Step 3: What do we need to fill the gaps?

By this point, you have identified your gaps and proposed the solutions. Now you need to outline the resources/personnel you will need to implement them.

• Are your current nurses spending all of their time answering the phone? Perhaps you need more administrative support.
• Is the biologic service growing? Consider a specialist sister to manage assessment, administration and monitoring.
• Are outpatient clinics full to capacity? A clinical nurse specialist could lead further clinics.

These are just examples, but it may be clear from your job plan where your service needs extra support.

Questions to ask yourself now:

• What resources do we need?
• What staffing do we need (and who do we already have)?
• How much would they cost?

Further Reading

• Job descriptions
• HSJ: A powerful case for specialist nurses

Step 4: Showing the value

Once you have identified the gaps in your service, you need to show how filling them will benefit the trust.

Because new staff with new salaries can easily be seen as a bottom line cost, you will need to show how much return on investment they can provide. This will typically involve showing how specialised care improves efficiency and eases the pressure on other parts of the NHS.

Service improvements generally fall into five categories: Risk management, service redesign and improvement, income generation, cost saving and increasing capacity.

For example, patients with access to an IBD telephone clinic may not have to resort to A&E or primary care – and when they do require face-to-face counselling, may not have to wait for an appointment with a consultant.

A specialised IBD team can also more effectively manage medication, reducing expensive over-medication and even managing the transition to biosimilars – saving even more money.

These are just examples, and will vary from case to case but typical service improvements include:

Risk Management     

• Compare the gaps in care to the National Standards
• Drug management pathways (assessment, patient information, safe monitoring, preventing complications)
• Risk register – have you identified risks in the IBD service for the risk register, how can nursing  address them?
• Complaints – are there any recurring themes?

Quality improvement and service redesign 

• Using nursing services to redesign
• Increasing self-management (patient education, telephone contact)
• Improving patient satisfaction

Income generation   

• Understanding tariffs (outpatient, non-face to face, procedures, day case) and how you generate income for the service

Cost savings            

• Improving high-cost drug management (appropriate use, ensuring funding, liaison with pharmacy, monitoring, stopping when appropriate)
• A&E avoidance
• Avoiding inappropriate outpatient appointments
• Preventing GP visits
• Reducing length of inpatient stay

Increasing capacity  

• Reducing medical workload
• Increasing non-face to face activity (telephone, virtual clinics, social media)
• Running community/primary care clinics
• Managing patients closer to home

Questions to ask yourself now:

• Which areas are we looking to improve?
• Is there a precedent for this kind of case?
• What were their outcomes?
• Is that applicable here?
• Is this saving time? Money? Resources? All of the above?