APPLICATION FOR BHF NURSE FUNDING 2008/11 FOR BHF HEART NURSES AND ASSOCIATED HEALTH CARE PROFESSIONALS
Section 1
1. Applicant Details: Name of health Organisation
NHS Grampian
Name of Application:
BHF Funding Request to support 2 WTE Heart Failure Nurse posts in Grampian for a three-year period £80,000 per annum plus £5,000 start up fee.
Office Address, Telephone Number and Email:
NHS Grampian
CHD Managed Clinical Network Office
1st Floor
Westholme
Woodend Hospital Site
Eday Road
Aberdeen
AB15 6LS
Telephone: (01224) 556713
Email:
2. Current Project
In the North East of Scotland Grampian has an approximately 529,690 population across a very large and often rural area.
The purpose of NHS Grampian is to improve the health of the people of Grampian by providing safe, high quality treatment based on clinical need in comfortable, accessible surroundings and within available resources. NHS Grampian has established three Community Health Partnerships (CHPs) – Moray, Aberdeenshire and Aberdeen City and an Acute Sector to work with local authorities and other patient organisations, communities, voluntary sector and other parts of the NHS in Scotland.
NHS Grampian provide a wide range of both Acute, Intermediate and Primary Care Services to prevent and treat coronary heart disease. All of these services are part of a well established Managed Clinical Network for Coronary Heart Disease with a Lead Clinician, GP Lead and Network Manager. Grampian does not have a special heart failure nursing service choosing instead to support the treatment of heart failure mainly within Primary Care. However, the Acute Sector within NHS Grampian is currently considering a proposal for a heart failure nurse within Aberdeen Royal Infirmary.
The MCN has for several years been examining innovative ways of delivering community-based cardiology involving GP Specialists. A group of GPs and Consultant Cardiologists reviewed a random sample of GP referral letters and identified that 40% of referrals coming into Acute hospitals could be managed appropriately within community cardiology clinics. Three new community based cardiology clinics have been established in the last two years in Grampian in Peterhead, Stonehaven and Elgin to complement the existing clinics in Turriff, Inverurie and Aberdeen. Nine GPs with a Special Interest in Cardiology (GPwSI) have been appointed on a sessional basis by the three Community Health Partnerships to support these clinics. All of these clinics are supported by a Consultant Community Cardiologist and other staff from the Acute Hospitals. It is envisaged that the Heart Failure Nurses would work very closely with these clinics.
In September 2007, NHS Grampian sent out a letter to all General Practitioners in Grampian informing them of the establishment of a primary care based Local Enhanced Service in Cardiac Failure. All General Practices are eligible to take up this Service. To date, a contract has been signed by 16 GP Practices in Aberdeen City, 21 GP Practices in Aberdeenshire CHP and 7 GP Practices in Moray.
Three Heart Failure nurses based in the CHPs have previously completed the heart failure training module at Glasgow Caledonian University. These posts would meet gaps in existing service provision, particularly in relation to the more severe heart failure patients (NYHA 3-4) and the recently discharged patients who are at high risk of re-admission and research has highlighted that re-admission can be significantly reduced by timely intervention by heart failure specialist nurses.
3. Current evaluation /Audit
All of the General Practices in Grampian maintain databases to include patients with coronary heart disease. These are audited and reviewed annually as part of the Quality Assurance Framework.
4. Proposed Service Provision
It is proposed to appoint two whole time equivalent (WTE) Heart Failure Nurses as follows:-
0.89 WTE for Aberdeenshire (236,260 population)
0.78 WTE for Aberdeen City (206,680 population)
0.33 WTE for Moray (86,750 population)
It is proposed that all of the post holders would carry a clinical caseload of complex heart failure patients (of approximately 50%). In addition, these posts will provide a rolling programme of Primary Care based education and support. The expected outcomes of the service would be:-
1. To improve the overall management of heart failure patients particularly those with the most complex heart failure and for those requiring end of life care
2. To provide continuity of care by working seamlessly across primary and secondary care sectors
3. To improve the education of patients and partners/carers regarding heart failure and its management and promote self management
4. To increase the use of recommended evidence based therapy amongst heart failure patients
5. To prevent and reduce unnecessary hospital admissions
6. To improve the education on heart failure and its management amongst community nursing and other staff and support them in taking forward the management of stable heart failure patients,
7. To improve access to investigations and diagnostic tools via links to the existing Community Cardiology Clinic network in Grampian
8. To liaise with palliative care teams where appropriate
These posts will be for three years inclusive of a 6-month staff re-deployment period.
5. BHF Evaluation
NHS Grampian is fully committed to collaborate with British Heart Foundation and its chosen academic partner in all aspects of its evaluation. This will be complemented by audit of activity via the CHD MCN Heart Failure Sub Group.
6. Clinical supervision/mentorship/professional development
Each of the Community Health Partnerships has already identified an experienced Nurse Manager to provide clinical supervision and support for the Heart Failure Nurse in their area. The nurses will also have easy access to a Consultant Cardiologist who has a dedicated heart failure remit. The existing 3 nurses will also closely link in with the 2 postholders, via an ongoing ‘Grampian Heart Failure Nurse’ Group.
The CHD MCN will also ensure that a strategic overview of the Service is maintained via its Project Board and the Heart Failure Sub Group will also be the steering group for the nurse project.
Any staff appointed will take part in NHS Grampian existing induction programme and become an integral part of the Community Health Partnerships’ operational teams.
7. Linkages
NHS Grampian works very closely with all other Health Boards in Scotland, particularly in the North of Scotland, where it forms part of the North of Scotland Cardiac Services Network.
8. Patient and Carer Involvement
Patients are members of the MCN Project Board, Heart Failure Sub Group and Public Involvement Sub Group. Patients have been actively involved also in the discussion and drafting of this proposal and earlier exploratory meetings with British Heart Foundation.
9. Disadvantaged Patients
These posts will particularly target those patients in the areas of highest deprivation. These areas of deprivation are well known in Grampian and this targeting can be achieved, for example, by providing proportionally higher input to those identified General Practices and their patients.
10. Longer Term Vision
It is an agreed long-term vision of the CHD MCN that heart failure treatment is embedded in Primary Care with the appropriate support of the Specialist Cardiology Service, as required. This will be complemented by NHS Grampian’s strategic intention to pro-actively promote “self care” and reduce unnecessary hospital admissions.
NHS Grampian would hope to continue to fund these posts after three years, but at this time, this cannot be guaranteed.
11. Service Benefits
This Service if approved will enable BHF and NHS Grampian to significantly improve the overall management of heart failure patients, use of evidence based therapy, knowledge of patients and support to their carers.
12. Appendices
Please find a series of appendices as follows:
· Coronary Heart Disease MCN Annual Report 2006
http://www.nhsgchdmcn.scot.nhs.uk/wp-content/annual-report-chd-jan-dec-2006.doc
· Local Enhanced Heart Failure Service – Letter to all GPs in Grampian
http://www.nhsgchdmcn.scot.nhs.uk/wp-content/heart-failure-update-on-enhanced-services-2.pdf
· Heart Failure Guidelines (Summary Version)
http://www.nhsgrampian.org/grampianfoi/files/Heart_Failure_SUMMARY_guidanceNov06.pdf
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