Asthma and the drugs associated with asthma cost the NHS £16b a year.
With the drive to treat more patients closer to home in primary care and save money on more costly hospital referrals, what can we do as nurses to get involved in service design?
What are the benefits for us – as we already juggle competing demands in our daily roles while dealing with increasingly more complex patients and numbers of conditions in primary care.
Clinical commissioning groups (CCGs) are looking to deliver services that ultimately meet three criteria’s. They need to be innovative, cost neutral and improve patient outcomes. If you can come up with an idea that could make a difference in those three areas then the CCG will be interested to hear more.
It might be that having dealt with patient care on a day to day basis, you can see a way to deliver great care but in a better way. We have all seen changes that might seem small and maybe obvious but would take waste out of the system without compromising patient care.
I have been working with a GP from the practice, Dr Hein Le Roux, clinical commissioning lead from Gloucestershire CCG and Stephen Ray, member of the regional Academic Health Science Network, to improve patient recall and to look at getting the best person carrying out the right care within the practice.
We have simplified and structured our recall system and freed up time for the complex patients to spend more time with the clinician by getting more routine tasks done by the health care assistants before the clinic appointment. Although this work has been undertaken in diabetes, it is translatable to all chronic diseases, and we can replicate the work across our respiratory care pathways with ease. This type of work can be used to take an improvement project business case to a CCG.
Our GP colleagues and practice managers have considerably more experience than most nurses in writing business cases and will certainly be more familiar with the format used locally, so working with them would certainly be an advantage. The advantage to the practice would be better patient care and in some cases reduced prescribing costs – so it is in their interest to be involved too.
With the changes in structure of primary care – namely federations, super practices, accountable care organisations and practices merging and closing – nurses need to move with the times and strengthen their position for the future as nobody knows what the future holds. There have been limited numbers of practice nurses in management up until now but this may have to change in the near future.
Carol Stonham is the expert blogger for the Nursing in Practice respiratory resource centre. She is a senior nurse practitioner working at Minchinhampton Surgery in Stroud, which is part of Goucestershire CCG. She has worked for many years as a practice nurse specialising in respiratory care and is also the nurse lead for the Primary Care Respiratory Society UK, a UK wide society for primary care health professionals keen to deliver high value patient-centred respiratory care.
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