Newsletter - August 2016 - Hearing from: Advance Nurse Practitioner

A team of Advanced Nurse Practitioners has been established to work within the communities across Stockport. Aligned to GP practices, the team is in place to help support people in their homes and reduce unnecessary GP appointments and hospital admissions. Team member Nicky Makepeace explains how their work is benefiting patients across Stockport.

Jacqueline Hall, Desiree Demingo, Nicky Makepeace, Kath Baines

The community based ANP team was launched as part of Stockport Together in October 2015 when Jacqueline Hall joined. Nicky Makepeace and Kath Baines followed in January and the team has recently expanded further with the appointment of Desiree Demingo and Jacky Grove.

The ANPs have extensive clinical experience and Masters degrees, meaning they can exam, diagnose, prescribe medicines and interpret results, enabling them to work with complex patients who would usually need to see a GP. After qualifying in 1990, Nicky Makepeace went on to work in general surgery and intensive care. She joined the trauma and orthopaedics team at Stepping Hill in 1991, where she worked for 25 years. In 1996 Nicky set up the trauma nurse team managing trauma patients who required surgery, before she went on to assisting with the setting up a hip fracture unit.

Nicky completed her Masters in 2004, and after that worked as an Advanced Nurse Practitioner on the hip fracture unit before leaving in January to work in the community.

Working with elderly people has always been a passion for Nicky, with dementia being a particular area of interest. “I just love helping older people, particularly in their own environment. Seeing the difference that caring for people and supporting them to look after themselves can have is so rewarding.” She explained.

“Our focus is on helping to optimise and manage people within their own homes.Because we can prescribe and have the links in to other professionals across health and social care, we’re able to look after, or co-ordinate all of a persons’ health and social care needs.”

Nicky and the team have access to a list of frequent attenders at A&E. This is a weekly set of figures circulated by the hospital which flags any potentially vulnerable older people who have made repeat trips to A&E.

“Through this data, we are made aware of people who may need our support, which in turn means we can get in touch with people as soon as they’re discharged from hospital to ensure they have the care and follow up they need.”

The ANP team work closely with GPs across the borough and maintain a regular dialogue between other health and care professionals in order to update on progress and request any additional support for people.

The ANPs each have responsibility for particular neighbourhoods within Stockport where integrated teams of health and social care professionals are working together to provide coordinated services for people as part of Stockport Together.

The biggest change to impact on how the different health and care professionals are able to work with other teams, is that each of the ANPs will soon be co-located with the other health and social care teams covering their neighbourhood area.

Nicky is now based in Stopford House, the Council’s building which houses the Adult Social Care team. “I’m now physically sat with a team of social workers and district nurses who all cover the Victoria area of Stockport. This has meant that key relationships have been built across the professions. We’re each increasing our knowledge of what the other professions do, and are now able to discuss patients to co-ordinate health and care support. Often this includes carrying out joint visits to provide better, more joined-up care for the people who need it most.”

The ANPs support a range of different needs within the community, but the main focus of their care is vulnerable elderly people. Nicky explained: “A typical example of someone we might see would be a person who has increased confusion, which could be as a result of an infection. I would be able to assess the person to find out the cause of the change, and treat or prescribe accordingly, and ensure prompt administration of medication. I would then typically carry out a review a few days later and monitor their bloods to ensure they’re improving.

“The idea is that our support in the community can help to avoid hospital admissions wherever possible, by finding out why that person is going into hospital and then seeing if there is anything we can do to avoid further admission. We work closely with the patient and relatives; it’s great that the relatives also have a link.

“Working with district nursing or social work colleagues means that people within the community are flagged to us as needing possible medical intervention. We’re then able to go and build a relationship with that person, and change care plans accordingly.

The biggest benefit for patients is that through this new arrangement, people now feel like they’ve got one care co-ordinator whether its social worker or ANP, third sector or district nurse looking out for them and managing all their needs. “It’s all about increasing patient satisfaction, helping to keep them out of hospital – which we know people are always keen to avoid – and ensuring people are well supported socially as well as with their health needs.

“The key thing that drives me is seeing the strengthening patient relationships, we often get told ‘thanks so much for caring’ which is so positive. It’s great that people feel like they’re being cared for within their preferred setting.”

“One of the main things that drives me is seeing just how appreciative people are about you going in and helping to co-ordinate everything for them. For example, there was a lady I had been out to see who needed to have a couple of scans at the hospital as part of her care. For her, going to hospital for appointments can be a very traumatic experience, so I helped to arrange for her to have two scans within one visit so that she wouldn’t have to go back to hospital on multiple occasions.

“It’s little things like that which can make a real difference for someone. Quite often they just really appreciate having someone who is looking out for them as a person, and thinking about what will work best for them.”

The ANPs cover the following neighbourhoods:

  • Jacqueline Hall – Cheadle and Bramhall
  • Nicky Makepeace – Victoria
  • Kath Baines - Tame Valley & Heatons
  • Desiree Demingo - Stepping Hill
  • Jacky Grove – Marple and Werneth

There are three main developments planned to take place in coming months which will have a real impact on both the team and the community:

  1. Two trainee ANPs have been recruited and will start in September, which will further strengthen the team. “Investing in new recruits means that we will be able to reach out to more and more people across the community, and that we’re working to ensure that the service can be delivered in the future.”
  2. The neighbourhood teams are all working towards co-location, with all areas in Stockport aiming to have a team that will be based in a convenient location to best serve their local area. The major benefit of this is to encourage and foster truly integrated services, by increasing awareness across health and care professions of other services that are available.
  3. Improvements to the IT systems, which will ensure ANPs have access to the relevant patient information to allow them to efficiently deliver their support. “Once we have access to all of the IT systems we need, we will be able to make referrals direct rather than having to rely on GPs to do this. It will also offer huge time savings as we’ll be able to access more of the information we need in one place, provide real-time updates once we’ve seen people, and ultimately to be able to see more patients.
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