On the 27th May, I met with Mhairi Cavanagh, FNP Nurse Supervisor in Glasgow, who invited me to attend a meeting of the Glasgow City Community Health Partnership. The meeting was chaired by Lorna Dunipace, head of Primary Care and Community Services in Glasgow, and included representatives from the Family Nurse Partnership, the local Child Protection authority, the Health Visitor program, and other members from the local NHS and Local Government authority.
The group was originally set up to oversee the implementation of Family Nurse Partnership in Glasgow. Although the initial goals of the group had been fulfilled, the group has continued to meet because of the benefit gained from ongoing information sharing between senior health and children’s services managers, and also to oversee the next phase of implementation.
Two teams have been established in Glasgow, each with the prescribed staff profile of eight nurses, one nurse supervisor, and one administrative person. The nurses have a caseload of between 19-23 clients.
The goal is to offer the program to all young pregnant women under 20 years of age, so that FNP becomes universal care for young women. To achieve this, Glasgow City will need eight FNP teams, and a plan was tabled which showed a phased implementation over three years. A new team of nurses would be recruited every four-six months. This represents a significant financial commitment, both in staffing and infrastructure, however Glasgow City has confirmed its support for the program.
When a nurse starts in the FNP program, she is in her “learning phase” which means that she doesn’t start with a caseload of 25, but builds her caseload as she learns the program. By the time her first clients are graduating at age two, she will have a full caseload.
There was a discussion about the career pathway for FNP nurses, and it was noted that this was lacking in the structure. FNP nurses may have the opportunity to become nurse supervisors, or to work in the National Unit in Clinical education or leadership, however, this is not an option for all. I observed that Maternal and Child health nurses in Victoria have a similar problem, with a very flat management structure, and few opportunities for career development and promotion.
Unlike Edinburgh, Glasgow does not have a centralised maternity intake, so recruitment of clients is less straightforward. The NFP teams have found more success if they are able to recruit the women directly, as leaving it with the midwives has been less successful, and potential clients have been overlooked. This may have been because of midwives not fully understanding the program, and having too many other things to cover at the first maternity appointment.
Working directly with the maternity hospitals, with the FNP nurses being able to contact the women directly, has helped overcome this. Also, with the full implementation of the program, it will be presented as universal care that women can “opt out” of, rather than a specialised program that they have to “opt in” to. This presents the Family Nurse Partnership as a universal program for young pregnant women, not just for those who need additional support, thereby removing any possible stigma attached to the program.