Can a Dutch model of organisation of district nursing be implemented in England and address issues of quality of patient care and staff retention?
Problem
District nursing as a home visiting service in primary care is facing increasing demands and difficulties in recruiting and retaining staff in many areas of the United Kingdom (UK). The Dutch social enterprise company, Buurtzorg, offers one model that emphasises patient centred care and has self-managing (also known as self-governing) nursing teams . It is reported to achieve high levels of patient and staff satisfaction . The Buurtzorg model is being introduced in a number of countries, including the United States, Norway , Scotland , England and China . This presentation reports on the evaluation of the introduction of an adapted Buurtzorg model in one team, known as neighbourhood nursing, in an inner city area in England. The aim was to evaluate the impact of introducing an adapted Buurtzorg model to a district nursing team for patients , nurses , general practitioners, managers and on service delivery.
Approach
Mixed methods case study including semi structured interviews with patient, nurses, general practitioners , other health professionals, conventionally organised and managers , observation of nursing practice and analysis of anonymised patient records. Data collection was undertaken January– August 2017.
Findings
The evaluation reported positive experiences and outcomes from patients, specialist nurses, general practitioners in comparison with conventionally organised district nursing. Observed nursing practice demonstrated differences between the new model and the conventionally organised district nursing in broader attention to health promotion and chronic disease management. The nursing practice included provision of personal care and meal preparation for short periods ,which is usually undertaken by social care in England. The nurses reported great job satisfaction but also challenges in being a self managing team within a large organisation. Not all nurses offered posts took them up and nurses starting in the team subsequently left . The neighbourhood nursing team agreed working practices which reduced a number of inefficiencies (for example in referrals and patient records) , increased continuity in patient care and attended to delivery of care as a team - all factors which conventionally organised district nurses pointed to currently problematic about their work.
Consequences
The evaluation demonstrated a model that showed promise. It raised questions as to whether some of the innovation and efficiencies in this team’s nursing practice were transferable more widely to the district nursing service. Not all nurses are comfortable with non-hierarchical , self-management. Further investigation is required in answering questions of cost effectiveness over a longer period.