Greater Glasgow and Clyde
This region has multiple sectors with different statistics.
You can expand the different sections below for a per-sector breakdown.
Patients per year
994
Urban / rural split
95%
from 95% in 2012.
Total region population
380,000
Specialist HF nurse WTE posts
5 WTE (4.25 staff)
from 5 WTE, from 4.25 staff in 2012.
Patients per year
1,659
Urban / rural split
85%
from 85% in 2012.
Total sector population
480,000
Specialist HF nurse WTE posts
5.79 WTE (7 staff)
from 5.79 WTE, from 7 staff in 2012.
Patients per year
1,191
Urban / rural split
70%
from 70% in 2012.
Total sector population
255,000
Specialist HF nurse WTE posts
4.5 WTE (5 staff)
from 4.5 WTE, from 5 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 some specialist links |
| Screening for psychological distress variable- 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 |
| Virtual | Virtual |
Additional notes
Service achievements
- Developed early supported discharge (ESD) approach. Evolved audit strategy to capture ESD and admissions avoided.
- Developed and launched web based patient management database allowing for more flexibility in cross site working.
- Broadly paperless way of working.
- Implemented peer review strategy.
- Developed patient engagement; this has led to development of in-patient information resource.
- Development a junior CNS role as part of the service model to improve succession planning and develops the ANP’s supportive/managerial role.
- Development of MDT’s and joint clinics in some hospitals in Glasgow
Service challenges
- Increasing expectation to manage more acute patients more intensively and for longer with no added resource (there has actually been a net reduction in admin and nurse time).
- Increasing range of patient referrals moving away from the tight criteria for which the
service is resourced (i.e. much broader caseload of heart failure patients and not just those with an admission to hospital with worsening heart failure. Not a negative development but requires better resourcing.
Future improvements
- Improving inpatient engagement and service and ward staff education, refining ESD.
- Including Home visits and indirect clinical telephone contacts onto a structured track care
template - With appropriate resourcing, would aspire to improve direct care involvement with
inpatients - With appropriate resourcing would aspire to include HFpEF patients into service
REMINDER
The following details are from our 2012 report and may not reflect the current state of the Greater Glasgow and Clyde Health Board.
Further details
| (Actual number of staff) | 2008 - 16.3 WTE (20 staff) |
| SIGN Ratio | 1:82,344 (2008 1:73,103) |
| Ave. caseload per post | 100 (community) |
| Individual patients managed by service (average year) | 1300 patients |
| Service Provision | Home visits 35% / Clinic Appointments 65% |
| Provision for HF-PEF | No |
| Administration support per week | 129.75 hours (across service) |
| Providing education to non-specialist staff | Yes |
| Doctor with specialist interest in Heart Failure | 5 Cardiologists |
| Cardiac Rehabilitation available/number seen | No |
| Access to psychological support referral pathway | None |
Notes on current service provision
Local enhanced service and diagnostic pathway, recently staggered launch over Board area. This will lead to greater interaction of referrals and discharges between HF service and primary care; efficacy being evaluated. Direct access echo route provided. Despite a reduction in the WTE posts, length of stay and admissions were reduced in 2011. Patient education programme provided by 3 WTE posts.
Funding in comparison to 2008
Substantive funding provided by NHS Greater Glasgow & Clyde. BHF providing 0.5 WTE funding over 2 years for IV Diuretic project.
Challenges
Due to limited rehabilitation resources, currently no class offered to patients with heart failure; MCN acknowledged that this should remain on agenda and as a group remains an aspiration. Increasing time demands from Caring Together palliative project with no increase in WTE posts. Community diuretic programme high demand of time per patient. Ongoing development of Electronic Patient Records impacts on nurse time and restricted ability of the service to provide full Early Supported Discharge [ESD] approach.
Development opportunities
Extending scope of IV diuretic role to provide ESD and day care approach may prove more time and cost efficient. Ongoing review of what can realistically be sustained from palliative care provision. Web based management system under development, which will allow greater flexibility to work between acute and community sites and aims to provide wireless home based/community working options.