Grampian
Grampian region
Service commenced in 2004 (break in service 2007-2009).
Patients per year
309
from 250 in 2012.
Urban / rural split
66%
from 64% in 2012.
Total region population
586,380
from 550,620 in 2012.
Specialist HF nurse WTE posts
5.5 WTE (6 staff)
from 2.65 WTE, from 4 staff in 2012.
Service provision
| 2012 | 2018 |
|---|---|
| HFrEF | HFrEF |
| HFpEF | HFpEF |
| HF post MI | HF post MI |
| Valvular HF | Valvular HF |
| Congenital HF | Congenital HF |
| Palliative Care | General palliative care with referrals to specialist services |
| Cardiac Rehabilitation for HF | |
| Screening for psychological distress- no direct referrals to psychology |
Service model
| 2012 | 2018 |
|---|---|
| Home | Home |
| Clinic | Clinic |
| In-pt education | In-pt education |
| In-pt management | In-pt management |
| GP surgery | GP surgery (stand alone clinics) |
| Virtual | Virtual |
Additional notes
Service achievements
- Successfully set up the permanent service which is Grampian wide ensuring equity of care and access to service for patients, carers and colleagues.
- Participation in the Heart Failure Hub supportive palliative care programme resulting in development of a medical anticipatory care plan and a pathway to palliative day unit services.
- Adoption of PHQ-4 as part of our psychological screening clinical assessment following the Heart Failure Hub programme.
- Development of MDT which runs 6 weekly.
- Secured a prescribing budget for the Non-medical prescribing for the Heart Failure nurses.
- IT development resulted in migrating service database to Trak for monitoring all referrals and reviews. Letters are via Winscribe.
Service challenges
- Recruiting and training the new permanent team which required intensive planning to ensure each new Heart failure nurse had equal access to training and development.
Future improvements
- The possibility of introducing a hospital based HF Specialist Nurse to identify and triage HF patients so they can be promptly treated and appropriately referred to Cardiology and receive specialist HF input.
- Launch a HF education programme including three levels: Carers and Support Worker, DN’s and Registered Nurse and thirdly Practice Nurse and ANPS. The programme aims to enhance patient and carer education about HF and self management.
- Psychology input within Cardiology/HF Service to support HF patients
REMINDER
The following details are from our 2012 report and may not reflect the current state of the Grampian Health Board.
Further details
| (Actual number of staff) | 2008 - 2 WTE (4 staff) |
| SIGN Ratio | 1:207,781 (2008 1:264,944) |
| Ave. caseload per post | 100 patients (community) |
| Individual patients managed by service (average year) | 250 patients |
| Service Provision | Home visits 80% / Clinic appointments 20% |
| Provision for HF-PEF | No |
| Administration support per week | 3 hours (across service) |
| Providing education to non-specialist staff | Yes – limited to primary care sessions within Aberdeen City |
| Doctor with specialist interest in Heart Failure | None |
| Cardiac Rehabilitation available/number seen | No |
| Access to psychological support referral pathway | None |
Notes on current service provision
The service has been operating in a fragmented manner with part-time provision in Aberdeen City and South/Central and North Aberdeenshire and there is no consistent management structure from which to develop the service.
Funding in comparison to 2008
Funding is an ongoing issue; currently guaranteed for only a further two years 2012-2014, in both Aberdeen City and Aberdeenshire. Following a service break 2007-2009, service was recommenced through BHF funded period (2009-2011).
Challenges
The inadequate administration support impacts on the service as Specialist Nurses take on the majority of the administration work.
Development opportunities
The nurses have worked hard to resurrect referral pathways following the break in service and are keen to share their knowledge with primary care colleagues and improve sustainability of provision against high caseloads and high demand in a challenging geographical area.