Overview Pilot study to embed a Clinical Nurse Specialist (CNS) into a large GP group practice whilst maintaining supervision under hospice framework.

Background Based at the hospice traditionally each member of our Community CNS team is linked to 5–8 GP practices within a geographical area. Issa, a large inner-city G.P. practice, approached the hospice with a proposal to fund a St Catherine’s CNS working solely with Issa patients (list size 30,000). The project commenced in November 2018. This project will be run as a three year pilot funded by the Issa Medical Group.

Method CNS is based at the practice hub. Referrals are now taken directly from primary care staff to the CNS. CNS has access to practices’ electronic systems to streamline communication and ensure timely treatment and prescribing. CNS maintains place in week-end rota, line management, clinical supervision and multi-disciplinary team input from the hospice.

Results Challenges we encountered were:

• I.T.; ensuring access to two electronic patient records in two locations;

• Establishing working relationships within a large two–centred practice;

• Adapting prescribing policy and practice to that used by the Group;

• Changing practice to enable greater flexibility and responsiveness;

• Acquiring enhanced skills, such as verification of death.

Initial benefits

• Joint ward rounds held at large nursing homes;

• Waiting time now less than 48hrs compared to the current CNSs wait of 4 weeks;

• Wider referral criteria, including early intervention. 23 patients seen who would not have been seen in the old model of which 14 were for end of life care;

• GPs appreciate being able to see entries put directly onto EMIS rather than in traditional letter format;

• Cancer care reviews undertaken on palliative patients.