24 hour, 7 day a week District
Nursing Service within
Herefordshire
Linda Marsden, Royal College of Nursing Safety Representative
UK Conference 2007
Historical care provision
Day DN service provided county wide
City and only one of the rural areas had an
evening service.
On call over night – provided county wide
by 5 nurses each night
No provision for rest period next day if
called out.
Poor management of lone worker
monitoring.
Why was change necessary
Highlighted in a review of the DN service
GPs out of hours now provided by private
provider
DN service becoming more busy.
Palliative Care service specification
recommended intermittent visiting day
and/or night.
Care provision needed to be standardised.
History
2 yrs of consultation with DNs
Equality of patient service across county.
Quality care provision
Continuity of care provision.
In light of the likely changes with provider
services.
Reluctance for change
Felt unsafe driving to unknown areas
when on call
On call was too regular – up to twice a
week
Needed to work day after on call
Introduction of late shift – Some DNs had
chosen to come into District Nursing
because of the more regular hours
Why did I take action
 Aware of nursing redundancies being made
throughout the country- some staff facing section
31 arrangements.
 Felt that nursing is a 24 hour service and should
be provided to patients wherever they needed
care.
 Concerned about possible risk of losing
complete DN service to private provider, as
plans were being made for a private provider to
take on 14 hours out of the 24 hours.
 Would create extra NHS jobs within the service
Meet with District Nurses to discuss
What would/might happen if they
relinquished a proportion of their service.
Take account of earlier feedback from DNs
Bring together a best option from previous
proposals according to the DN feedback.
Held a secret ballot.
Proposal
Evening service – provide our own.
Extra resources for teams. (shared out
across teams as per resource allocation)
A system of Earlies and Lates across
larger partner teams.(8am – 10pm)
Proposal
Only 1 member of “larger" team required
per late shift- 8 for the county.
Buddy system set up to address lone
worker issues.
Staff with personal issues which may
make this difficult would receive 1 to 1
interviews, to find solutions
Proposal
Overnight service- provide an on call
service ourselves 10pm – 8am
2 on call one north one south (approx 1 in
12 for all = 2% pay wte)
Band 6 and 7 only
Proposal
Taxi service for on call nurses
Split according to population (50 % 50%).
Mileage included with rurality weighting.
Triage
Clear referral criteria.
Lone worker tracking.
Proposal
Time off next day –
For call out of less than 2 hours report to
work for 10.30.
Over 2 hours call out report to work at
appropriate time e.g. out for 6 hours
report to work at 2pm; out for 7 hours
report to work at 3pm.
A year on
Fully implemented.
Ongoing reductions in overnight call outs,
care now more proactive.
Patients now seen late evening rather than
when they are in a crisis overnight.
No difficulties with recruitment to the DN
service.
Patient feedback – excellent