Policy update - January 2008
Way Ahead 2008;12(1):4-5
- New education plan for post-registration nurses in England
- Our NHS, our future: interim report October 2007
- NSF for long-term conditions: best practice examples
- Policy skills in practice: telephone tips
New education plan for post-registration nurses in England
Towards a framework for post-registration nursing careers: a national consultation, has been launched by the Department of Health and is inviting input until 15 February 2008. It is an extension of Modernising Nursing Careers which came out in 2006, and is looking at how to ensure a suitably skilled nursing workforce for the future. The outcome of the consultation has the potential to change the shape of generalist and specialist nursing over the next 10 years.
Five career pathways are proposed, with one in long-term care. Nursing is supposed to focus on supporting self-care, independent living, personalized care, case management of complex conditions and end of life care.
There are core competences across all pathways, ranging from novice to expert. The long-term goal is to enable nurses to transfer their core competences from one area of expertise to another.
The core competences are:
- health promotion;
- preventative, long term conditions management or crisis monitoring;
- safeguarding vulnerable people and those in need;
- end of life care; and
- holistic care.
Our NHS, our future: interim report October 2007
Lord Ara Darzi's Our NHS, our future review of the NHS in England, produced its interim report in October. This report emerged following a number of meetings with the general public.
The interim report proposes some immediate changes to the NHS such as extending patient choice in primary care and longterm conditions; and the introduction of new providers - though there is little detail about this as yet. Unsurprisingly, extending GP services into evenings and weekends is also suggested. A new one-stop incident reporting service based at the National Patient Safety Agency, called Patient Safety Direct, for all adverse incidents of both care and medicines, is also envisioned.
There is a significant focus on healthcare acquired infections, proposing a new regulator with tougher powers backed by fines to inspect and intervene where hospitals are failing to meet hygiene and infection control standards. The report proposes the introduction of MRSA screening for all elective admissions in 2008 and all emergency admissions by 2011.
Any major change in local NHS service provision is to be clinically led, with consultation proceeding only where there is effective and early engagement with the public; and resources made available to open new facilities as old ones close. There is to be greater investment in new GP practices, more GPs in poor areas, and access to health centres no longer restricted by registration.
The second stage of the review is underway, and is engaging groups of health and social care staff in every region of the country, to discuss how best to achieve clinician-led, fair and accessible healthcare. It will look at eight areas of care:
- maternity and newborn care;
- children's health;
- planned care;
- mental health;
- staying healthy;
- long-term conditions;
- acute care; and
- end-of-life care.
Lord Darzi is also exploring the idea of an NHS constitution. The final report is due in June 2008. Progress is reported on the Our NHS Our Future website
NSF for long-term conditions: best practice examples
The Department of Health website is encouraging submissions for examples of best practice in line with the eleven quality requirements of the National Service Framework for Long-term Conditions. There are excellent examples of MS services under some of the quality requirements while others - such as QR10 Supporting families and carers - are crying out for MS involvement. Do you have good practice you can share with others? The interesting thing about these examples is that many are simple but innovative and may already be provided by many MS health professionals. So have a look at the website and advertise your service!
Policy skills in practice: telephone tips
Alice Hamilton and Vicki Matthews, MS Trust
This article is the first in a new series that link health professional practice to target-driven managers. Telephone calls can be clinically invisible to management, and yet offer a vital service to people with MS. Effective management of telephone time can be liberating, but it is all too easy to be swamped by phone calls.
What follows is a very basic list of tips on managing telephone calls. A more comprehensive document is available from the Royal College of Nursing[1].
Telephone communication skills
Telephone calls remove the visual cues of body language. Communicating with people with MS on the telephone requires the ability to triage[2]. All the following skills are useful:
- opening and engaging rapidly so the nub of the phone call is identified early - this is particularly applicable to distress calls, frequent callers, and those who may be unable or reluctant to expose the real reason for calling;
- detailed history taking, including active listening. This requires frequent clarifying and paraphrasing to ensure that messages are understood in both directions;
- picking up cues, such as pace, pauses, changes in intonation;
- offering opportunities to ask questions;
- offering advice and information, including efficient onward referral for non-health calls; confirm in writing if necessary;
- closing conversations professionally, which can be aided by working consciously and constructively towards an ending from the beginning of the call[3]. Closing a call might include reiterating the actions you will take, confirming how pleased you were to have the call and hanging up;
- documenting the call and any subsequent actions. A telephone record should include: name, date, time of call, brief outline of call and actions taken/required if any, total length of call, and basic classification.
Documenting calls and audit
Consider
- log book next to phone for calls; or
- simple spreadsheet open on the computer by telephone to log calls;
- standardised call sheet - paper or electronic - for recording information;[1]
- colour coding each call simplifies a monthly audit of call types and lengths;
- service user satisfaction: consider a more sophisticated audit over a three month period of all services about their views of the telephone response service. The RCN, CSP and COT libraries all hold textbooks on auditing services that can guide you through the auditing process;
- assess non-health related calls as they come in. Could they be directed elsewhere? You may like to have to hand a short list of key numbers for redirecting calls to more appropriate places.
Managing telephone time
To avoid spending all day, every day, on the phone, identify some ground rules and stick to them:
- voicemail messages for days when you do not work or for protected time. Ensure that these clarify your unavailability and when you are in a position to return a call;
- innovate - eg. can people with MS text test results for DMT monitoring? Think about other ways to minimise routine telephone call time;
- identify the telephone dependent. Managing telephone dependency is outside the scope of this article but centres around identifying and setting aside times for their calls, with agreed objectives. More information is available in the RCN's guidance;
- consider a telephone skills course.
References
- Royal College of Nursing.
Telephone advice lines for people with long term conditions: guidance for nursing practitioners.
London: RCN; 2006. - Porter et al.
Key Steps.
In press 2007. - Lendrum S.
Satisfactory endings. Information Sheet P10.
London: British Association of Counselling and Psychotherapy; 2004.
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Way Ahead articles are reproduced as published. They are not updated to take account of subsequent developments. Use appropriate caution in acting on the information in any article.
