Mission Accomplished

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Mission Accomplished?

• Roland Valori and Debbie Johnston

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Outline

• Achievements
• Visits Programme
• Workforce developments
• Nurse endoscopist programme
• Visiting GIN programme
• Roland's section

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Visit Programme

• Three types

1. Intensive Support
2. PreJAG Visit
3. JAG Accreditation
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Intensive Support

• Recently the primary focus of the National Team
  has been to support struggling services
• Conducted intensive support visits to ten
  Trusts during the last six months
• These 10 Trusts have 20 endoscopy sites between
  them (10 of the total Acute Trust sites)

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Ten most challenged
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Service risk challenges
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Most Common Challenges

• Patient related challenges
• Environment and decontamination
• No understanding of workforce/skill mix needs
• Undervalued Workforce
• Recruitment into vacant posts is often frozen or
  delayed
• Training and development
• Achieving GRS standards

• Wider organisational challenges (such as Trust
  mergers)
• Ineffective leadership (Clinical, Nursing and
  Managerial)
• Poor middle management support
• Inability to meet targets (waiting List)
• Poor productivity

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Intensive Support Visits

• The goal of these visits has been to
• understand the issues
• help devise solutions
• encourage better working between the general
  management and endoscopy teams
• ensure the organisation has a plan to control
  waits and deal with other issues that might
  affect the viability of the service

Do they work?
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The Bristol Story

• 2007
• Floundering service
• Very serious challenges
• - huge waits 1 year
• Big busy shared service (DCU)
• Fragmented unhappy team
• Unsure about priorities i.e. where to start

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The Bristol Story

• 2007
• Floundering service
• Very serious challenges
• - huge waits 1 year
• Big busy shared service (DCU)
• Fragmented unhappy team
• Unsure about priorities i.e. where to start

• 2008
• A clear Plan
• Joint Medical/Surgical Leadership. Defined roles
• Nursing leadership roles clarified
• Focus on teamwork initially,
• then the system
• Expert support direction provided from
  national team
• JAG accredited February

The visits make a huge difference
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Purpose
Pre JAG Assessment

• Preparing for a JAG visit and meeting the
  standards
• Working with the unit to identify areas in need
  of improvement
• Preparing action plans to deal with these areas
• Agreeing a date for the visit
• Focusing the Trusts attention on supporting the
  unit, particularly if there are resource
  constraints
• linking units with others nearby that have solved
  the challenges they face

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Supporting the service
Pre JAG Assessment

• 85 of units have had a pre-JAG visits
• Priority has been given to those with significant
  waits and challenges

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Most common issues in need of improvement before
a JAG visit

• Training
• Audits
• Environment and Decontamination
• Achieving the waits standard and sustaining it

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Training Challenges

• No training lead, or lack of clarity around role
• Poorly integrated approach between physicians and
  surgeons
• No induction programme
• Poor use of DOPS forms
• Poor feedback from trainees and/or nurses

www.grs.nhs.uk
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Sustainability of waits

• 6 weeks not achieved
• Systems and processes do not support a
  sustainable low wait service
• no pooling
• no vetting
• lack of clerical and clinical validation
• unclear guidelines
• Surveillance lists not up to date
• Inequitable waiting times between clinicians (no
  pooling)

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• Meeting the Challenges March 2008
• Section on how to prepare for pass your JAG
  visit

Collect at the BSG or order/download from
www.grs.nhs.uk
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Key Workforce Developments

• GRS Workforce Domain
  Live!
• Endoscopy Career Framework
  May 08
• - opportunities in endoscopy services
• Endoscopy Competence framework
  Live!
• NVQ in Endoscopy Care
  May 08
• Endoscopy Leadership Development Programme
  Live!
• 
  
• National Nurse Endoscopist Project
  Live!
• - Workforce Survey and Training Development
  
• Visiting GIN Programme
  May
  08

www.grs.nhs.uk
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GRS National Workforce Results
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National Nurse Endoscopist Project (NNEP)

• Nurse Endoscopists are often underutilised
• incomplete training
• poor job planning
• lack of certification of competence

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Achievements to date

• Workforce Mapping exercise
• Web based questionnaire developed training,
  education, clinical practice, professional
  development
• Supported by 15 regional nurse endoscopists
• Identified 349 nurse endoscopists in England.

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Years in practice
Average age45
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Results training requests
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Workforce Issue
Significant variation by region in Agenda for
Change Banding and Job Plans
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Results in brief

• Identified the current working practice for all
  nurse endoscopists in England
• Workforce issues (AfC)
• 166 nurse endoscopists have, to date, identified
  that they require further training and
  professional development
• First wave applications have been commissioned

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Training Commissions - three broad categories

• knowledge based certification e.g. university
  module

• 2. Developing new skills certification e.g.
  polypectomy

• 3. Refining established skills validation
• e.g. assessment of competence, knowledge, skills
  and attributes

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Travelling GIN

• Visits have identified the need for structured,
  accessible training
• A skilled workforce is essential for
• achieving a patient centred service
• achieving targets
• sustaining quality
• Adoption of the Endoscopy Competence Framework
  has been slow

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Training the Nursing workforce

• In-house
• Regional study days
• Training from manufacturers
• GIN courses
• University based courses
• Workforce Domain

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Why do we need to develop the GIN course?

• Limited access 9 courses per year
• 70 uptake of GIN courses in 2007
• Restrictions on
• Funding
• Study Leave
• Staff Shortages
• Lack of understanding from management

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What do we want to achieve?

• Accessible training
• Relevant
• Facilitate evidence based practice
• Link training to the National Endoscopy
  Competence Framework
• Implement strategies to achieve sustainability
  long term

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Intensive Support Pathway
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Demand

• 207 Endoscopy Units (NHS)
• 3000 endoscopy staff
• 10 SHAs
• 10 Training Centres in 8 SHAs
• Each SHA has 15 30 units

We need to work in partnership with you to move
this forward for all regions
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Questions?