Nationally, NHS providers face the challenge of an increase in patients with complex needs living in the community coupled with rising admissions. This, combined with rapidly increasing GP workloads, is leading to new ways of working across the NHS system.
Community nursing plays a key role in this. My role as a nurse practitioner in the admission avoidance team at Northumbria is an example of how as a trust we are developing a different skill set for community nurses, in particular prescribing capability, urgent response and clinical decision-making skills.
I’m part of a multi-disciplinary team that includes physiotherapy, occupational therapists and nurses. With one referral pathway to the team, patients can more readily access the right care, at the right time, every time an urgent response is required.
This seven-day service supports people at home with minor injuries or an illness or those in residential or care homes to prevent a hospital admission. We also care for patients who have been discharged from hospital, helping people to remain independent and identifying their ongoing needs.
Patients are identified by their GP or a healthcare professional on a daily basis. We do some routine home visits that GPs would previously have done themselves, allowing them to concentrate on more complex cases. In particular, we support patients at risk of admission due to a fall or possible urinary tract or chest infections.
We do an assessment in the community, which involves a full clinical history, checking symptoms and concerns, discussing how they have managed symptoms previously. We also do a medication review and a physical examination. We then identify urgent response treatment plans, including prescribing and referrals for X-rays, reablement or district nursing as required. We also feed back to other health professionals involved in their care.
For example, if we know a patient in a care home is susceptible to a certain condition like a urinary tract infection, we can do a urine test to diagnose the infection and prescribe medication. We can also do the same for a chest infection.
Additionally, we advise care homes on the importance of nutrition and hydration. This is especially useful for patients living with dementia, where often a sudden decline in health is attributed to the illness but is in fact due to dehydration. By encouraging care home staff to be vigilant and understand the symptoms and what they indicate, they can act in a timely way and prevent the infection escalating to a hospital admission.
Also, if the patient doesn’t respond to the prescribed drugs, or has an allergic reaction, we liaise with their GP to identify alternative medication or revise treatment plans.
More recently, we began providing first responder support to a care alarm company called Care Call – for example, when someone has fallen but it isn’t an emergency case because they are still mobile. Here, we carry out the initial assessment and treatment and refer if follow-up is required, such as wound care.
The approach is working well, with patients being seen more quickly in the community. We have nearly four times more referrals compared to 2015-16 figures. At the same time, the number of people referred who go to hospital or A&E have more than halved over the same period. We are now looking to offer a similar service to the local out-of-hours doctor service for minor injuries and illness to further develop capacity across the system and reduce unnecessary admissions.