Coronary heart disease is the UK’s biggest killer and has a devastating effect on families as well as placing extra cost and pressure on an already stretched healthcare system. Currently, there are around 155,000 deaths every year from heart and circulatory diseases, which includes heart attacks and strokes, accounting for over a quarter of all deaths in the UK. To add to this, there are around 491,000 hospital episodes related to coronary heart disease each year, and it is estimated that cardiovascular disease costs the UK economy around £15.2 billion each year.
Malnutrition (undernutrition) affects three million people in the UK (Brotherton et al, 2010) and is responsible for health and social care costs exceeding £19 billion annually in England alone, half of which is due to people over 65 (Elia, 2015). While it is accepted that good nutrition is important to maintain health, there is a general lack of responsibility and ownership around the problem of undernutrition in primary care. Lack of understanding, including how to identify and treat it is also widespread. Despite National Institute for Health and Care Excellence (NICE) guidelines stating that all healthcare professionals should be involved in nutritional screening and treatment (NICE, 2006), there are barriers stopping primary care nurses from screening, i.e. challenges of organisational culture and competing priorities (Green and James, 2013; Green et al, 2014).
The 21st September 2016 saw the launch of the latest version of our national asthma guideline, published jointly by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016).
The original BTS guideline was published in 1990, and SIGN’s own version dated back to 1996. In 1999 the two organisations recognised the need to develop a joint guideline, the result of which was the 2003 BTS/SIGN asthma guideline (SIGN/BTS, 2011).
This is the seventh version of this guideline, which has been produced in conjunction with a range of stakeholders including the Royal College of Physicians (RCP), Primary Care Respiratory Society (PCRS), Asthma UK and Health Improvement Scotland (HIS).
The ‘General Practice Nursing – Leadership for Quality’ (GPNLQ) programme was developed by Judi Thorley and Sally Rogers (both chief nurses and directors of quality and safeguarding at NHS South Cheshire and NHS Vale Royal clinical commissioning groups [CCGs] and NHS Eastern Cheshire CCG respectively), after local discussions within their CCGs around the need for further support and learning opportunities for general practice nurses (GPNs).
They felt that GPNs were unintentionally professionally isolated, and had to work in a climate that did not support personal development, with some GPNs not being released for clinical training, let alone training for personal development in an area as ‘non-clinical’ as leadership.
Judi and Sally invested a significant amount of their own time in scoping out the programme, planning and, indeed, delivering the training. They also networked assiduously and gained the support of key individuals promoting the role of GPNs on the national stage.
Over the past five years, NHS commissioners have started to practise outcomes-based commissioning. Many of the new provider-led models of care heralded in the Five Year Forward View (NHS England, 2014) build on the concept of ‘accountable care organisations’ (ACOs). The ACO model is predicated on payment for outcomes.
While still in its infancy, our understanding of outcomes that matter most to people and families is growing — and those outcomes may be different to the clinical biomarkers we have traditionally measured.
Accounting for person-centred outcomes would fundamentally change conversations with patients and the focus of clinical practice, because we would worry less about the numbers and more about supporting people to live full, productive lives. Let’s imagine how that might work.
What is fascinating since the launch of the Journal of General Practice Nursing in May 2015, is that we have become increasingly aware of the demands that delivering skin and wound care places on community- and practice-based nurses.
The team of Eczema Outreach Scotland (EOS) has been working with families dealing with the day-to-day struggle of childhood eczema for over five years. Magali Redding, a West Lothian mother of three and voluntary sector professional, set up the group when her daughter asked tearfully: ‘why am I the only scratchy girl in the world?’ In between their precious clinic appointments, the family had been feeling increasingly frustrated and isolated in their battle with the impact of eczema on life.
For the first time, the Queen’s Nursing Institute’s (QNI’s) annual conference was a two-day event, with a range of speakers on the twin themes of inspiring quality and success in nursing and on shaping the future of the nursing workforce. The speakers — from England, Wales and Northern Ireland — spoke about the various challenges facing the nursing workforce and some of the new initiatives that are being introduced to address them.
Technology is all around us and while it enables us to do things that were not possible in the past, I still talk to nurses around the country who have very different levels of professional engagement with it.
Success!