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									DRAFT 2. 8-02-06



Lynn Callard
Assistant Director of Services
Ealing PCT

0208 893 0177
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
    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

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

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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