About the new ways of working identified by City Hospitals Sunderland NHS trust, and the neonatal unit in Sunderland Royal Hospital, part of the Neonatal Clinical Consortium.
City Hospitals Sunderland NHS Trust is a medium sized Trust serving the population of Wearside. The neonatal unit based in Sunderland Royal Hospital is categorised as a level two and forms part of the Neonatal Clinical Consortium that includes James Cook University Hospital in Middlesbrough, North Tees Hospital in Stockton and the RVI in Newcastle upon Tyne. A local network also exists with South Tyneside Health Care NHS Trust. The catchment area has a significant level of social deprivation with above average unemployment and one of the highest levels of teenage pregnancy in England. Other issues include a high level of Do Not Attends (DNAs) at antenatal clinics and greater than average number of congenital abnormalities.
It has been agreed that the trust will host a Changing Workforce Programme (CWP) test site to establish new ways of working across the neonatal network. Judy Hargadon has given formal written confirmation of the establishment of the test site to the Chief Executive of the Trust, Andrew Gibson.
Preliminary discussions regarding the establishment of the test site have been with the Head of Corporate Affairs, Carol Harries, and the Business Manager responsible for paediatrics, women's services and the neonatal unit.
Agreement has been given to the following criteria:
A project plan, which is used by the Associate Workforce Designer and the neonatal team, as a working document, is available.
Shadowing of the current workforce has taken place with several roles identified to test, these roles have been finely tuned at the CWP toolkit held with all stakeholders. Roles to test are:
This event also identified desired outcomes and measures, although there is general agreement nationally regarding 'hotspots' where focus and change are required, it is important to ensure that specific local needs, in relation to new ways of working, are met. The Associate Workforce Designer and the staff working within the unit are currently gathering information and working towards identified measures and outcomes.
Input at national level is through a reference group, established by linking with relevant members of the Children Care Group Workforce Team and the external working group of the Children's National Service Framework.
In addition to the work within the neonatal unit, links have been established with the UK National Neonatal Screening Committee. The Child Health Sub group has been focusing on the Newborn Physical Examination in relation to what competencies are required and how these should be delivered. Traditionally this examination has been undertaken by SHOs on discharge of the infant and GPs at six weeks.
Work has been undertaken in conjunction with Christine Samson Project Manager, Child Health Screening Programmes and the University of Northumbria at Newcastle to train Midwives from Sunderland in screening of the newborn and follow up screening after six weeks.
The initial training for the Newborn Physical examination commenced in July to be completed August. The Midwives will commence the practical aspect of the programme under the preceptorship of the Advanced Neonatal Nurse Practitioner. Further work is to be undertaken linking with Primary care for the six weeks screening.
Further CWP work has commenced with the RVI in Newcastle to look at using Paramedic and Nurse Practitioners for Neonatal Transfers. Neonatal Transfer teams in the UK have traditionally been staffed by a paediatrician in training (SpR grade) and a nurse from the neonatal unit.
The Northern Health Region operates a collaborative consortium of four neonatal intensive care units which undertakes all long term intensive care for infants within the region. There is also a well-established neonatal transfer service in existence.
A problem for neonatal services is the expected reduction in the number of junior medical staff, which is part of the drive towards a Consultant led service and the reduction in the number of hours worked by junior medical staff.
The British Columbia Infant Transport team has adopted a model which uses paramedic staff for all maternal, paediatric and neonatal transfers. It is proposed to adopt this model and adapt it to a local neonatal transfer and retrieval team training both Paramedics and Advanced Neonatal Nurse Practitioners. This aligns with the recommendations for improvement within the recent Report of the Neonatal Intensive Care Services Review Groups - Strategy for Improvement
Preliminary discussions have been undertaken with the neonatal team, the Northumberland ambulance Service and the local university regarding the establishment of the project. A local implementation team has been identified. A CWP toollkit event was held at the end of June to develop the job description and person specification for the Infant Transfer Practitioner.
For further information please contact:
Marian McGill
Associate Workforce Designer
Tel: 0191 296 0261
Mobile: 07919 576 015
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