Background to the Trust
• 36 District Nursing Teams across the whole of Birmingham
• 6 Clusters in which the teams work together to support the geographical area
• 500 + Clinicians
• 3 Clinical Commissioning Groups
• Working with various Federations and Vanguards
• 16,000 community nursing visits a week
• Diverse patient population
• Large geographical area
Challenges The division spoke to clinical staff about what they felt the challenges were that impacted on their clinical day and spent time shadowing the clinicians in practice, so they could really experience the difficulties associated with community nursing in a busy city over a large geographical area.
It was quickly evident that there were some key areas to address:
- Clinicians were concerned that staffing was not being managed equitably and this was impacting on care delivery
- Clinical allocation was time consuming and subjective
- Geographical patient allocation was a manual process and was extremely subjective across the city
Description of Initiative: Care in Focus
Care in Focus is the clinically led initiative that Birmingham Community Healthcare NHS Foundation Trust (BCHC) commenced as a driver for ensuring high quality care whilst utilising resources in the most efficient way.
BCHC is a large community Trust providing clinical care in a wide range of settings to a diverse patient population. The initiative involved multiple community services but for the purpose of this report the focus will be on community nursing.
The community nursing service in Birmingham was formed from a merger that took place over 5 years ago between three organisations. It was widely recognised that the historical practices of legacy organisations had continued, and the community division had not developed a robust methodology to ensure staffing levels were equitable across the service and met the needs of the citywide, diverse population.
Aim of Initiative
The key aim of the improvement was to enable clinicians to spend more time with patients and ensure that the team shape for each individual community nursing team was reflective of the acuity and dependency of the patients that they cared for. From the outset of the initiative it was widely agreed that this improvement needed to be clinically led. This was to support the essential engagement of clinicians and to gain their valuable input into all the important factors that support the delivery of safe and effective care.
After much debate the clinicians gave the initiative a name - ‘Care in Focus’.
One of the key objectives was to support the aims was agreed as:
- Develop a bespoke dependency tool for community nursing that facilitates the allocation of workload and informs team shape
The clinically led workshops quickly adopted a ‘Care in Focus’ methodology where all aspects of a work stream were analysed and understood. For example, all clinical interventions were listed and discussed to determine average length of time, skill and banding required and then compared to electronic data historically.
Benefits The Care in Focus programme led to the following outcomes for clinicians:
- A citywide electronic allocation tool that can allocate the visits based on the location of the patient, the nurses address, the competency and skill required and the timing of the visit
- The allocation tool supports the data analysis of the caseload and enables the service to have a clear understanding of the day to day clinical hours required to safely manage the workload of planned work
- The ability to forecast staffing requirements into the foreseeable future
As this is a citywide tool, all caseloads are visible and this facilitates fair distribution of workload across the city. The teams can also utilise the commonly agreed clinical formulary which standardises practice across the teams but have the flexibility to adjust the tool based on patient need.
Submitted by Birmingham Community Healthcare NHS Foundation Trust (BCHC)
Lorraine Galligan – Divisional Director for Nursing and Therapies
Rupinder Chal – Head of community Nursing and Partnerships
Rebecca Martin – Lead Nurse
Dawn Davies – Matron for Community Nursing