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Family Health - Nursing in Scotland: A report on the WHO Europe pilot
What did we set out to do and why?
Within Scotland population sizes, health profiles, and local economies are changing. The current community nursing service provision, however, remains focused on specific roles. Remote and rural communities now have a different landscape, often with declining and increasingly elderly populations spread across large geographical areas. This changing profile means that consideration must be given to the way in which we deliver services in order to ensure that communities continue to receive high quality health care. The Family Health Nursing model described by WHO Europe combines a locally-based skilled generalist with a support network of community nurse specialists who may be geographically distant. Whilst theoretically this model may seem feasible, in order to effectively evidence-base our practice it was important to first test it in a small number of pilot areas.
Two principal reasons underpinned the decision to participate in the WHO multi-national study and to pilot this role in remote and rural areas of Scotland:
1. The policy emphasis on health improvement rather than purely health care. This message is a central tenet of the main strategic documents outlining the future direction of health care services in Scotland.
The focus on family rather than individuals within the Family Health Nurse model creates a role that is focused not just on health care, but on the wider determinants of health. A truly family-focused health improvement role.
2. The difficulties associated with operating a specialist model of practice within small remote communities.
Nursing built on traditional models of education and service has led to a number of difficulties in remote and rural areas. These include recruitment and retention of nurses, professional isolation, and increasing problems of maintaining skills and competencies in sparsely populated areas. Previously this issue was addressed through the appointment of triple duty nurses who had undertaken educational programmes in general nursing, midwifery, health visiting and district nursing. Many of these nurses also provided school nursing services. Whilst double and triple duty nurses remain a mainstay of service delivery in some remote and rural areas of Scotland, NHS Boards are finding it increasingly difficult to recruit, educate and retain people in these posts. There is also anecdotal evidence that equipping nurses with a tool bag of specialist roles does not necessarily prepare them well for a generalist role.
It was against this backdrop of a changing demography, modernisation of health care services and an evolving nurse education system that the piloting of family health nursing was debated and agreed with service and education partners.
The specific objectives of the Scottish pilot were:
A pilot project running over two years was established to achieve these objectives. The development of the project and the outcomes and learning from it are summarised in subsequent chapters.
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