Kate Howard, NHFT AP Presentation

Assistant Practitioners (AP’s)
Our story…..
Kate Howard
Deputy Director of Nursing, AHP’s and
What does NHFT do:
• 4,500 staff
• 1800 health professionals
• 800 Bands 2 – 4 clinical staff
• Multi functional sites across the county delivering the
following services under 3 pathways: child, adult and
Adult and Children
Mental Health in-patient and
Learning disability in-patient and
Forensic in-patient and
Crisis (MH)
Early intervention in psychosis….
Prison health
District Nursing
Community Beds
Palliative care in-patient and
Frail and older persons hub
Child mental health inpatient and community
Children’s community
Looked After Children
Current Assistant Practitioner Workforce:
• 3 x community hca’s (qualified in 2013); one now accepted
onto pre registration
• 3 x hcas’s (1 x Mental Health, 1 x support worker: schools, 1
x community nurse) just about to qualify
• 5 x hca’s (1 x mental health, 1 x community, 2 x Learning
disability, 1 x specialist services) commenced in 2014
The AP journey - starting point
This AP process was not without its challenges (or chaos)
the key ones for NHFT :
• Staff buy in
• Concern that band 5’s will be at risk
• Accountability
• Safety
• Role and responsibility
• Training support – difference in ability
• Band 4 job availability
Role and Responsibility
-What does a band 4 do?
-Competence in the
community work force (band
3’s currently doing a hugh
amount of independent,
advanced work)
-Who’s responsible for the
practice? (linked to
- A robust job description
based on RCN guidance
and examples from other
- Clear identification of
what a band 3, 4 and 5 does,
what skills are needed (what is
the difference)
- Educating those supporting/
employing band 4’s around
accountability, skill maintenance
and accountability
Staff Buy In
- Why do we need band 4’s
- What will they do?
- Are we going back to the
old enrolled nurse
- We have no posts
- Will they replace band 5’s?
- Education, discussion and
regular bullet in’s
- Looking at developing the
workforce via transformation
and consultation
- Job descriptions which
give distinct responsibilities
to bands 4 and 5
Where we are now…
How it works in practice…
John was a 62 year old ex warehouse man whom over
the past 30 years had a series of cardiac events. However
18 months ago at his appointment with a specialist
‘heart’ hospital they had told him in no uncertain terms that
his heart could fail at any time. Because of the way this was
communicated John was anxious, and suspicious of health
However John went home and carried on!
At home as John deteriorated it was obvious
that he needed District Nurse support – he refused, until it
got to a point where his wife was really struggling!
How it works in practice….
The District Nurse went to assess him, he was hostile and
refused to answer any questions.. John stated he didn’t want
female nurses coming to see him!
However John’s need was so great in terms of blood tests,
vaccinations, equipment ordering, skin assessment, pain
assessment etc that he required someone with the skills and
experiences to visit as he could no longer get to the GP’s!
How it works in practice…
Luckily, we had a male trainee assistant practitioner
associated with the District Nurse Team.
Visit 1: TAP visit discussed rugby, football, and the TV from
last night! Engagement meant that without knowing it the
TAP was able to observe; how dry was the mouth? how
breathless was John when talking/ resting? How tired was
John? Skin integrity on hands and visible skin…What was
the social/ environmental situation?
How it works in practice….
Visit 2: Discuss England football results, favourite films..
Able to steer conversation into an assessment of need –
TAP able to find out about equipment needs, ADL’s and
Undertake SSKIN. Bloods taken…
Visit 3: Join John in the garden for a glass of juice, comment on the
cricket John is listening to on the radio, talk about the garden (picking up
some tips as John is a keen gardener!) Raise the issue of equipment
delivery dates – reduce John’s distress, try to reassure him that the
equipment is there to help him and not because he is deteriorating and is
losing his independence (a key anxiety).. John feels able to raise an issue
around incontinence.. TAP able to undertake an incontinence assessment and
How it works in practice….
I hope you see the picture – the male to male engagement is
paramount, but the skills the TAP was learning/ had
learnt maximised the visits whilst maintaining John’s comfort
around only having a male practitioner.. I think this is a real
success story and I know it was a positive patient
experience for John and his wife.
Name and key details have been changed to protect confidentiality
Where I would like to be…
What next…
Integration of more band 4 posts within the services.
Promotion of this pathway to our AHP colleagues.
Continued support of our current Trainee AP’s – providing
them with an optimal education experience.
On going development of the bands 1 – 8 education
Evaluating how this fits with the DH Trailblazer programmes.
Many thanks for listening..
Any Questions?