21 September 2021

By Emily Guilmant-Farry, Children’s Community Asthma Nurse Specialist, Newham, London

Community-based clinical nurse specialist (CNS) roles can be a lonely experience, with poor links into secondary and tertiary care and  a reduced opportunity to keep up to date with care happening in the acute setting and with new research and changes to practice. The North East London Asthma CNSs set about empowering, upskilling, developing knowledge and networking across London (and beyond) to reduce the postcode lottery of care in asthma in London.

In 2018, with the commissioning of a winter resilience project in Newham, I was employed as an asthma nurse in the same borough. Having learned my asthma craft in a tertiary centre, I knew a few others in similar positions and set about saying hello and reconnecting with them. We had similar roles, some community, some hospital based, but all set around the North East London Area. We all had a drive to standardise our practice as much as possible. We also had the help of the local acute trust CNS to keep our learning up to date and to share that with others on study days.

We realised the benefit of our regular meetings in terms of networking, learning from others about innovative practice and Continuing Professional Development (CPD) accreditation (often difficult to obtain in the community). We felt it would be great to share these benefits with our colleagues across London.

Tentatively, we approached some pharmacology and technology reps for help. Not only did they know where other nurses were based, but they also offered support for us to meet in central London for our very first meeting.  We (but mostly Louise Cherry) put together a programme looking at advances in asthma care and air pollution and also set aside time to discuss our aspirations for asthma care in London and if we wanted this type of networking to continue.

We linked with Healthy London Partnership (now NHS England, London Region) to send out details. We booked a room that could take 40 people, thinking that would be more than enough; I mean, how many of us were there after all?

Turns out – a lot!  We eventually needed a waiting list for people to join us (this was pre-pandemic Zoom days).  We had set it out to be a London (within M25) meeting, but had colleagues from Essex, Milton Keynes and Brighton join us for that first meeting.  We discovered people working in solitary roles, as part of big teams and had people from community, secondary and tertiary care join in.  To meet so many like-minded people in one room was a joyous moment.

We agreed that we would love this type of meeting to continue quarterly and be London based, while recognising that country wide would be a bonus. We wanted to focus on supporting each other as a network, learning from each other, developing skills through teaching and inspiring asthma care across London.  We agreed to develop a WhatsApp group for support in-between times, and collated up to date information on who worked where. We agreed for agendas and teaching to be based on what the group wanted to learn about.

So what have been the benefits?

• Knowledge of where our colleagues are in London, who they are and what they love to do. This has come in handy with an ever-moving London population, who before the network would move boroughs and get lost to follow up.  Now we just email our colleagues and refer them to an appropriate CNS to ensure continuity of care – something the families appreciate.
• Quick knowledge boost from the teaching sessions which have included: housing and asthma, viral induced wheeze, air pollution and asthma, smoking cessation, and innovations in care – such as Asthma Friendly Schools (AFS), 48-hour reviews, group consultations, and updated guidelines to name a few. Because the group requests these, we know we have an interest in the subject matter!
• A dynamic WhatsApp group – where questions are asked and someone somewhere knows the answer – and responds very quickly; it’s a great resource!
• Innovations discussed have gone on to change practice across London. For example, the teaching by Hillingdon inspired a review of Newham’s AFS policies and a new roll-out of AFS in the borough – which has been incredibly successful. The team at the Whittington Hospital discussed group consultations, and many of us have now looked to see if this can be incorporated into the work we do.
• The group are often contacted when new information or consultations are required for asthma care. This would never have happened pre network – as we just weren’t co-ordinated. We have the fabulous team at NHS England, London Region, to thank for this as they help us organise the meetings, keep us up to date with other learning available, consultations and ask us to take part in events such as #AskAboutAsthma.

Two years on, I co-chair the group, which continues to meet quarterly.  With Covid-19 we feared a loss of the group when it might be most timely to catch up with colleagues who were redeployed or being asked to stretch themselves and work in a different way.  However, we swapped to online meetings (didn’t everyone?) and found we had an even bigger reach not limited to room size.

We embraced our GP nurse colleagues, school nurses and even had a few medical students join us along the way, as well as supporting those who were in effect lone workers.

We have managed largely to continue as we were, but I am hopeful that we can progress to a hybrid mix of in-person and online meetings (networking is so much easier in person).  We have not yet taken on the challenge of meeting up nationally, but it has been discussed – as the benefits to ourselves and others as a forum for discussion about the state of asthma care would be huge.

Maybe that’s a challenge for 2022 ….

See more from #AskAboutAsthma 2021