The NHS Long Term Plan (NHS England, 2019) has necessitated changes in how different healthcare teams work together. It calls for collaboration between GPs and community teams in order to give people greater control over their health and care. Changes are underway across healthcare settings to realise the plan, with the development of primary care networks (PCNs) and the introduction of new roles and innovative practices. During the author's time as the District Nurse Team Manager, an opportunity arose to extend the scope of the role of the modern matron in the community hospital to a modern matron for the West Devon neighbourhood, that is, the entire geographical area covered by the author's PCN. This also presented the opportunity to build a Neighbourhood Nursing Network (NNN)—a consortium of nurses working in the PCN who have come together for the purpose of improved collaboration and to provide increased opportunities for learning and sharing practice.
Tavistock Neighbourhood Nursing Network
The purpose of the Tavistock NNN is to increase the voice of the nurses in the PCN, to enable them to articulate their value and, in doing so, to deliver the aims and objectives of the NHS Long Term Plan (NHS England, 2019), as well as meet the aims and vision of the trust, Livewell South, itself. Thus, the NNN is the nursing arm of the primary care network, covering all aspects of nursing, such as frailty, dementia, learning disabilities, mental health, physical health and child health. Since it is common for different nursing disciplines to work independently of each other, the network aims to identify shared and unique skills in order to develop new ways of working together in order to ensure the sustainability of NHS services. In addition, the network gives the nurses greater power to identify patients or groups of patients at risk of health inequalities and work together to develop innovative ways to promote good health and prevent ill-health.
Development of the network
An informal primary survey was carried out among nurses working in nursing homes in the neighbourhood, through which a common theme emerged. All the nurses who responded to the survey said that they felt isolated in their role, as they often worked as a single nurse on duty and only saw their nursing colleagues at shift changeover. They also reported that they were not given much opportunity for further training and upskilling by their employers, so they felt they were at risk of becoming out of date with their practice.
The same informal survey was administered to GP nurses in the PCN, who shared that they had access to academic learning opportunities but would welcome more general access to learning and updates, in order to ensure adequate continued professional development for their Nursing and Midwifery Council (NMC) revalidation.
Both groups stated that they would welcome an opportunity to meet other nurses working in the neighbourhood to help disseminate knowledge and skills and understand more about each other's roles. Similar conversations were had with other nursing groups, and all echoed this message, reflecting the aspiration quoted by the Queen's Nursing Institute (QNI) (2019):
‘Collaboration is the act of coming together and working with another, or others, to create something that goes beyond the ability of any one person to produce.’
In addition, during discussions of future care, some patients had provided feedback to social care colleagues that they did not want to go to a particular nursing home or residential care home, because either they themselves or someone they knew had not had a positive experience. Although this feedback was disappointing, it provided further incentive to ensure that the new, enhanced modern matron role reached out to all care settings, for them to be included in the goal of making high-quality care a consistent theme in the PCN. This would mean that people in the community would have the confidence that they could choose a place of care convenient to them and their family, rather than on the basis of reputation or Care Quality Commission (CQC) rating.
Nurse engagement
The engagement process began with informal surveys administered to different nursing groups to assess interest and needs. The surveys were carried out face-to-face with approximately 20 participants across a variety of establishments, with all expressing interest in being involved. Email addresses were gathered for invitations to be sent out electronically, and a small local hall was booked for 2 hours for the first meeting. The electronic events management system Eventbrite was used to create and send the invitations as an efficient way to reach out to people and generate interest in the first meeting. However, a week before the event, only six people had confirmed they would be attending. Phone calls were made to all participants, to remind them of the event personally. It was a relief to find that the poor response to the Eventbrite invitation was due to people not being familiar with the platform. They had simply printed out the invitation and put it on their notice board or written it in their diary, rather than sending an electronic RSVP. Finally, 18 people confirmed their attendance, with 16 actually attending.
Collaboration in action
At the first event, there was representation from district nurses, practice nurses, nursing home nurses, ward nurses and diabetes and dementia specialist nurses. There was a participative approach to the event, and it was ensured that everyone felt involved. The participants went over their unique and shared skills to identify potential points of collaboration with training and development, particularly where significant updates in guidelines from National Institute for Health and Care Excellence (NICE) and clinical practice needed to be communicated.
All attendees shared their contact details, and on the following day, emails were sent out to the group and colleagues who had not been able to attend, with links to some QNI learning resources. In addition, information was shared about frailty workshops, which were attended by many of the group and received very positive feedback.
The group discovered collectively that frailty was a topic most members were interested in. Approximately 27% of the population in the PCN neighbourhood is aged 65 years or over. According to the Joint Strategic Needs Assessment town profile for 2013–2014 (County Council, 2016), it is predicted that the older population in Tavistock will increase between 2011 and 2026 as follows:
6.4%, and the greater increase in the older population is offset by a predicted decrease in the younger population. The increase in the former group could be due to people living longer, but it could also be that people are moving into the area in older age, as there are a number of retirement complexes being developed. Therefore, it is important to consider that frailty will become an increasingly significant feature in the neighbourhood's population health profile.
The second event was planned for 2 months later, and it was agreed that the focus at this event would be frailty. One of the practice nurses arranged for their GP surgery to be used for all future events, so there were no concerns related to funding for a venue. More nurses attended on the second occasion, as word had spread about the venture. The trust's frailty project nurse presented some interesting statistics to the group. According to the British Geriatrics Society (BGS) et al (2015), approximately 10% of those over 65 years are living with frailty, and this figure rises to 25–50% among those over 85 years. The group jointly looked at how these statistics apply to the neighbourhood population, and they agreed that a proactive approach to frailty needed to be at the top of the agenda to ensure that services are ‘fit for frailty’ in the future.
Another example of collaboration in the NNN is related to the ‘Don't be a Dipstick’ campaign, which was being promoted in the PCN in accordance with recent guidance produced by Public Health England, the Royal College of General Practitioners, NICE and the Scottish Intercollegiate Guidelines Network (SIGN). A geriatrician presented on this campaign at an NNN meeting, which also involved other nursing provider partners, including practice nurses and nursing home nurses. The new guidance information was shared across the neighbourhood in a single session. This was an example of the nursing network in action to ensure consistency in practice across the neighbourhood.
Similarly, as part of the trust's end-of-life strategy and vision for frailty, training on advance care planning (ACP) is being rolled out across the trust, and this is another project that will be extended to partner providers in order to promote consistency of care across the neighbourhood.
Meeting the aims of the trust
The introduction of the NNN to break down barriers to skill development and information sharing is a bold move in the NHS, where the culture focuses on funding sources and clear division of responsibilities. Therefore, it is important to demonstrate how the NNN and any projects arising from it meet the trust's (Livewell South) mission statement of ‘supporting people to lead independent, healthy lives’ and the aims of the trust, of:
What next?
The NNN meets every 2 months or so, and the learning events continue. Any learning opportunities that arise are opened out to everyone, and any initiatives or projects on the horizon are reviewed by the NNN to determine how they affect the neighbourhood and how all partners can be included.
The author has recently applied for funding for the PCN to buy equipment necessary for preventative care. The hope is to carry out a project for opportunistic atrial fibrillation (AF) testing. According to the Atrial Fibrillation Association (2012), 6% of people over the age of 65 years are affected by AF. However, as some people are asymptomatic, it is estimated that up to half of all cases are not detected. GP practices have started using tools such as GRASP-AF to identify patients with AF needing anti-coagulation. Thus, this project will go a step further in detecting undiagnosed cases. The pathway will be led by the author, with the expert input of a cardiac nurse, and this will be the first official collaborative nursing project where all partners will work towards a single cross-organisation pathway.
Conclusions
The NNN has achieved a number of outcomes, the main one being improved relationships across nursing services in the trust. Nurses from different sectors recognise each other by name despite their paths not often crossing. This has helped nurses feel valued and helped them realise and understand the important part that each of them plays to ensure the delivery of high-quality care. Because of the NNN, the modern matron's views at the PCN monthly meetings represent those of the entire neighbourhood nursing community.
The NNN has also opened up the concept of supporting each other with clinical supervision across partner organisations, and, going forward, there are plans to develop smaller special-interest forums, such as for nursing home clinical leads.
The feedback from members of the NNN has been very positive, with everyone stating that the increased opportunity for learning is valuable for their continued professional development. What they appreciate most is being part of a nursing community where people feel valued and supported and know where to seek advice.