A new model of community nursing inspired by an approach to district nursing used in the Netherlands is expected to be fully adopted by a trust in Cheshire following a successful trial.
Cheshire and Wirral Partnership NHS Foundation Trust, which provides community, mental health and learning disability services, has been piloting its version of the Buurtzorg – or “neighbourhood care” – model in the west of the county since September.
“What we want our nurses and therapists doing is working to the edge of their practice”
The Dutch approach is focused on nurse-led care in small teams that manage themselves. The trust is also using this approach but, instead of using the Buurtzorg model of a team of 12 district nurses who co-ordinate care from other healthcare professionals, it has been testing a multi-professional version.
The trust’s pilot includes a team of five community nurses, a mental health worker – currently a mental health nurse – an occupational therapist, physiotherapist, social worker, care co-ordinator, wellbeing co-ordinator and administrative assistant.
In addition, while the Dutch model includes a typical caseload of 40 to 60 patients per team, those behind the model at Cheshire and Wirral Partnership said it was focused on providing care for the entire local population of 15,000 people.
While the trust’s model features a mental health professional, the organisation’s chief nurse said the team would only be providing mental health support – not specialist mental health treatment and care.
As part of the focus on the team managing itself, it has devised new initiatives to address problems with patients in rural areas, who find it more difficult to access services.
The team has worked with a community interest company to deliver classes about prevention and self-care – including linked to pulmonary rehabilitation and other health issues specific to the population in the area.
“Previously nurses would have been on the receiving end of a model design but now they are in the driving seat”
By increasing support for patients so they understand more about their health and community services, it is hoped they will recognise triggers or deterioration sooner and access help more quickly before they become more ill.
The team is also working closely with social care services so that patients who become acutely unwell can be admitted to a local nursing home “step up” bed – rather than a hospital – in cases where they could be overseen by a GP.
In addition, the co-ordinator roles are intended to ensure the nurses are not required to fill gaps in social care, which in the past they had done.
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Trust director of nursing Avril Devaney said: “We asked them what got in the way of working to the edge of their practice and we found they were trying to be person-centred – and couldn’t help but see social needs. So they were filling a gap – which actually another role is better placed to do.
“We didn’t want nurses filling people’s fridges… What we want our nurses and therapists doing is working to the edge of their practice and then the other people on the team support them to do that,” she told Nursing Times.
Ms Devaney said the benefits of a self-managed team included nurses having more control over how they spent their time, being able to provide more person-centred care and having a better relationship with the local medical centre and care homes.
“When we come to expand, changes to services will be different in each area because each geographical region has it owns challenges,” she said. “But the teams will determine with their community what is most effective for them.
“Previously nurses would have been on the receiving end of a model design but now they are in the driving seat,” stated Ms Devaney.
“When we come to expand changes to services will be different because each geographical area has it owns challenges”
The pilot, developed in partnership with NHS West Cheshire Clinical Commissioning Group and Cheshire West and Chester Council, is still being evaluated by the University of Chester but Ms Devaney said her team had “seen nothing so far which makes us think this isn’t the right direction”.
She said the trust was looking to switch several of its community nursing teams in west Cheshire to the new model this year after the evaluation had been completed.
Ms Devaney added that she believed the principle of self-managed teams could also be used for its mental health and learning disability inpatient settings in the future.
Earlier this week, Guy’s and St Thomas’ NHS Foundation Trust in London announced that it was also one of the first NHS organisations in England to trial key elements of the Buurtzorg model.
It is also being piloted in various other parts of the UK, either at organisation or national level, as previously reported by Nursing Times.