Step 1: What are you already doing?

In order to identify the changes that need to be made, you first need to establish what you’re already doing.

A detailed job plan is one of the best and easiest ways to show how you (and the rest of the team) spend your time. Laying it all out will help you show the service you currently provide, and who is providing that service (for example, you may find that nurses spend a lot of time doing admin). It will also help you identify the gaps in that service.

Below is a link to the job plan builder on the Apollo Nursing Resource to help you get started. This is an excellent source of information and support for specialist nurses.

Questions to ask yourself now:

• What service do we currently provide?
• Are there any obvious gaps?

Further Reading

• Example job plan (pdf)
• Job plan builder

Step 2: Identifying the need

Now that you know where the gaps in the service are, your job plan (used in conjunction with the IBD standards) can form the basis for your business case.

The standards are a good place to start, and you might be able to easily identify where your service is currently not meeting requirements. Where do you meet them and where could you improve?

For example, is your service falling short of the recommended minimum of 2.5 whole time equivalent IBD Nurses per 250,000 population, or maximum of 500 patients per nurse?

Beyond the standards, identify the pressure points within the trust that your proposal might be able to resolve.

For example:

• High A&E attendance for IBD symptoms
• Heavy spending on biologics
• Long waiting lists for IBD referrals
• Repeatedly resorting to surgical IBD interventions

Questions to ask yourself now:

• Where do we meet standards?
• Where are we falling short?
• Are there any obvious pressure points or bottlenecks?
• Would you be able to resolve any of these?

Further Reading

• IBD Standards | IBD UK (2019) NICE quality standard for inflammatory bowel disease, 2015
• Case modelling report (pdf)