Project Initiation Document Review of Community Nursing Services in Wyre Forest Contents Page 1. Management Summary 1 2. Introduction 1 2.1 Purpose of Document 1 2.2 Background 2 3. Project Definition 3.1 Project Objectives 3.2 Project Scope 3.3 Exclusions 3. Assumptions 3. Constraints 3. Interfaces 3.7 Security.0 Business Case.1 Reasons.2 Benefits expected.3 Cost. Timescales. Possible Supplier(s) & Key Delivery. Project Risks.0 Approach.1 Project Approach.2 Project Organisation.3 Stakeholders. Communications. Quality. Project Controls 7 7.0 Project Plan 7 Appendix 1 -Project Plan 8 0 P age
1. Management Summary This Project Initiation Document (PID) sets out the approach for reviewing the provision of community nursing services in Wyre Forest. Following the countywide review of District Nursing Services in Worcestershire in 2010, a number of recommendations were made with regard to the future provision of the service including review of skillmix, team sizes and caseload profiling. In relation to district nursing services in Wyre Forest, the main observations were as follows: There had not been a recent review of the services in Wyre Forest; There was a perceived higher skill mix (Bands 7 and ) in the Wyre Forest teams when compared with the rest of the county No dedicated phlebotomy services in Wyre Forest and the impact this had on the district nursing teams; Highest referral rate into the service and lowest discharge rate ; High numbers of self referrals into the service. Noted during two week data review used to support the report and therefore may not be reflective of the service. Wyre Forest Clinical Commissioning Group (CCG) has identified community services as a priority for 2012/13, which includes community nursing services. Therefore, Wyre Forest CCG is proposing a review of the community nursing service to formulate the following: A Wyre Forest model of provision for community nursing services based on a fair shares allocation of resources; An output/outcome based service to ensure delivery of the key aspects of the service; A model that is fully integrated into other extended services in the community including the Admission Prevention Team (Virtual Ward) and GP practices/practice staff; A model that ensures the resources are available within the teams to support the effective management of more complex patients (both now and in the future), supports early discharges from acute/community hospital beds, improves management of patients to prevent admission to a hospital bed and which ultimately delivers care closer to home enabling patients to remain in their own homes. 2. Introduction 2.1 Purpose of Document This document aims to define the framework through which the review of community nursing services will be undertaken to ensure successful execution of the project and delivery of the projects key objectives (as above). It provides a statement of; What is the project is aiming to achieve during 2012/13 and thereafter; How the review will be undertaken in Wyre Forest; Who will be involved in managing the project and their roles and responsibilities in the delivery of the project; Timescales associated with ensuring the successful implementation of the project including the expected outcomes and success criteria. The PID will ensure that the project has a robust framework to deliver the key objectives identified and ensure a robust mechanism through which community nursing services will be commissioned in the future. 1 P age
2.2 Background A countywide review of District Nursing Services was undertaken by Worcestershire PCT (Provider Services) in 2010 as part of their Cost Improvement Programme (CIP). The review identified 1 recommendations including: Development of a robust strategy to review of the skillmix within teams and professional and clinical leadership; Review of team size in terms of viability at an operational and governance level to ensure demand is matched with supply at an individual team level; Regular caseload profiling across all teams to assess demand and future requirements in relation to skillmix and team size; Requirement for better integration; Ensuring resilience of the teams through more robust planning particularly around management of long term absences. A number of observations were made in relation to the services delivered in Wyre Forest including: Absence of a recent review of services in Wyre Forest; Perception that Wyre Forest has a higher skillmix within the teams (Bands 7 and ) than the rest of the county; No dedicated phlebotomy service and the additional demand this had on district nursing teams; High referral rates and low discharge rates (see previous note Page 1); High number of self referrals into the service (see previous note Page 1). There is a service specification in place with Worcestershire Health and Care NHS Trust to deliver integrated community nursing services in Worcestershire. The main aims of the service are specified as follows: Provision of nursing care interventions to people in their own homes through individualised care plans; Provision of end of life care Avoidance of health deterioration or hospital admission; Supporting earlier discharge from hospital. The outcomes expected of the service are specified as follows: Improvements in patients overall health status; Improved patient autonomy and patient satisfaction; Improved service satisfaction; Improved use of resources. A review of community services, including community nursing services, has been identified as one of the work programmes for Wyre Forest CCG for 2012/13. Broadly speaking, the following objectives have been identified: To agree a Wyre Forest model of provision for community nursing services based on a fair shares allocation of resources; To agree and develop a model that is fully integrated into other extended services in the community including the Admission Prevention Team (Virtual Ward) and GP practices/practice staff; To agree and develop a model of provision that ensures resources are available within the teams to support the effective management of more complex patients, supports early discharges from acute/community hospital beds, improves management of patients to prevent admission to a 2 P age
hospital bed and which ultimately delivers care closer to home enabling patients to remain in their own homes.. At the GPA Executive meeting in Wyre Forest on 18 th October 2011, practices were asked to provide feedback to the Executive on community nursing services on what appeared to work well and also on how they thought the service could be improved. The Wyre Forest Locality Manager was also asked to seek views from the District Nurses on what they felt worked well/not so well to ensure a rounded view was obtained. The main comments received from GP Practices were as follows: Need for teams to potentially cross cover to ensure sustainability and continuity of service provision although the success of the shared Team Leader role is variable across the locality; Need for better information between and within community nursing teams and with the practices they support; Ensuring teams are fit for purpose to meet increasing and changing needs of the population ie. earlier supported discharges, admission prevention; Ensuring teams are suitably skilled to manage increasingly complex patients particularly around management of long term conditions and patients requiring palliative care. Areas for potential improvement identified by the practices included: Need to align core working hours (8.00am.30pm) with GP practice opening hours; Wish to be involved in recruitment and interviews of community nursing staff; Opportunities around having specific staff roles ie. phlebotomy to reduce demand on district nursing services; Having practice based community nursing teams; Need to have more integration with extended teams such as the Admission Prevention Team; Having a standardised model of provision of team resource to ensure equity and sustainability. Feedback from the Community Nursing teams addressed some of the comments given by the practices and included: They feel they have excellent working relationships with GPs and practice staff; Integration of the service needs to be both ways; Issues with IT and the incompatibility of systems, which increases demands on nursing time in terms of data input and reporting; Need for practices and practice staff to have a better understanding of the different roles within the community nursing teams; Difference between expectations and what is commissioned; Impact of external change such as the introduction of the Falls Strategy (falls assessments) and extended nursing roles ie. Nurse Advisors for the Elderly; Patients discharged into the community are becoming increasingly complex and this puts different pressures on the community nursing teams ie. CHC assessments, IV therapy. As a result of the discussions at the GPA, the following comments were made by those represented which will form the basis of the discussions with the WHACT with regard to future provision of community nursing services in Wyre Forest: Would like to look at the options with regard to having practice based teams, although acknowledgement was given that a hybrid model including cross cover of staff is probably more realistic; 3 P age
Would like to investigate whether there is an opportunity for appointing healthcare assistants to undertake specific roles within the community nursing teams ie. phlebotomy, insulin; Would like the opportunity to investigate the options for practices directly employing their community nurse team, possibly as a pilot. 3. Project Definition 3.1 Project Objectives Overall Objectives: To work collaboratively with WHACT to develop and deliver a community nursing service in Wyre Forest that meets with the requirements of the GP practices and patients alike, which is affordable and delivers high quality care, and which integrates with extended services in the provision of community based nursing and social care; To develop a robust service specification for community nursing services in Wyre Forest with clear performance and quality indicators and which allows the provider to effectively deliver the service commissioned by the GP practices in Wyre Forest. Specific Objectives: To develop an implementation plan to ensure delivery of the project within the timeframe required, which identifies clear interim goals and timescale to allow effective monitoring of the project; To develop and agree with the provider a clear service specification for delivery of an integrated community nursing service based on outcomes; To improve information flows around the service particularly around performance, outputs and outcomes; To move potentially towards a cost and volume contract (requirement for shadowing in the first year); To develop and agree the quality performance indicators to ensure high quality services are commissioned. 3.2 Project Scope This project covers district nursing service delivered across Wyre Forest and may extend into other services ie. Nurse Advisors for Older People, Admission Prevention Team, Medicines Management/Pharmacy and Mental Health Services to deliver an integrated model across community based nursing services. 3.3 Exclusions None identified at this stage although this may change as the remit of the project is clarified. 3. Assumptions There is ongoing support from the Wyre Forest CCG Board for this project to remain as a priority for 2012/13; There is sufficient project support and engagement with identified project leads to enable this project to move forward within the stated timescales. 3. Constraints The project may be constrained by; Insufficient project management support; CCG identification of higher local priorities for 2012/13; P age
Availability of additional resources in the event of further investment being required to deliver the objectives of the project. 3. Interfaces The project will interface with; Clinical Commissioning Groups District Nursing Teams (Worcestershire Health and Care NHS Trust as the current provider of the service) GPs and practice staff Admission Prevention Team Nurse Advisors for the Elderly IV Therapy team PPI/Patient Advisory Groups Other community based services Wyre Forest GP Advisory Wyre Forest CCG Community and Mental Health Locality Board Worcestershire Health & Care NHS Trust Contract Management Board Wyre Forest Patient & Public Involvement Group 3.7 Security The project will be as open as possible, although discretion will be applied where commercially sensitive information is involved..0 Business Case.1 Reasons NHS Worcestershire is fully committed through its year strategy to delivering high quality, patient centred, efficient healthcare to its local people, when it is needed and which is as close to their home as possible. It aims to do this by commissioning high quality community based nursing services that is appropriately skilled and will be deliver accessible nursing care to the patients of Worcestershire. Five of NHS Worcestershire s ten strategic priorities relate to providing better care for people with long term conditions or in end of life for whom evidence shows that through risk stratification and concentrating resources on pro-actively managing those most at risk, emergency admissions can be reduced and quality of life improved. Through reducing exacerbations and sudden deterioration leading to emergency admissions the cost of providing healthcare to these individuals can be reduced. Wyre Forest s population is expected to increase by % over the next 20 years. Wyre Forest also has the highest proportion of over year olds in Worcestershire (20.8%). A recent Health Needs Assessment (HNA) identified an expected increase in the + year old population of 8% over the next 20 years on the numbers seen in 2010. This will inevitably mean an increase in the number of patients living with long term conditions, increasing the requirement community based nursing care, effective discharge planning and admission avoidance..2 Benefits expected A community based nursing service that meets the needs of Wyre Forest s population enabling them to be managed effectively and successfully within their home environment; Reduction in emergency admissions; P age
Earlier discharge from secondary care; Better integration with extended community based services; Efficiency gains by ensuring better use of resources; Better patient experience..3 Cost To be scoped.. Timescales See project plan Appendix 1.. Possible Supplier(s) & Key Delivery Chain Worcestershire Health & Care NHS Trust as the main current provider of district nursing services in Wyre Forest.. Project Risks To be identified on the project implementation plan..0 Approach.1 Project Approach The project will be managed in accordance with this project document..2 Project Organisation Project Team Anita Roberts, Lead Commissioner for Community Services Dr Tony Carter, GP Dr Nigel Cockrell, GP Alison Field, Practice Manager, Kidderminster Health Centre Jan Austin, Locality Manager - Wyre Forest, Worcestershire Health & Care NHS Trust District nurse representatives (to be determined).3 Stakeholders Customers/users: Wyre Forest Clinical Commissioning Group GP Practices in Wyre Forest Patients/Public Other interested parties: NHS Worcestershire. Communications Internal to the Project Project Manager acts as the hub for communication within the governance structure. External Detailed communication plan to be developed for distribution to the CCG Board and GP practices. P age
. Quality Customer's quality expectations To be defined within the service specification and which will be in line with NHSW quality requirements.. Project Controls None specified..0 Project Plan See Appendix 1 will be amended as project requirements and timescales become clearer. 7 P age
APPENDIX 1 - Project Plan Review of Community Nursing Services in Wyre Forest High Level Project Plan Issue: Version 2 Issue Date: 3 rd February 2012 Ref Project Goal Project Timescales Driver Person(s) Responsible 1.0 First draft 31/10/2011 AR (development) Development of Project Initiation Document Governance Second draft 31/01/2012 Working Group (sign off) 2.0 Initial scoping meeting with commissioners to agree: Aims and objectives of the work programme; Membership of the Working Group; Timescales for implementation. 3.0 Working Group to: Develop and agree service specification based on outcomes; WHCT to work up the model to deliver the requirements of the service specification; Assessment of the implications of moving towards delivering the service specification; Agree any amendments to the service specification to achieve the optimum outcome of the review; Monitor implementation of the agreed service specification; End of November 2011 CCG priorities for 2012/13 31/03/2012 Critical to project success 30/0/2012 Critical to project success AR (to co-ordinate) Commissioners (to sign off) Working Group WHCT 31/0/2012 Critical to project success Working Group 30/0/2012 Critical to project success Working Group 31/12/2012 Critical to project success Working Group Evaluation of any changes required; 31/12/2012 Critical to project success Working Group Report to Wyre Forest Community and Mental Health Locality Board; Monthly Governance AR (to represent Working Group) Report to Wyre Forest CCG Board on work programme particularly in relation to QIPP. Quarterly (March 2012, June 2012, Sept 2012, Dec 2012) Governance AR (to represent Working Group) 0 P age