A London trust is looking to roll out a new nurse-led model of community care, after patients and staff said quality of care improved during its test phase.
Guy’s and St Thomas’ NHS Foundation Trust is one of the first NHS organisations in England to trial key elements of the Dutch nursing model known as Buurtzorg – or “neighbourhood care”.
“We’re doing something quite radical here”
The Buurtzorg approach is based on small, self-managing teams of community nurses who have access to coaches for ongoing support and spend at least 60% of their time with patients.
It is being piloted in various parts of the UK, either at organisation or national level, as previously reported by Nursing Times.
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Between October 2016 and June 2017, Guy’s and St Thomas’ began testing its own version of the model with a team of six community nurses in North Brixton. The trust also began a second test in August 2017 with seven community nurses based at Southwark’s Aylesbury Health Centre.
The trust’s version is slightly different to the Dutch model, which is based on a team of 12 district nurses who are usually part-time.
The “neighbourhood care” provided by community nurses in the trial included both nursing and social care – such as giving medicine, dressing wounds, washing, dressing, meal preparation and shopping.
It is expected that time spent on these activities reduces as patients become independent and take control of their care.
“This is an important step towards finding a new way of caring for people in our community, so they can stay at home longer”
An evaluation of the trial by Kingston University and St George’s, University of London found patients and carers were positive about the new model.
It concluded that the new approach meant patients were more likely to know the staff, receive improved support for multiple long terms conditions – including physical, mental and social – and be provided with more proactive assistance navigating services.
Nurses found they were able to provide better care and the new model improved their job satisfaction due to better team working.
This was in contrast with the existing district nurse team, in which “each staff member had their list of patients for the shift and the responsibility was theirs alone” said a report on the evaluation.
But researchers highlighted further analysis was needed to decide whether the new model would improve staff retention and how cost-effective it was.
In addition, they noted it was unclear how far all staff would be comfortable with working in self-managing teams – and how salaries and career progression would fit with the structure.
The trust said it would continue using the two teams working under the new model, while also considering how different versions can be rolled out to other teams.
“This model… offers real potential for addressing some of the challenging issues facing patients, carers and nursing staff”
Cepta Hamm, head of adult community nursing at the trust, said: “We’re doing something quite radical here but we are not doing this alone. We don’t have all the answers yet and we will need to work closely with our partners like social care colleagues to make this happen.
“This is an important step towards finding a new way of caring for people in our community, so they can stay at home longer and out of hospital,” she added.
“It’s about putting the patient and their carers at the centre of what we do while ensuring that this new way of working helps us to recruit and retain highly motivated and satisfied community nurses who are given the time to care,” she said.
Professor Vari Drennan, who led the evaluation, said: “This model of community home nursing offers real potential for addressing some of the challenging issues facing patients, carers and nursing staff. It empowers neighbourhood nurses to be able to have a real impact on patients’ lives.”
“Having more time to spend with those they care for allows these nurses to build relationships that enable them to understand and address the health issues most important to patients,” she said. “They are then able to put in place joined up packages of care tailored for each individual.”