Standard Operating Procedure 5 (SOP 5) Family Nurse Partnership Caseload Management Why we have a procedure? Family Nurse Partnership (FNP) is an evidenced based licensed programme that was developed in USA over 30 years ago. The programme was introduced into England in 2006 and became part of the offer provided by the Trust Pre School Service in February 2013. The fidelity to the programme is rigorous and is delivered under a licence agreement that is held by the Trust on behalf of Department of Health. Since October 2015 it is the responsibility of the Local authority to commission providers to deliver the programme. FNP is strength based, preventative home visiting Public Health programme. The programme is voluntary and offered in the antenatal period to first time teenage parents living in Dudley. It is an intensive therapeutic service, consisting of structured weekly/ fortnightly home visits from early in pregnancy and continues until the child reaches the age of 2 years old. A programme schedule is followed which covers; personal health, environmental health, life course, maternal role and family/ friends. The aim of the programme is to give children the best start in life through sensitive, responsive parenting to enhance child development and have a positive impact on their emotional and physical health and social wellbeing. The programme focuses on improving outcomes in three main areas: Improving outcomes of pregnancy by helping young women improve their antenatal health and health of their unborn baby. Focusing on bonding and attachment Enhancing child development and school readiness by helping parents provide consistent, competent care for their children Linking the family to wider social networks and improve parental economic selfsufficiency by encouraging completion of their education, finding employment and planning subsequent pregnancies Large scale randomised controlled trials for a period of over 30 years demonstrates FNP delivers significant improvements in the health and wellbeing of the most disadvantaged children and their families. The programme contributes to the vision within Dudley Borough Children and Young People s Partnership Plan and addresses priorities identified within Dudley Health and Wellbeing Strategy. FNP is included in the National Service Specification No.27 Children s Public Health Services (from pregnancy to age 5).FNP in Dudley is accountable to the FNP Advisory Board that monitors the implementation and progress of the programme. The purpose of this document is to provide clear instructions for Family Nurses and other members of the team in caseload management / operation procedures across the Family Nurse Partnership Caseload Management Page 1 of 10 Version 1.0 February 2016
Black Country Partnership NHS Foundation Trust. This document clarifies roles and responsibilities, and enables practitioners to provide an excellent service that is both safe and effective. The objective of these procedures is to ensure that all Family Nurse Partnership (FNP) staff are able to: Provide a standardised approach to caseload management whilst agenda matching clients needs Allocate and action all referrals to the service Promote greater accountability within an allocated caseload Create an equitable distribution of workloads across the team Promote leadership, team work and communication Comply with record keeping SOP, FNP National Unit guidelines, information governance and the NMC Code (2015) Administration staff understands their roles and responsibilities within the Health Visiting team What overarching policy the procedure links to? Pre-School - Health Visiting (Overarching) Policy Which services of the trust does this apply to? Where is it in operation? Group Inpatients Community Locations Mental Health Services all Learning Disabilities Services all Children and Young People Services all Who does the procedure apply to? All Family Nurse Partnership (FNP) staff including administrative staff When should the procedure be applied? When FNP staff members are managing caseloads for FNP programme offered in the antenatal period to first time teenage parents living in Dudley How to carry out this procedure Service Delivery Model When a client enrols onto the FNP programme they will not have a named Health Visitor, the Family Nurse will undertake all elements of the Healthy Child Programme for children and families who are enrolled onto the programme and live in the Metropolitan Borough of Dudley. By implementing the FNP and Healthy Child Programme, Family Nurses enable positive health outcomes including: Promotion of healthy lifestyles, working with communities to build and use the strengths within those communities to improve health and well-being and reduce inequalities Achieving population (or herd ) immunity through the increased uptake of immunisations Family Nurse Partnership Caseload Management Page 2 of 10 Version 1.0 February 2016
Promoting access to evidence-based interventions through the FNP and Healthy Child Programme to children and families and tailored to specific needs Increasing breastfeeding, appropriate infant and adult nutrition and lifestyle changes including smoking cessation to tackle illness in later life Improving maternal mental health and wellbeing, enabling strong early attachment and infant emotional wellbeing Improved school readiness Reducing number of children requiring formal safeguarding arrangements achieved through early identification and intervention Workload Allocation All children in Dudley enrolled onto the FNP programme will have a named Family Nurse allocated in the ante natal period. All clients enrolled onto the programme are categorised as Universal Partnership Plus within the service offer of the Health Visiting Implementation Plan due to the intensity of visiting within FNP. Family Nurses have a maximum caseload of 25 clients that are visited weekly/ fortnightly throughout pregnancy, infancy and toddlerhood, depending on their stage in the programme (maximum of 60 visits). Caseload Management Family Nurses are responsible for the prioritisation and management of the families on their caseload from recruitment until handover to The Health Visiting service Family Nurses will meet FNP licencing requirements and core model elements for programme delivery Family Nurses will follow programme objectives and guidelines issued by the FNP National Unit Family Nurses should be aware and follow the standard operating procedures in place for the Healthy Child programme within the Trust to support them in delivering care to children and families Family Nurses should be aware and follow Trust pathways for the timely and effective handover of caseload files from FNP to Health Visitors It is important that professional boundaries are maintained within the therapeutic relationship between the Family Nurse and Client Administrative staff should be aware of their role in supporting the FNP team All client files need to be locked away when not in use, when out of the office and at the end of each working day within a locked drawer and keys are accessible to other members of staff If practitioners are facing difficulties managing their workload, they have a professional responsibility to raise this issue with the FNP Supervisor who will offer support and guidance and suggest appropriate actions to address this issue In cases of sickness (of less than four weeks) it is the responsibility of the team members to ensure that any urgent or new work is reallocated. If the sickness is or expected to be, more than 4 weeks, it will be the responsibility of the Supervisor to assess and allocated cases appropriately Authorisation must be obtained from the supervisor for permission to attend all internal and external training Family Nurse Partnership Caseload Management Page 3 of 10 Version 1.0 February 2016
When planning annual leave, time off in lieu, training etc., teams must ensure that there is adequate cover for all team commitments It is expected that Family Nurses will be flexible and able to prioritise planned contacts to accommodate more urgent work if appropriate Maintaining Communication Links All Family Nurses will ensure that communication links are maintained with GP s in order to safeguard children and families. The Family Nurse will: Maintain an up-to-date list of their mobile telephone numbers, email addresses and base telephone number. The list is to be updated on a three monthly basis by the Pre School Administrative Team Leader Contact the GP surgery on an individual client needs basis. Evidence of contact with the GP Surgery will be documented in the Client s notes Negotiate regular face to face contacts with partners (GP, midwives, children centre etc.) to discuss families who have been identified as needing additional support or intervention Follow the integrated care pathway between FNP and Dudley Community Midwives: The FNP team receive electronic notification of women booked by midwives on a fortnightly basis Inform Health Visiting teams when clients are enrolled onto the FNP programme. A database containing the client s details are emailed to the Health Visiting team nhs.net account via the FNP team nhs.net account, the database is stored on the shared drive and a letter is sent to the Health Visiting team when a client enrols in the antenatal period and also the team are informed when the baby is delivered. These letters should trigger a tracer card to be placed in the Health Visiting filing system for these clients Strive to maintain good communication links with Children s Centres Supervision Family Nurses must attend supervision with the FNP Supervisor weekly and this should be requested by the Family Nurse via a calendar request in outlook. Safeguarding supervision is provided by the Named Nurse (CYPF) and Psychology supervision is provided by the team Psychologist on a monthly basis for the team. Nurses should access these supervision sessions as per FNP licencing requirements and core model elements. Team Communication and Meetings Team meetings are 2 hours weekly These may incorporate allocation, review and updates regarding caseload, allocated work and general communication as appropriate. Formal team meetings should be recorded and minutes reviewed at subsequent meetings Records of the meetings should be completed by the Administrator where possible; minutes should be typed up within 3 working days and saved on the FNP shared drive. It is the responsibility of the Supervisor to check the accuracy of the minutes and notify the Administrator when they are happy for them to be circulated to the team In keeping with the Lone Working Policy members of staff will comply with local guidelines. Details of home visits will be shared on electronic calendars Filing Administration staff are responsible for making up files for the Family Nurses to use antenatally, when a new birth / transfer in notification is received Family Nurse Partnership Caseload Management Page 4 of 10 Version 1.0 February 2016
All records are to be stored in lockable, metal cabinets. Staff should adhere to Trust policy for record keeping Tracer cards, stating who has receipt of the notes, should be used to clarify if notes are removed by any member of the team other than the named Family Nurse for the client All files should be returned to the main filing cabinet at the end of the working day whenever possible and they should not be left in drawers, on desks or in trays. It is both administration and Family Nurses responsibility to ensure that if a file is taken out it is put back. Trust policy should be followed if notes are not returned to base at the end of the working day Process for Archiving to and Retrieving Files from Iron Mountain Since 2013 all files for the FNP services are to be stored at Iron Mountain storage. The Health Records Department at Penn Hospital is responsible for the dispatching and retrieval of all records which are stored at Iron Mountain. All administration staff must follow the process below for any files which are going to be sent to or retrieved from Iron Mountain: Dispatching: All files to be placed in an Iron Mountain box, other boxes will not be accepted Iron Mountain boxes can be requested from healthrecordspenn@bcpft.nhs.uk The boxes will be sent flat packed together with a security tie and an address label. Once the box is complete, attach the label with the security tie to the side of the box Files contained in the box must not be filled above the line level on the inside of the box Nothing should be written or attached to the outside cover of the box Staff must complete the Archived Pro-forma (appendix 27) and a copy should be attached to the inside of the lid of the box. Another copy should be kept by the service Once this has been completed administration staff must make arrangements with Trust Transport to arrange collection. This can be done by contacting the helpdesk on 0121 612 8011 Retrieval: When requesting files from Iron Mountain, staff must complete the Request For the Retrieval of Files from Iron Mountain (appendix 28) and email it to healthrecordspenn@bcpft.nhs.uk Health Records staff will advise Health Visiting staff by email when they can expect deliver of the files or if there is a problem in retrieving the files Health Records staff at Penn Hospital will request files and they will be sent in a secure box/red bag via Trust transport If there are any queries regarding this process then Health Visiting Administration staff should email lynda.groves@bcpft.nhs.uk or telephone on 01902 445643. Post Opening and Distribution All post opened by administration staff needs to be stamped with date the post was opened. In the absence of administration, the post should be opened by a member of the FNP Team All post should be reviewed/ triaged as soon as practical by the named Family Nurse Family Nurse Partnership Caseload Management Page 5 of 10 Version 1.0 February 2016
If the named Family Nurse is not present due to leave or sickness, the team will be expected to ensure any action needed from the post is completed and any concerns are highlighted to the Supervisor Each Family Nurse should sign (signature, printed name and designation) and date the correspondence, and indicate what action has been taken based on their professional judgement and knowledge Standard Letters Administration staff are to send appropriate standardised letters saved in the shared drive as and when required. Administration staff are also expected to copy type letters from Family Nurses i.e. referrals to specialists, housing letters etc. Team NHS.net Account It is the administration responsibility to ensure all staff has access to the team NHS.net account. The Safeguarding team are to send Safeguarding information/reports to the team NHS.net accounts. The Administrator is responsible for check the inbox twice a day and action any emails. In the event of the Administrator being on leave, it is the Supervisors responsibility to ensure this task is delegated. Administrators will print off reports/papers to be filed away in the Health Records. Child Health are to send changes to the child s details, antenatals, miscarriages and other queries to the team NHS.net account, which the Administrators will check and action. Diaries Electronic calendars are to be used as the main record of working activities. Staff can also keep paper diaries in conjunction with electronic diaries if this is their preference Diaries are a part of clinical records and staff should be aware of their responsibilities for maintaining their diaries. All entries in diaries are to be work related Lost diaries should be reported according to policy All diaries are Trust property Taking Messages/ Message Book Guidelines Administration staff are responsible for answering the telephone in the FNP Service. If the Administrator is unavailable, the telephone should be answered by a member of the Team. If the Family Nurse is not available to take the call administration staff must take comprehensive messages and write in the message book. The following should be adhered to when writing in the message book: Ensure that as much information as possible is recorded If information is not available or given, record this in the message Messages should be responded to within 1 working day. If a message is to be left specifically for a named practitioner and not to be actioned by anyone else, this is to be made clear If a member of staff is not due in work within the next 24 hours, another member of the team must action the message (unless the above applies) Family Nurse Partnership Caseload Management Page 6 of 10 Version 1.0 February 2016
The member of staff actioning the message must clearly sign, date and time in the appropriate area, and write a short summary of action If a message was retrieved from voicemail, then this is to be made clear in the message If a message was taken face to face, or via a note, then this is to be made clear Under no circumstances should pieces of paper be stapled or taped into the message book. Written notes should be transcribed into the book In the event that telephones will be unattended and it is not possible for the team to retrieve their messages, telephones can be diverted to a mobile or the answerphone message should be changed informing callers of the new number to call. Pages of the message book need to be kept for three years and then archived, there should only be 50 pages in the message book at any one time. Documentation, Data Requests and Activity Recording All team members must document their entries in accordance with the Trust s Record Keeping Policy and the Nursing and Midwifery Council s Record Keeping Guidance All team members must allow sufficient time to input their contacts into the National Care Records System (NCRS) within 3 working days All Family Nurses must provide any data requested by the supervisor or administrator and Open Exeter data should be accurate and up to date Administrators will support with any requests as and when required Monitoring Compliance A pre-evaluation audit will be utilised as this is implemented. This is followed up by a post-evaluation review at six months targeted at staff and service-users. This will be led by the FNP Supervisor and the Governance Team. Results will be reported into Dudley Quality and Safety Meeting and results discussed at team meetings and the Pre-school Forum. Key Performance Indicators Key Performance Indicator 1. For all FNP team to have read these guidelines Method of Assessment Evidenced by signed register and reviewed at Appraisals as part of the Core objectives to implement Trust Values Evidenced by team meeting minutes 2. For all team members to implement the guidelines 3. Service user satisfaction Service user feedback Family Nurse Partnership Caseload Management Page 7 of 10 Version 1.0 February 2016
Legislation Data Protection Act 1998 Data Protection Act came into force in March 2001, replacing the 1984 Act, to control the way information is handled and to give legal rights to people who have information stored about them. It sets out strict rules for people who use or store data about living people and gives rights to those people whose data has been collected. The law applies to data held on computers or any sort of storage system, including paper records. On 6 April 2010, the Information Commissioner s Office was given new powers to issue monetary penalties requiring organisations to pay up to 500,000 for serious breaches of the Data Protection Act. Children Act 2004 Children Act 2004 provides the legal basis for dealing with issues relating to children. These guidelines have been put in place so that all individuals who are involved in looking after children are aware of how they should be looked after in the eyes of the law. This act was brought into being in order for the government in conjunction with social and health service bodies to help work towards these common goals: To allow children to be healthy Allow children to remain safe in their environments Help children to enjoy life Assist children in their quest to succeed Help make a positive contribution to the lives of children Help achieve economic stability for our children s futures Links to other Policies Lone Working Policy This policy aims to promote safe working practices for lone working staff and to heighten staff awareness regarding safety issues when working alone. It aims to provide guidance for managers and individuals, support the development of safe systems of working where the health, safety and well-being of lone workers can be carefully considered within a variety of settings. Child Protection Policy The policy sets out Black Country Partnership NHS Foundation Trust standards and expectations in respect of safeguarding children. The purpose of this Policy is to ensure that the interests and safety of children within the Trust are recognised by all staff and that as a result, these children are protected at all times. It provides guidance for staff on how to reach a decision regarding the appropriateness of such visits so that they have a clear understanding of their roles and responsibilities. Supervision Policy This policy will define and describe four types of supervision in use within the organisation: Clinical Supervision Managerial Supervision Professional Supervision Safeguarding Children Supervision Through defining and outlining standards & practice within these four types the policy seeks to inform both the delivery of these models and the development of local Family Nurse Partnership Caseload Management Page 8 of 10 Version 1.0 February 2016
guidance and procedures for the delivery of all other forms of supervision in use within the Trust and to make clear: The expectation of the Trust in relation to clinical supervision, managerial supervision, professional supervision and safeguarding children supervision The roles and responsibilities within all supervision arrangements The process for monitoring that all staff receive the appropriate supervision for their role Care Record Keeping - Standards and Practice Policy The maintenance of high standards with record keeping is essential for safe and effective service delivery. In particular, health care records that have been well maintained can: Assist all those associated in the delivery of care to the patient/service user, now and in the future Reduce the chance of errors and mistakes Enable efficient administration processes, for example, in filing retrieval and storage, and those associated with the individual legal right of accessing care records Therefore the purpose of this policy is to outline standards of record keeping that the Trust expects of all those involved in the delivery of care to patients/clients. Where do I go for further advice or information? Family Nurse Partnership Supervisor Health Visiting Team Leaders Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust s Mandatory & Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy Data Protection Act and Freedom of Information Act Please refer to overarching policy Family Nurse Partnership Caseload Management Page 9 of 10 Version 1.0 February 2016
Standard Operating Procedure Details Unique Identifier for this SOP is State if SOP is New or Revised BCPFT-CYPF-SOP-01-5 New Policy Category Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP Month/year consultation process completed Children s Services Executive Director of Nursing, AHPs and Governance Health Visitor Team Leader Dudley CYPF Quality and Safety Group December 2015 Month/year SOP was approved February 2016 Next review due February 2019 Disclosure Status B can be disclosed to patients and the public Review and Amendment History Version Date Description of Change 1.0 Feb 2016 New SOP developed for BCPFT to provide clear instructions for Family Nurses and other members of the team in caseload management Family Nurse Partnership Caseload Management Page 10 of 10 Version 1.0 February 2016