude innate or informed or both

Did you think of the following

◦ Increasing demand, ageing population

◦ New Treatments

◦ Increased pressure - 3 million avoidable A&E attendances - reduce 2000 – 3000 beds (146 -200 000 less admissions)

◦ Increased General Practice (7 day/week)

◦ Focus on frailty

◦ Integrated services and Funding (Accountable Care Systems)

◦ Technology and Innovation

Political Climate: Neo Liberalism

◦ Based upon

◦ Economic liberalisation

◦ Privatisation

◦ Fiscal Austerity

◦ Deregulation

◦ Free Trade

◦ Individual responsibility rather than state managed

◦ Underpinned UK government strategy since 1980’s

Consequences of this ideology for patients with LTCs

◦ Individual Responsibility

◦ Shift from “treating” to “living with”

◦New normal

◦Responsibility for self-care

◦Use of wider resources – community, digital

◦ Is this driving a paradigm shift in nursing?

Ideology underpinning policy shaping care services◦ Examples of Policy Documents

◦ Current Core Policy Driver is Five Year Forward View, available at https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

◦ What is a paradigm shift according to https://dictionary.cambridge.org/dictionary/english/paradigm-shift

◦ "It is a time when the usual and acceptable way of doing and thinking about something changes completely" so is nursing undergoing a paradigm shift and what is driving this shift?

Care built on these Principles

◦Prevention

◦Empowering Patients

◦Efficiency

◦New Models of Care (House of Care)

◦ In patient care as a last resort

Commitment 1 -We will promote a culture where improving the population health is a core component of the practice of all nursing, midwifery and care staff

Drivers

◦ All our Health

◦ Five Year Forward View

◦ Public Health Outcome Framework

Action

◦ Act as a role model in adopting a healthy lifestyle

◦ Share information about healthy choices

◦ Support people to make informed choices

◦ Be open and willing to change in response to evidence/research

Commitment 2 -We will increase the visibility of nursing and midwifery

leadership and input in prevention

Aims

◦ •Championing health promotion

◦ •Social movement for health

◦ •Leading and shaping care especially young people and children

Actions

◦ •Promote culturally appropriate systems of prevention for sustainable change

◦ •Enable people to take responsibilities for their behaviours

◦ •Make every contact count Design and implement prevention programmes

Commitment 3 - We will work with individuals, families and communities to equip them to make informed choices and support them to manage their own health

Context

◦ Poor health of older population

◦ Making every contact count

◦ Working with communities

Actions

◦ Encourage and engage individuals to make healthy choices

◦ Co-design personalised care plans

◦ Work with communities – harness voluntary sector

◦ Share skills of self- management, self-esteem, social contact and build networks for resilience

Commitment 4 -We will focus on individuals experiencing high value care

Ideology

◦ No decision about me without me

◦ Putting people first

◦ Care planning

◦ User voices

Actions

◦ Individuals influence all aspects of co-ordinated care – ensuring culture,

difference and vulnerability is respected

◦ Listen and respond to actual needs

◦ Curiosity to unwarranted variation

◦ Adapt care to “place” based care

Commitment 5 -We will work in partnership with individuals, their families, carers and others important to them

Approaches

◦ Asset based care

◦ Integrated Services – including volunteers

◦ Personalised care, community partnerships, equality, valuing carers, volunteering and social action

Action

◦ Co-design plans to provide care in the right time, in the right place to agreed outcomes

◦ Build trusting relationships

◦ Co-ordinate care

◦ Coach individuals and families for care to be delivered in a way that works for them

Commitment 6 -We will actively respond to what matters most to our staff and colleagues

Aims

◦ What matters to you?

◦ Mental Health First aiders

◦ Work environment

◦ Right staff support systems

◦ Staff engagement

Actions

◦ Sharing learning

◦ Listen to our colleagues to ensure we

deliver outcomes

◦ Listen and create opportunities for new

ways of working

◦ Seek feedback on the quality of services

Commitment 7 -We will lead and drive research to evidence the impact of what we do

Aims/Targets/Goals

◦ Celebrating success

◦ Building competency and capability to

identify unwarranted variation

◦ Use metric to improve productivity

◦ Share findings

Actions

◦ •Effectively manage resources to reduce waste

◦ •Understand local systems

◦ •Act as an agent of change

◦ •Listen to individuals to deliver measurable care

Commitment 8 -We will have the right education, training and development to

enhance our skills, knowledge and understanding

Aims and Goals

◦ Revalidation

◦ Shape of Care Review

◦ Career progression

◦ Clinical academic careers

◦ Working across settings

Actions

◦ Value of reflection and learning from

experience

◦ Seeking constructive feedback

◦ Team and action learning

◦ Acquiring right skills, knowledge and

behaviours to measure our impact

Commitment 9 -We will have the right staff in the right places at the right time

Aims/Targets

◦ Carter Review

◦ Working across organisational boundaries

◦ Recruitment and retention

◦ Evidence behind workforce decisions – local context

◦ E-learning package to monitor and support development

Actions

◦ Engage in development and training

◦ Facilitate new ways of working

◦ Flexible patterns of work

◦ Workplace as a beacon of excellence

Commitment 10 -We will champion the use of technology and informatics to improve practice, address unwarranted variations and enhance outcomes.

Goals

◦ Technology literate workforce

◦ Technology to reduce variation

◦ Leading as early adopters

◦ Empowering for self management

◦ Technology to manage workforce

Actions

◦ Embrace technology and informatics

◦ Understand benefits to increase time to

care

◦ Technology for co-ordination

◦ Dissemination and tool to reach hard to

reach groups

These 10 commitments

◦Are designed to equip the nurse with the skills required to survive/shape a modern health care service underpinned by neo liberalism ideology

◦Therefore and final thought if and when the political climate changes from the current neo liberalism ideology, would this result in a further paradigm shift for nursing?

References

◦ JaneCummings – Supported Self Care commentary, available at https://www.england.nhs.uk/2017/01/jane-cummings-29/

◦ Five Year Forward View, available at https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

◦ Leading Care, Adding Value, available at https://www.england.nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf

◦ Next Steps on the NHS Five Year Forward View available at https://nhs.engand.nhs

◦ Nuffield Institute, available at http://www.nuffieldtrust.org.uk/

◦ NHS England Self Care, available at https://www.england.nhs.uk/ourwork/patient-participation/self-care/