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Health Visitors

Health Visitors

To ask if the Health Board will confirm the crucial role of practice-based Primary Care Teams in delivering a Universal Health Visitor Service? Recognise that it Health Visitor Review has lost the confidence of workers in Primary Care Teams? Halt local implementations of the old review? Work with GPs and Health Visitors to develop services for vulnerable children which are not at the expense of current services?

There are plans to change the focus of the Health Visiting Service in Scotland. I would like to know if and when NHS Greater Glasgow and Clyde are going to implement these plans – given the fact that the health Visiting/District Nursing Service is seriously undermanned and has no direction at present ?

In response, I would firstly like to take the opportunity to reassure you that we absolutely recognise the importance of practice-based Primary Care teams and that there are no plans to remove health visiting services from NHS Primary Care. Health Visitors will remain employed by NHS Greater Glasgow and Clyde and will continue to provide a wide range of local health services to children and families. We see Health Visitors as a core and integral part of the primary healthcare team, centred around GP practices.

We are indeed, as you may be aware from media reports, currently undertaking a comprehensive review of the functions of Health Visitors in Greater Glasgow and Clyde. We see Health Visitors as a core and integral part of the primary healthcare team, centred around GP practices but, as you indicate in your question, there are key issues as to how these staff are used and deployed.

The purpose of our review of health visiting services is to consider:

  • Making the best use of Health Visitors’ skills, continuing to provide fully universal services but also to provide a stronger focus on meeting the needs of the most vulnerable families
  • Achieving closer relationships between Health Visitors and Social Workers – not at the expense of their critical relationship with GPs but building on the development of integrated assessment. This in itself is a response to concerns from health staff about present ways of working and the ‘compartmentalisation’ of services. These closer relationships would provide a better link from Social Work into GP practices, with Health Visitors acting as a ‘bridge’ • Ensuring that we provide properly comprehensive and integrated interventions to families with the most complex needs, using the distinct skills and roles of health and social work staff
  • Ensuring that immunisation in Primary Care is delivered by nursing staff with the appropriate level of skill – but under the continued supervision of Health Visitors, in part overcoming some of the problems of coverage
  • Achieving more robust cover arrangements by making use of geographic teams and ‘equitable case-holding’ to address the present large variations in workload between practices – however, the proposals would see that numbers of named Health Visitors would be maintained for each GP practice
  • Providing better administrative support to Health Visitors, including improving the support the have to effect communication and improve dialogue within and across agencies about families’ needs
  • Ensuring that teams have a range of professional support staff to deploy under the supervision of Health Visitors
  • Re-affirming the integration of Health Visitors’ skills as a key asset in the Primary Care team to develop and extend services to prevent problems arising and effect early intervention where families do have problems

In August 2007, a document was issued to staff to encourage widespread discussion and debate. A wide range of local events and meetings were also organised to give Health Visitors, GPs and other frontline staff an opportunity to feedback their views and comments on the proposed changes.

Local implementation groups, which have representation from local GPs, school nurses and Health Visitors, were established across the Community Health (and Care) Partnerships in Greater Glasgow and Clyde to take forward the proposals. These groups were intended to produce detailed proposals that would have been strongly influenced by the input of local GPs. Originally, the proposals were to be subject to extensive local discussion, with the aim of reaching agreement with GPs and moving forward with implementation of the final proposals from October 2008.

We do accept that there may have been a lack of clarity about the purpose of local implementation groups, nor had there been sufficient clarity about the degree of local flexibility in the proposals and the importance of GPs to the final outcomes. In the light of this, Dr Linda De Caestecker, Director of Public Health, and Tom Divers, NHS Greater Glasgow and Clyde’s Chief Executive met with representatives of the Local Medical Committee a few weeks ago. We have now written to the chairs of the Committee confirming as agreed that we will suspend local implementation work to allow the review document to be re-visited.

A joint group comprising Community Health (and Care) Partnership and Local Medical Committee representation, chaired by Linda de Caestecker will seek to confirm where there is agreement in terms of existing review proposals, determine any points of misconception or confusion and make changes to the proposals where required. It is our expectation that we should be able to find ways to equitably overcome any areas of disagreement.

The group’s intended output will be a Statement of Principles on the way forward that will in turn inform the work of local implementation groups upon their resumption of activity. The statement will clarify working arrangements of Health Visitors with practices that take on board GPs’ concerns about relationships and the key principles of the review without compromising effective team working.

This piece of work will also describe how immunisation contacts can be maximised for health improvement, early intervention and advices for families and the Health Visitor role in overseeing immunisation.

The proposals will be subject to local discussion before they are finalised and implemented, with the aim of reaching agreement with GPs and Health Visitors. The discussion period required to achieve this will be to a timescale negotiated by the joint group. When agreement has been reached on the detailed plans, a further timetable will be set out for implementation and this will apply across all Community Health (and Care) Partnerships. In return, the joint group will be provide scrutiny and comment on subsequent local implementation proposals from Community Health (and Care) Partnerships.

The upshot of this is that our review will proceed and we are entirely confident it will introduce the improvements in the focus and effectiveness of services you point out is required.

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