VOL: 19, ISSUE: 10, PAGE NO: 7
Anne Duffy is Director of the Community and District Nursing Association (CDNA)All those working in primary care are aware that health practices must change to cope with the escalating numbers of elderly, frail people living in the community.
All those working in primary care are aware that health practices must change to cope with the escalating numbers of elderly, frail people living in the community.
While the number of people requiring assistance rises, the pool of staff health services can call on to deliver care is declining, forcing changes to how care is given.
The Government has responded with initiatives such as the National Service Framework for the Older Person (NSF) and its intermediate care policy.
Although these developments do improve care and services for older people, they still do not offer the complete holistic care required long-term by frail, elderly people.
The benefits of Evercare, a health-care improvement programme developed in the USA to improve the quality of care for vulnerable older people, were flagged up in a Department of Health press release in May 2004.
The programme involves the use of specially trained nurses to identify and monitor at-risk older people so that treatment can be given before a visit to hospital is necessary. It is currently being piloted in nine English primary care trusts*.
Evercare is a nurse-led programme, and will be driven by the advanced primary nurse (APN), a new nursing post. They will have complete autonomy over their caseload.
They will work with all the other professionals in health and social care connected with their patients and will be trained in the new skills required to carry out their duties. These nurses will eventually have other advanced skills. They will:
- Be responsible for all clinical aspects of their patients' care, orchestrating all health and social care interventions
- Communicate between all service providers, especially between hospital and primary care
- Coach and inform patients, relatives and their carers in all aspects of illness and its consequences, including preparation for death
- Identify health issues, and champion the public health role of primary nurses.
This role is a very labour intensive and so the APN will have about 55 to 60 patients, identified from the number of hospital admissions and based on strict criteria.
The initial findings from a series of the Evercare programme were revealed in the DH press release at the beginning of May. It stated that:
- The development of the APN role can lead to better co-ordination of pro-active care of older patients and better collaboration with GPs and geriatric consultants
- Better monitoring and education of older patient populations means high-risk patients can be identified and treated before hospital admission becomes necessary
- The work is already addressing the needs of vulnerable older people in the community, using primary care - local doctors and nurses - as the main way of delivering care.
The Community and District Nursing Association (CDNA) cautiously welcomes Evercare. However, it does have concerns that, without extra resources in the community, the extra pressure this will put on district nurses will push the service to breaking point.
Proper funding needed
Everyone working in primary care is aware that practices must change to cope with the escalating numbers of frail, elderly people living in the community. We welcome the fact that the Government is taking this issue seriously but urge it to ensure new initiatives are properly funded.
District nurses are best placed to take on this new role, provided adequate support is in place.
It is an exciting time for nurses working in the community precisely because they will be involved in shaping nursing to ensure the care delivered meets future needs.
Staff delivering care have the power to challenge the present power base and aim for equality among health professionals. But giving them the support to achieve that is a key ingredient.
*The nine primary care trusts piloting the Evercare model are Airedale; Bexley (care trust); Bristol North; Bristol South and West; Halton; Luton; South Gloucestershire; Walsall and Wandsworth. A tenth, North Tees, is looking at data and analysis for more effective commissioning and clinical governance.
DH press release 2004/0159, 3 May 2004.