1. DGSPCT1 District Nursing Renaissance Towards role re-design to meet changing demand – a local health economy solution Janice Owen Adult Health Nursing Lead and Lead for Renaissance Project Gillie Lewis Practice Nurse Lead and Nurse Practitioner Dartford, Gravesham & Swanley PCT

2. DGSPCT2 Demand ManagementWork Streams Nursing Renaissance (DNs, PNs, acute sector nurses and others) Non- elective services Elective services Practice Resource Utilisation

3. DGSPCT3 Purpose Building on closer to home strategies Resource effectiveness Improving access Service improvements Appropriate professional Agenda for Change and implications for DNs

4. DGSPCT4 Why now? Opportunities Building on primary/community care development Building on the DGSPCT step up model Shifting resources Benefits Closer to home Effectiveness Drivers Payment by Results Financial Recovery Plan nGMS Agenda for Change

5. Improving Chronic Illness Care Model (after Wagner et al 2000) 1. Community Resources & Policies 2. Health System NHS organisation 3. Self Management 4. Delivery Systems design 5. Decision support 6.Clinical Information Systems Informed, Activated Patient Prepared, Proactive Practice Team Productive Interactions

6. DGSPCT6 Primary and Community HealthCare Provision Health Surveillance Access to health care Health Advice Health Promotion Elective / episodic care Intermediate/ rehabilitative care Long term, chronic sick Care of older people Palliative/ terminal care Independent (well) Dependent (ill) Care continuum - delivering the service improvement agenda Requirement for improved Nursing interventions through role and service redesign Chronic Disease Management/ self care NHS Service demands and pressures

7. DGSPCT7 Key Components of Renaissance Role redesign Activity and caseload classifications Working patterns Image Skills Escalator

8. DGSPCT8 Elements of how we will do this Extended nursing skills Intensive mentorship programme Developing core competencies Devising comprehensive tools Identifying high risk caseloads

9. Dartford, Gravesham & Swanley Primary Care Trust Dartford, Gravesham & Swanley Primary Care Trust - The 4 Rs Workforce Redesign Model 2001/02 STEP 2 Refocus the workforce skill mix through consultation with team STEP 1 Review reconsider vacant post/s in the light of emerging patient needs and local HimP priorities STEP 4 Reskill in collaboration with education providers offer appropriate training to meet skills deficit STEP 3 Redesign by identifying skills required within the team to meet needs

10. PILLAR ONE Health Improvement & Clinically effective care PILLAR TWO Trans-formational/ emotionally intelligent nurse leadership PILLAR THREE Whole systems /integrated working 1. Health Care Assistants 2, Registered Primary Care Practitioners (generic role) current staff nurses 3, Senior Registered Practitioners (Specialist /Advanced practitioners) 4. GPs with Special interests First Contact Practitioners and Nurse Consultants DGS PCT Rethinking provision & preparation for future care delivery 2001 Socio- Economic & Demographic Trends Policy Imperatives Patient /Client needs The Expert Patient

11. DGSPCT11 Our goals and Aspirations 1. The maintenance and palliative care functions of community nursing teams will continue however the service will become more focussed and utilise better all team member skills more appropriately 2. Based on the release of 6 / 8 renaissance nurses as key worker to 50 – 60 frequent flier patients with chronic diseases we anticipate: An overall reduction of admissions to hospital in the region of 30% An overall reduction in the number of in-patient beds More satisfied patients and PCT teams

12. DGSPCT12 In DGS PCT ---- We have : A District Nursing workforce enthusiastic and committed to improving health of the local community where the need is greatest – eg: chronic disease management A keen group of staff nurses and health care assistants willing to support the new modus operandi Education providers ready to experiment and introduce new programmes to skill up nurses to respond Team leaders and managers seeking evidence / good practice and ensuring risk issues were addressed Experienced the benefits of introducing skills escalator approaches over the last three years

13. DGSPCT13 Some Risk Factors within the Renaissance project in DGS PCT No new resource therefore reviewing existing roles and practices and introducing change Assessing capacity and team readiness Role redesign and skills acquisition GP and acute sector buy in Resource impact measurement

14. DGSPCT14 March04April 04May 04June 04July 04August 04Sept 04Oct 04Nov 04Dec 04Jan 05Feb 05March05April 05 DN Renaissance Project Determine contribution to the demand management project Identify target population / disease groups Caseload Classification –team readiness PEC GP buy in Identify and Review range of acute sector services for collaborative ventures Obtain DN team buy in MapGMS2 implications Visit out to selected practices to secure commitment and active team support Develop classificati on tool Determine nurse / team capacity Implementation / set realistic targets for each renaissance nurse Pilot classification tool across teams GP reps on steering group Establish steering group Project launch Revised DN structure Role re- design Call for expressions of interest / select 6 DNs Training secured and accessed Targeted work on caseloads commence / peer support established Staff Nurses and HCAs implement new ways of working in selected teams General Practice Contribution Referral criteria and protocols agreed within each practice Recruitment for further renaissance nurses commence Acute Sector Contribution Resource impact Acute sector out reach models agreed 4 /5 Practice Nurse renaissance schemes commence Identify how base line data will be collected Bench mark data against Evercare information Revisit data collection methods report to steering group and demand management project Monitor renaissance impact on caseload maintenance / GP and patient satisfaction Mid Project report DN team staff nurses and HCAs agree role and responsibility areas Ensure enhanced roles of staff nurses and HCAs are reflected in job descriptions

15. DGSPCT15 The Nursing contribution – seeking renaissance! It is not about making the balloon fly better it is making the balloon into an aeroplane Gavin Davis Economics Editor BBC on the 2004 Spending Review