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DRAFT 2. 8-02-06 SERVICE SPECIFICATION DISTRICT NURSING SERVICE Lynn Callard Assistant Director of Services Ealing PCT 0208 893 0177 07944867011 Lynn.Callard@ealingpct.nhs.uk DRAFT 2. 8-02-06 1. Service Aims The District Nursing Service in Ealing provides nursing for people over the age of 18 years that are unable to get out. The service is central to the capacity of individuals to remain in their own homes. It plays a pivotal role in assessment, care co-ordination and care giving. It aims to optimise health, prevent avoidable admission to hospital and facilitate return home.. This service consists of; Generic District Nursing Services – A skill mixed team of qualified community based nurses led by a qualified District Nurse providing both an assessment and care service for people that need urgent, long term, palliative or terminal care. Most qualified district nursesare Nurse Prescribers. The teams are GP attached and are responsible for patients registered with the attached GP practices. Although a number of teams have recently started organising their work on a more corporate basis. If a patient is not registered with a GP but lives in the area, care will be provided on a geographical basis. Community Matrons - Highly skilled qualified nurses providing ‘care management’ for patients with complex long term conditions The care of these patients is managed in a more anticipatory way by a named Community Matron. The Trust believes that treating this group of patients, sooner, nearer to home and earlier in the course of their disease will help to reduce the number of inpatient emergency bed days (the time spent in hospital following an emergency admission). Specialist Nurses – Provide specialist clinical skills in the management of patients with complex problems in their specialist area. They also have a responsibility for training and development of staff in their specialty. They have a vital role to play in maintaining the quality of the service and ensuring that the generic service has the required level of skills. Most of the specialist nurses will be extended nurse prescribers. There are specialist nurses in; Tissue viability Appendix 1 Continence Appendix 2 Diabetes Appendix 3 TB Appendix 4 The specialist services have provided specific service specifications detailed in the relevant appendix. 2. Client Group The service is equipped to care for those over 18 years however the majority of clients are in older age. The service is increasingly delivering more complex care to those with Long Term Conditions and those coming to the DRAFT 2. 8-02-06 end of their life, many of whom are under 65 years. More than 60% of patients have multiple nursing needs (Audit Commission Report, 1999). 3. Location District Nursing Teams are mainly based in PCT premises such as health clinics. The PCT is managed in seven Neighbourhoods and each Neighbourhood has its own base. There are a small number of teams that are based in the larger GP practices. Each Neighbourhood will have several nursing teams. In addition to care being provided in the patients own home, the nurses run ? weekly ‘Ulcer clinics’. Patients are brought to these clinics by transport organised by the PCT (Some Neigbourhoods provide a daily clinic sessions ………) The generic district nursing teams also provide care for patients in residential homes and the specialist nurses provide care in nursing homes. 4. Hours of Operation. All services run 365 days a year. Day Service Available from 08.00 to ?17.00. Evening Service Available from 16.30 to 23.30. Night Service Currently contracted from Hounslow PCT Available from 23.30 to 06.30 During 2005/6, it is the intention of the PCT to run the day service from 07.00 to 19.00 with an enhanced evening service available until 23.00. The PCT will then provide the overnight service from 23.00 to 07.00. 5. Referral Process There are a number of possible access routes in to the District Nursing Service; GP – using a faxed referral form. It is intended that this will be via the Single Assessment Process (SAP) referral form. Acute Trust (including OPRACS and ERICS) – using a faxed referral form. It is intended that this will be via the SAP referral form. Good discharge planning should result in direct communication between the referrer and the District Nursing team. Social Services using a faxed SAP referral. Clayponds Hospital – using a faxed SAP referral Self referral – this is usually for patients who have previously been known to the service. ECP - using a faxed SAP referral DRAFT 2. 8-02-06 6. Core Specification See Appendix 5 7. Skill Mix and Staffing Levels The District Nursing teams are comprised of a combination of the follow staff; General administrative support Clinical support Health Care Assistants – Level… Qualified Nurses – Level 5 Qualified District Nurses – Level 6 (under review) Community Matrons – Level 7 (under review) Each team will vary in construction depending on the needs of the area in which they are working. The following is a guide to the composition of a team Staffing level Approximate number General administrative support Shared within clinic so difficult to assess – try to get Clinical Support Workers 1 Health Care Assistants – Level 2 Qualified Nurses – Level 5 4 Qualified District Nurses – Level 6 2 Community Matrons 2 For composition of Specialist Nursing Teams – see relevant appendix 8. Physical Resources, Assets and Equipment Each team requires a space from which to work with desks, chairs, access to IT and filing cabinets for safe storage of records. They also require a fax machine and printer. Each nurse will carry a case with basic equipment e.g. BP machine, What else can we say about what equipment is required? The prompt provision of appropriate equipment for patients is vital if they are to be maintained safely in their own homes.. All nurses are able to prescribe equipment for patients in their homes through a contract provided through an external provider – Milbrook. More expensive items, such as pressure relieving equipment has to be authorised by the team leaders. Tony Thomas – how are we going to cost this in? 9. Response Times, Follow-up Times and Waiting Lists There are no waiting lists for the District Nursing Service. When a referral is received it is assessed and a visit prioritised in accordance to need against a priority rating scale. DRAFT 2. 8-02-06 PRIORITY RATING SCALE 1 Immediate – seen within 4 hours 2 Urgent – seen within 48 hours 3 Non – urgent - seen within 72 hours 4 Planned care 5 Managed over phone 6 Can leave/delegate to competent carers/self For example, a patient discharged from hospital with complex needs will be visited within 4 hours . At the first visit an assessment is carried out and a care plan devised in collaboration with the patient. Some patients will require visits more than once a day whilst others will require attention less frequently. The needs of the patient will be assessed at each visit and the care plan modified as required.
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