Riding along with the Community team at @BucksHealthcare NHS Trust

I recently spent a morning with Teri Blease visiting patients in the Community — Teri is one of our Advanced Community Practitioners at Buckinghamshire Healthcare NHS Trust (and I’ll come back to Teri later).

Whenever I’m in the patient setting I’m humbled by their experiences, their forbearance and their willingness for me to understand their journey.

I’ll give a pen portrait of the patients I met today, protecting their privacy but giving enough detail so you understand the work our colleagues in the community do.

A couple of patients were elderly with a number of conditions and Teri was there to check on their diabetes (blood sugar levels and insulin injections) and support them in managing their own care. A large part was also checking on their general wellbeing — had their care team been in?were they eating, were they taking on board enough fluids? I think this is as vital as checking blood sugar levels.

I had a wonderful chat with a patient with MS — again there to check blood sugars but also general wellness. And she was super competitive with herself about her own blood sugar levels and her blood pressure — properly taking ownership of her health. She couldn’t use her arms and this led to a great discussion about the use of technology in the NHS and with patients at home — the role of voice recognition — video calls– AI — and for her receiving a new electronic wheelchair (that term didn’t do it justice) she could control with movements of her head. A really lovely and humbling chat and I wish her all the best.

A couple of other patients needed their bandages replacing, pressure sores looked after and creams applied. One patient had lymphoedema and both legs needed re-bandaging which meant whilst Teri did all the hard work we spoke for probably 30 minutes about his life experience over the last few years, how he’d gone from an active life to being housebound and the issues this has caused. We talked about our respective ages and as he put on an 80s playlist it was obvious the pain he was in and the limited mobility he now has.

It was also obvious the physical effort Teri had to put in to lift heavy legs, kneel on the floor for prolongerd periods and whilst doing the work asking questions to ensure the best care was being provided. As well as the excellent clinical knowledge required community nursing is a very physical role.

What did I learn from this?

  • Our community team do outstanding work — and it’s important that me and my teams understand all of our user needs at BHT — from outpatients to inpatients to ED to spinal injuries to community. So often we talk about ‘hospital’ but that probably doesn’t do justice to community teams working in people’s home every single day, and often around the clock (yes I know about ‘virtual hospital’ and ‘virtual wards’ but that still uses a hospital for it’s labelling/mental model)
  • (As ever) systems needs to talk to each other better. The teams have a laptop (for accessing Rio — our Community EPR), a tablet (for accessing Total Mobile and capturing pictures), and a phone (largely for calls). The days’ appointments are managed in Rio, and then as colleagues visit patients they update (‘outcoming’ and/or making notes to request follow ups) in Total Mobile. Back in the office (or home) emails may also be sent.
  • The shared care record (Carecentric) is linked to Rio — but it’s not used as much as it could be because the data within it is highly variable — meaning folks can’t rely on equal levels of data, so I don’t think it’s become trusted and part of the normal workflow.
  • Mobile phone connection is variable in the County — and there’s some legacy issues with mobile providers e.g. Vodafone seems better than EE — which means it takes some time for notes in Total Mobile to write back to Rio.
  • We also use services like NRS (https://www.nrshealthcare.com/) to order equipment and that invokes the ‘many applications’ multiple logins question
  • Community teams use specialist systems (Rio and Total Mobile) but there is crossover into hospital systems — for example when patients are discharged, when Datixes need to be raised
  • As well as the care delivered in the community there was significant follow up activity when back in the office — like many public services it’s not just the activity at the point of care it’s all the follow up that takes a significant part of time. And for me that’s where better joined up systems, and maybe changes to some roles will help frontline teams put their time where it’s needed most — at patient facing care.

So what next?

  • I’m going to explore whether Windows Surface devices might help the mobile/office experience
  • As we go forward with our future EPR strategy we need to tailor the tools Community use to their needs.
  • We need to think about the touchpoints between the ‘hospital’ and the community — how and where patient records join up, how and where e-prescribing may work and I am sure lots more.
  • We need to build on national infrastructure work to make sure we have good connectivity in the community — the best 4G/5G service — and maybe programmes like Gigabit (https://digital.nhs.uk/services/future-connectivity) can help us.
  • Make sure the shared care record is (a) better populated across all providers and (b) we integrate it into people’s natural workflows.
  • Within the Digital portfolio more of us need to get out an about, and think less about ‘hospital’ and more about colleagues in whatever setting delivering the best patient care with the best possible tools we can provide.

And back to Teri — it was interesting hearing her career journey (and forgive me if I get some of this wrong Teri). After leaving school without maybe the right qualifications she went into office work, but always had a hankering for nursing. Through adult study she got the qualifications she needed, has now been at BHT for 15 years and is an Advanced Community Practitioner, at a senior level, and to cap it all she is a Queen’s Nurse (see https://qni.org.uk/nursing-in-the-community/queens-nurses/).

As I meet more of our NHS colleagues this is becoming a theme — a drive to care, to be a nurse to support the community and often to make career choices as an adult to fulfil what may have been early life dreams.

It’s quite inspiring.

And humbling hearing the patient’s experience.

ps — an overnight reflection. Chatting with Teri about the start of Covid — the Community teams just carried on what they were doing. And at the start, before we had Covid tests, way before we had vaccines, and when we were still going about our business without masks the Community teams were seeing a much higher level of deaths in the community. This means the true number of Covid deaths will never be known, and is something to reflect on in quieter times. And they were making local decisions every day about the risks to the patients they were seeing and the risks they were presenting to their families when they went home. I’d seen our early reactions to Covid first hand in an Acute, sobering to hear the Community team’s experiences.

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ian roddis

ian roddis

by nature a product manager, working in digital and health