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Specialist nurses could play key role in driving new models of care for HIV patients

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Clinical nurse specialists could play a leading role in delivering more co-ordinated care to those with HIV, according to a report that says the fragmentary nature of current services is hampering progress.

It highlighted that there were “pioneering” nurse specialists in some part of the country who were developing their role in case management that could be expanded to other areas.

“There are pioneering clinical nurse specialists developing their role in case management”

King’s Fund report

While the report from the King’s Fund stated that HIV care in England was among the best in the world, it highlighted the need for a much more joined-up approach to ensure the very best care for people with HIV.

The report, which was funded by the MAC AIDS Fund, also underlined the need for more work on prevention.

Improvements in treatment mean people with HIV are able to live longer, healthier lives and there are now significant numbers of older people with the condition, noted the report – titled The future of HIV services in England.

But having responsibility for delivering services spread between NHS England, local NHS organisations and councils has made it harder for areas to respond effectively to changing needs, said the report, which identified a lack of integrated commissioning.

The “labyrinthine structures” created by the Health and Social Care Act, pose “a real threat to future quality of care”, according to Alex Baylis, assistant director of policy for the King’s Fund think-tank.

“The health needs of people with HIV are changing rapidly, but healthcare for people with the condition is too fragmented to be able to keep up with this pace of change,” he said.

“The rising number of older people with HIV are more likely to need care from other parts of the health and social care system, and so joined up working will be vital to them getting the care they need,” he added.

“The future of HIV service in England is far from certain”

Ian Green

The report stressed the need for change was urgent in London, with nearly half of all people with HIV in England accessing services in the capital, which also has the highest rate of new diagnoses.

The research included a review of existing research and data, as well as interviews with national bodies and organisations.

The team then took an in-depth look at how HIV services operated in four different areas, which included focus groups with people with HIV.

It showed clinical nurse specialists already played a key role in delivering services. However, the report suggested there was scope for the role to be expanded amid the development of new, more streamlined models of care.

“In various parts of the country, there are pioneering individuals among clinical nurse specialists developing their role in case management, and pharmacists developing expertise in HIV-related medicines and testing,” said the report, whose authors include David Buck, the think-tank’s senior fellow for public health and inequalities.

“As well as building on the work of these individuals for future care models, it is important that local services specifically consider how they can support the development of roles in the HIV workforce,” it said.

King's Fund

David Buck

David Buck

When it comes to developing “stronger and better aligned networks of care” for people with HIV, the report said the way these were configured would vary depending on the needs of local populations in different parts of England.

This could include creating more integrated services where specialist care, primary care, social care and voluntary organisations worked more closely together to meet the needs of individual patients.

Or it may mean developing services that focused on specific groups of people with similar needs, rather than having services that try to do everything.

“London currently has 30 HIV clinics, with 18 providers each offering a different mix of care with differing resources,” stated the report.

“There is an increasing acceptance among clinicians that this configuration does not consistently meet the needs of people living with HIV in London,” it noted.

Another option is a “hub and spoke” model, where specialist services “which could be nurses and pharmacists as well as doctors” support a group of GP practices, care homes or other services to provide care for people with HIV in the community.

The Terrence Higgins Trust said it was also important to recognise the key role of charity and community organisations.

“It’s clear that challenging times lie ahead and the future of HIV service in England is far from certain,” said its chief executive Ian Green.

“The role of the community in working alongside the NHS and local authorities has never been so important,” he added.

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