Paradigm Shift

1. PRIMARY CARE: THE
FUTURE
In the context of the Role of the Nurse LO4 :A paradigm Shift

2. The aim of this session is to
◦Analyse key NHS and Nursing Policy in relation to
supporting care provision for people living with long
term conditions
◦Address LO 4 "Analyse the role of the professional
nurse in promoting self care and management of adults
with long term conditions"
◦

3. By the end of the session
◦ List core Health Policy that is shaping the care of patients with long term conditions
◦ Define paradigm shift
◦ List the models of care being introduced in order to support patients with long term conditions
◦ Reflect upon the role of the nurse and list the skills required to coordinate care for patients with
long term conditions
Content mapped with the Module LO 4 and can be used to underpin and inform discussion
related to the role of the nurse

4. Reminder from yesterday
◦ 15 Million people have a long term condition
◦ 58% of over 60’s have a long term condition (increased in lower socio-
economic groups)
◦ 50% of all GP appointments
◦ 64% of all Outpatient appointments
◦ 70% all in patient bed days
◦ £7 of every £10 of total health and social care budget is spent on
patients with a long term condition. NHS Budget 2017/18 = £124.7
billion

5. First complete the following
Reflection (5mins)
◦ Reflect upon the NHS and highlight 3 areas
that concern you from each of the
following perspectives:
◦ One as a member of the public
◦ Two as a student nurse
◦ Three as an advocate for a patient who has
co morbitities and living on their own
Consider
◦ Political climate
◦ Media reports
◦ Experience
When construction your responses

6. Look at your responses
Consider
◦ The responses from each perspective
◦ Do they differ?
◦ Is there a common area across each of the
perspectives
◦ Your sources
◦ What do you conclude from your
responses?
Self Assessment
Using a scale 1-10 1 being none
5 being good 10 being excellent
◦ Your knowledge
◦ Your understanding
◦ Your confidence on the topic
◦ Conclude innate or informed or both

7. Did you think of the following
◦ Increasing demand, ageing population
◦ New Treatments
◦ Increased pressure
- 3 million avoidable A&E attendances - reduce 2000 – 3000 beds (146
-200 000 less admissions)
◦ Increased General Practice (7 day/week)
◦ Focus on frailty
◦ Integrated services and Funding (Accountable Care Systems)
◦ Technology and Innovation

8. Political Climate: Neo Liberalism
◦ Based upon
◦ Economic liberalisation
◦ Privatisation
◦ Fiscal Austerity
◦ Deregulation
◦ Free Trade
◦ Individual responsibility rather than state managed
◦ Underpinned UK government strategy since 1980’s

9. Consequences of this ideology for
patients with LTCs
◦ Individual Responsibility
◦ Shift from “treating” to “living with”
◦ New normal
◦ Responsibility for self-care
◦ Use of wider resources – community, digital
◦ Is this driving a paradigm shift in nursing?

10. Ideology underpinning policy shaping
care services
◦ Examples of Policy Documents
◦ Current Core Policy Driver is Five Year Forward View, available at
https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
◦ What is a paradigm shift according
to https://dictionary.cambridge.org/dictionary/english/paradigm-shift
◦ "It is a time when the usual and acceptable way of doing and thinking about something changes
completely" so is nursing undergoing a paradigm shift and what is driving this shift?

11. Care built on these Principles
◦Prevention
◦Empowering Patients
◦Efficiency
◦New Models of Care (House of Care)
◦In patient care as a last resort

12. Commitment 1 -We will promote a culture where improving the
population health is a core component of the practice of all nursing,
midwifery and care staff
Drivers
◦ All our Health
◦ Five Year Forward View
◦ Public Health Outcome Framework
Action
◦ Act as a role model in adopting a healthy
lifestyle
◦ Share information about healthy choices
◦ Support people to make informed choices
◦ Be open and willing to change in response
to evidence/research

13. Commitment 2 -We will increase the visibility of nursing and midwifery
leadership and input in prevention
Aims
◦ •Championing health promotion
◦ •Social movement for health
◦ •Leading and shaping care especially
young people and children
Actions
◦ •Promote culturally appropriate systems of
prevention for sustainable change
◦ •Enable people to take responsibilities for
their behaviours
◦ •Make every contact count
Design and implement prevention
programmes

14. Commitment 3 - We will work with individuals, families and communities to
equip them to make informed choices and support them to manage their own
health
Context
◦ Poor health of older population
◦ Making every contact count
◦ Working with communities
Actions
◦ Encourage and engage individuals to make
healthy choices
◦ Co-design personalised care plans
◦ Work with communities – harness
voluntary sector
◦ Share skills of self- management, self-
esteem, social contact and build networks
for resilience

15. Commitment 4 -We will focus on individuals experiencing high value care
Ideology
◦ No decision about me without me
◦ Putting people first
◦ Care planning
◦ User voices
Actions
◦ Individuals influence all aspects of co-
ordinated care – ensuring culture,
difference and vulnerability is respected
◦ Listen and respond to actual needs
◦ Curiosity to unwarranted variation
◦ Adapt care to “place” based care

16. Commitment 5 -We will work in partnership with individuals, their
families, carers and others important to them
Approaches
◦ Asset based care
◦ Integrated Services – including volunteers
◦ Personalised care, community partnerships,
equality, valuing carers, volunteering and
social action
Action
◦ Co-design plans to provide care in the right
time, in the right place to agreed outcomes
◦ Build trusting relationships
◦ Co-ordinate care
◦ Coach individuals and families for care to
be delivered in a way that works for them

17. Commitment 6 -We will actively respond to what matters most to our
staff and colleagues
Aims
◦ What matters to you?
◦ Mental Health First aiders
◦ Work environment
◦ Right staff support systems
◦ Staff engagement
Actions
◦ Sharing learning
◦ Listen to our colleagues to ensure we
deliver outcomes
◦ Listen and create opportunities for new
ways of working
◦ Seek feedback on the quality of services

18. Commitment 7 -We will lead and drive research to evidence the impact
of what we do
Aims/Targets/Goals
◦ Celebrating success
◦ Building competency and capability to
identify unwarranted variation
◦ Use metric to improve productivity
◦ Share findings
Actions
◦ •Effectively manage resources to reduce
waste
◦ •Understand local systems
◦ •Act as an agent of change
◦ •Listen to individuals to deliver measurable
care

19. Commitment 8 -We will have the right education, training and development to
enhance our skills, knowledge and understanding
Aims and Goals
◦ Revalidation
◦ Shape of Care Review
◦ Career progression
◦ Clinical academic careers
◦ Working across settings
Actions
◦ Value of reflection and learning from
experience
◦ Seeking constructive feedback
◦ Team and action learning
◦ Acquiring right skills, knowledge and
behaviours to measure our impact

20. Commitment 9 -We will have the right staff in the right places at the
right time
Aims/Targets
◦ Carter Review
◦ Working across organisational boundaries
◦ Recruitment and retention
◦ Evidence behind workforce decisions – local
context
◦ E-learning package to monitor and support
development
Actions
◦ Engage in development and training
◦ Facilitate new ways of working
◦ Flexible patterns of work
◦ Workplace as a beacon of excellence

21. Commitment 10 -We will champion the use of technology and
informatics to improve practice, address unwarranted variations and
enhance outcomes.
Goals
◦ Technology literate workforce
◦ Technology to reduce variation
◦ Leading as early adopters
◦ Empowering for self management
◦ Technology to manage workforce
Actions
◦ Embrace technology and informatics
◦ Understand benefits to increase time to
care
◦ Technology for co-ordination
◦ Dissemination and tool to reach hard to
reach groups

22. These 10 commitments
◦Are designed to equip the nurse with the skills
required to survive/shape a modern health care
service underpinned by neo liberalism ideology
◦Therefore and final thought if and when the political
climate changes from the current neo liberalism
ideology, would this result in a further paradigm shift
for nursing?

23. References
◦ JaneCummings – Supported Self Care commentary, available at
https://www.england.nhs.uk/2017/01/jane-cummings-29/
◦ Five Year Forward View, available at https://www.england.nhs.uk/wp-
content/uploads/2014/10/5yfv-web.pdf
◦ Leading Care, Adding Value, available at https://www.england.nhs.uk/wp-
content/uploads/2016/05/nursing-framework.pdf
◦ Next Steps on the NHS Five Year Forward View available at https://nhs.engand.nhs
◦ Nuffield Institute, available at http://www.nuffieldtrust.org.uk/
◦ NHS England Self Care, available at https://www.england.nhs.uk/ourwork/patient-
participation/self-care/