Multiple care groups

Team: Research Department
Contact: kelly.mccarrick1@nhs.net

What did we want to achieve?

The ‘Family and Carers Booklet’ that Kelly created is designed to support people who are caring for someone at home at the end of life. During her time as a CWP Community Nurse, Kelly found there was anxiety and a lack of knowledge among family and carers about the normal symptoms of the dying process and where to go if they needed help or advice. The booklet bridges this knowledge gap. It aims to improve the end-of-life process for service users and carers. It uses current best practice in providing clear, accessible information in different formats (text, visual and interactive elements) to meet diverse needs.​​​​​​​

What we did

The approach that Kelly took was to unite palliative care specialists, community nursing teams and quality improvement experts to collaborate on a prototype booklet. The design was informed by the lived experience of a bereaved service user and Kelly’s nursing experience during the end-of-life process. It also followed recommendations made in national policy reviews (such as NICE Guidelines and the NHS Long Term Plan 2021).

Amendments were made and the booklet was put forward to CWP Governance for consideration as a service improvement pilot and evaluation in 2023. See details of the pilot, at: https://youtu.be/-s6frFOf4R8? si=8c0A2IyMdX1icWaJ​​​​​​​

Results

Stakeholders and carers who had experienced caring for someone during end-of-life took part in focus groups. They were asked to read through the booklet and then report on how it would have affected their own experience.

Additionally, four community nurse teams piloted the booklet as part of their clinical practice. The insights and suggestions of all these individuals were crucial in making the booklet practical and applicable to end-of-life care.

Every carer and health professional who took part in the 2023 evaluation reported that the booklet, and its quality of information, was either ‘very useful’ or ‘useful’ in practice.

Next steps

The next 12 months are exciting for Kelly’s booklet. She has applied to the Marie Curie Foundation for funding to expand the reach of the booklet so that it can be provided to more families and carers. The booklet’s design also makes it highly adaptable, and it is planned to transfer its remit to other healthcare settings such as hospices and community palliative care.

Training will also be provided for healthcare professionals on how to use and distribute the booklet effectively. Kelly is also exploring digital versions of the booklet to increase accessibility, making it more sustainable and reducing costs.

Team: Education, Learning and Development Team
Contact: cwp.educationcwp@nhs.net​​​​​​​​​​​

What did we want to achieve?

The team wanted to improve the experience of people joining CWP by ensuring they had access to the right support, information, resources, and patient-safety-critical training at the very start of their journey with CWP, within a safe and protected learning space.

They also wanted to ensure the clinical teams who the Education, Learning and Development Team are here to support have new starters competent in mandatory skills, have completed systems training and have received ICT support before they reach the workplace for local induction. Key driver: In February 2024, after 12 weeks, only 51% of new starters had completed their mandatory training.

What we did

• Engaged with over 200 stakeholders across CWP to find out the elements of induction most valued by them.
• Designed the ‘Prepare to Care’ programme based on their feedback across 32 pathways defined by service and role to meet the needs of CWP’s dynamic and diverse workplace.
• Worked with colleagues across Clinical Support Services, including Recruitment, Human Resources, the Electronic Patient Record team and ICT to ensure the right support is available within the ‘Prepare to Care’ programme.
• Developed bespoke training programmes, including care planning, safety planning and therapeutic observation training.

Results

In June 2024, 91% of new starters had completed training and were ready to deliver person-centred care. Initial feedback and highlights over the first 12 months showed:

• staff value opportunity to meet the Chief Executive on day one
• workforce wellbeing sessions rated highest, with 93% finding it useful
• staff said it gave them the opportunity to build networks and feel part of CWP
• it provided quality person-centred training with dedicated time to complete
• a decrease in new starter calls to ICT from 3.5 contacts in February 2024 to 0 contacts in September 2024
• a decrease in the non-attendance rate on new starter mandatory training courses, from 20% in 2023 to 1% in 2024
• the retention of leavers within six months of start date improved from 27 leavers in April to September 2023 to 22 leavers in same period in 2024

Next steps

• Launching of additional programmes within ‘Prepare to Care’ including the Oliver McGowan training programme.
• Commencement of line manager engagement, with additional workshops on how to support new starters, including reasonable adjustments.
• Continued improvements and updates to learning environments, such as at Sycamore House and Soss Moss.
• Further work on mandatory and role-essential training to ensure content is valuable.
• Further background work to improve digital systems, supporting staff and reducing burden.
• Updating communications, working from the start of process with recruitment and beyond ‘Prepare to Care’ with new starters.

Team: Lead Mental Health Practitioner in Primary Care Network for Congleton and Holmes Chapel​​​​​​​
Contact: laura.duncan11@nhs.net

What did we want to achieve?

The key aims of the Thriving in Mental Health Nursing book were to explore topics that are common experiences for those working in mental health in an understandable and engaging way.

Improving the wellbeing of professionals is a core theme and this is explored through how to support yourself and colleagues by recognising signs of burnout, improving self-care and wellbeing, and compassionate leadership.

What we did

The book covers lots of different topics including those outlined above but also key subjects such as working with trauma, compassion, resilience and maintaining hope.

The book was written using up-to-date literature and research as well as vignettes from the author’s clinical experiences, reflective activities and case studies to support readers in engaging with the topics in a reflective and meaningful way.

Results

The book was published in February 2025 and has been promoted in CWP’s internal Trustwide newsletter (CWPeople), as well as in local newspapers across the region.

Those who have read the book described it as “thought-provoking” , “interesting” and one individual said it was “the first book I’ve actually read the whole way through in years”.

Readers commented that they enjoyed the way it linked personal stories and ways to put theory into practice. Others enjoyed the “many useful tools and tips to help nurses to reflect, grow and provide the best care for their clients, which starts with caring for themselves”.

Next steps

As the book was only recently published, next steps are not yet planned but there is opportunity to share good practice and promote discussions of how to maintain and improve staff wellbeing throughout the Trust.​​​​​​​

Team: Electronic Patient Record Team
Contact: jenny.gillison@nhs.net

What did we want to achieve?

The Electronic Patient Record (ePR) team’s aim was to not only to digitise this essential process but improve it to:

• ensure data was legible and recorded directly on the patient record
• highlight where patient’s observations are overdue, so these can be actioned quickly - keeping patients safe
• allow staff to write more detailed and relevant information than they were previously able to
• make observation data visible for reporting so this can be analysed and understood

What we did

• Visited every ward to gain a good understanding of the existing process and variations in practice.
• Tested the solution alongside clinicians working the old process on each ward.
• Multiple testing sessions delivered on inpatient buildings including role play/ scenario testing.
• Creation of information video and quick reference guides to provide support to staff.
• Pilot with four wards before rolling out across the Trust.
• Provided face to face support on go live day to both the day and nightshifts so that everyone felt confident and supported.
• Provided dedicated telephone support to all wards late into the evening to make sure everyone felt supported.

Results

Staff feedback received included:

• How do you rate the app? Average score - 4.05/5
• How do you rate the new process for recording observations? Average score - 4.20/5
• How confident do you feel using the app? Average score - 3.95/5

Next steps

The ePR Team will look to digitise more of the paperwork currently on the wards to Brigid, including:

• National Early Warning Score (NEWS) 2 and Paediatric Early Warning System (PEWS) physical health scores
• fluid balance
• other physical health assessments
• recording patients leaving and entering the ward
• managing patients leaving the ward

Team: Electronic Patient Record Team
Contact: jenny.gillison@nhs.net​​​​​​

What did we want to achieve?

SMS text messages and emails to be sent from SystmOne to patients to enable:

• patients to confirm their phone number
• appointment confirmation
• appointment reminders
• ad hoc messages
• electronic fit notes to be sent
• links to support and guidance to be sent to patients in crisis

What we did

The Electronic Patient Record (ePR) Team worked with other teams to understand their processes for communicating with patients and booking appointments.

They redesigned SystmOne clinics and rotas to optimise them for digital communication and provided onsite training and support to each team.

Results

The following teams are now live with digital communication from SystmOne:

• Chester Community Mental Health Team
• Children and Young People’s Mental Health Support Team
• Adult ADHD Service
• Crisis Line
• Children and Young People’s Mental Health Service (0-18) - West Cheshire
• Mental Health in Schools Teams
• Wirral Single Point of Access
• GP Out of Hours Service
• West Cheshire Physical Health Single Point of Access

Electronic fit notes have also been rolled out Trustwide.

Next steps

The ePR Team plans to roll this out to all other services. The ePR Team is also looking to expand to include two-way SMS messaging, and sending links to questionnaires and outcome measures to patients to fill in, that will be filed back to SystmOne.

Team: Continence and Urology Service
Contact: c.evans13@nhs.net ​​​​

What did we want to achieve?

Claire Evans, a community urology lead nurse specialist also works as a urology scrub nurse in secondary care. Three years ago, whilst in theatre, she was supporting a surgical procedure on a young patient who had irreversible damage to their urinary system secondary to recreational ketamine use. Soon after, she noticed an increase in young people with irreversible damage to their urinary system in primary and secondary care. It became apparent to Claire that there was an increase in recreational ketamine use and education was vital. Therefore, she dedicated her spare time to carry out preventative work.

What we did

Claire began visiting schools, youth services, charities and a local prison service to provide the preventative education. She presented to pupils, staff and volunteers that worked alongside youths. She was also invited to present her work at CWP’s Physical Health Conference. Due to the target audience at the conference, she was approached by Public Health and invited to join a Ketamine Harm Reduction Task and Finish Group. Since joining this group, she has been commissioned by the local authority to provide educational sessions on a weekly basis. She has also started providing the educational sessions to GPs.

Results

Positive outcomes have unfolded across both settings:

• Young People’s Community Drug and Alcohol Misuse Service has seen an increase in ketamine referrals.
• Young people are managed with correct medication whilst they are waiting for review in secondary care.

Feedback has included: “Claire advised me to use certain medications, which I now take on repeat prescription until my body heals. Claire regularly checks up on me, giving me advice and answering any questions. Without the advice and support Claire has given me, I wouldn’t be where I am now. I will always be so grateful and will never be able to thank her enough.”

Next steps

Claire’s plan is to develop a model of proactive care (ketamine champion model) and health prevention education whilst raising awareness amongst young people. This will enable clinicians to identify ‘red flags’ surrounding recreational ketamine use, whilst recognising early signs and symptoms of ketamine-induced uropathy in young people. Clinicians would then be able to provide preventative education and signpost to relevant support services.

The ultimate aim is to reduce health inequalities within young people whilst preventing irreversible damage to their urinary system secondary to recreational ketamine use.

Team: Involvement, Recovery and Wellness Centre / Community Mental Health Team - Crewe / Nantwich and Rural Primary Care Community
Contact: tracey.williamson3@nhs.net​​​​​​​​​​​​

What did we want to achieve?

Nantwich and Rural Primary Care Community, the Community Mental Health Team (CMHT) in Crewe, and the Involvement, Recovery and Wellness Centre (IRWC) collaborated to address an unmet need identified by the people of Nantwich.

Together, they established a time-specific, safe peer support group for neurodivergent individuals - both diagnosed and undiagnosed, that included conditions like attention deficit hyperactivity disorder (ADHD), autism, Tourette’s syndrome, obsessive-compulsive disorder, dyslexia, and dyspraxia.

The group’s aim was to provide a dedicated space for participants to share experiences, exchange knowledge, and support one another in a sharing and learning environment.

What we did

Research conducted by the Nantwich and Rural Primary Care Community highlighted that neurodivergent individuals often face similar challenges in social interaction, communication, and navigating a world that is not always accommodating to neurodiversity. As a result, establishing a peer support group could provide valuable support.

This idea was discussed at a care community meeting, attended and supported by Crewe Community Mental Health Team’s manager. On recognising the benefits, she offered support from her own team and enlisted staff from the IRWC to assist with its development, and to ensure a safe and supportive environment.

Results

The trial group ran for six weeks and was promoted through IRWC prospectus and Facebook page, as well as the Nantwich and Rural Care Community’s Facebook page.

The brief advertising period could have contributed to lower attendance than expected. Despite this, eight people registered interest, with five attending regularly. Participants completed a Recovering Quality of Life outcome measure in weeks one and six to assess the group’s impact and quality. The scores and feedback indicate an enhancement in wellbeing was achieved because of the group.

Feedback included:

• “Brilliant.”
• “Well-structured and knowledgeable, especially by drawing on lived experience.”
• “I now understand my behaviours.”

Next steps

After assessing their strengths and areas for improvement, they identified the need for longer, more effective advertising to boost attendance, reduce dropout rates, and enhance cost efficiency. Adding more structure to sessions will also improve self-management and service signposting. Due to requests from Nantwich and Rural, along with additional support requests from the Additional Roles Reimbursement Scheme workers, they now plan to trial and facilitate groups in Macclesfield, Crewe and Wilmslow areas.

Team: Pharmacy Team
Contact: v.earnshaw1@nhs.net​​​​​​​

What did we want to achieve?

Antimicrobial resistance (AMR) is a significant global health problem as resistant organisms lead to longer illnesses, increased treatment costs and increased mortality. The Pharmacy Team wanted to strengthen their systems for antimicrobial stewardship across CWP inpatient mental health services, and develop a digital reporting system to support the audit of antimicrobial prescribing across inpatient services. This would reduce burden on clinical staff having to complete manual data collection. The team wanted to collaborate with external partners to develop a national antimicrobial audit tool / standards, to ensure best practice is followed across inpatient services.

What we did

• Through collaboration with a Business Intelligence Analyst, the team developed a report to extract antimicrobial prescribing in an automated way.
• The team joined the NHS England Antimicrobial Stewardship (AMS) national working group for community health, mental health, and health and justice.
• They joined the NHS England National Data and Benchmarking Working Group, and through this developed / piloted an inpatient mental health antimicrobial audit tool.
• They presented the digital tool, audit results and next steps at an NHS England Antimicrobial Stewardship National Webinar and via internal Trust governance.​​​​​​​

Results

• Pre-digital reporting 97 prescriptions audited in a quarter - now increased to 453.
• Pre-digital reporting 66% of prescriptions have a stop date on antimicrobial prescriptions - now increased to 98%.
• Audit process is more automated with less manual data collection.
• Antimicrobial audit standards have been developed for inpatient mental health services, which are now being used at a national level.
• Infection Prevention and Control ward visit check list updated to include checks on antimicrobial prescribing during ward visits.

Next steps

To continue to build on the following digital developments which are in progress:

• Add a hyperlink to antimicrobial formulary in Electronic Prescribing and Medicines Administration (EPMA).
• Mandatory allergy status to be required prior to prescribing medicines.
• Include antimicrobial data in ward dashboards to support better oversight of antimicrobials.
• Better engagement of prescribers in antimicrobial stewardship and audit process.
• Continue to address health inequalities and ensure patients with mental illness, and learning disability have appropriate antimicrobials prescriptions.