How can we create the flexibility to deliver a more personalised FNP for clients?

Family Nurse Partnership (FNP), like any commissioned service, is a valuable and finite resource within a local context. It’s absolutely vital that it can be used to maximum effect for improving outcomes for children and families. And this often requires flexibility, particularly in response to clients’ needs.

But how do we manage flexibility within a manualised programme like FNP?   

This is our challenge as we embark on an exciting project within the ADAPT programme to design and test personalisation in FNP.

We know from work undertaken in Nurse Family Partnership in the USA that by responding more flexibly to client needs, in terms of both visit schedule and the content of visits, family nurses are able to focus work on the clients who need it most while still achieving good outcomes for clients who require less intense support. This approach also decreased attrition in the USA. The message from FNP teams, provider organisations and commissioners in England is clear: we’d like to know if this could work well here.

In England, we plan to focus our adaptation work around four key areas of flexibility:

  • The eligibility criteria – to ensure the most vulnerable first time mothers receive the service.
  • Visit content – flexing it in response to identified client needs.
  • Visit frequency – increasing and decreasing the numbers of visits (which we are calling dialling up/dialling down) in response to individual client need. 
  • Early graduation – transitioning clients to universal services before their baby reaches 2, when and if they are ready.

Assessment is at the heart of getting decisions right about flexibility. It’s clear from our early work on personalisation that we need a tool that will support family nurses to think with their clients, and with their supervisors, about changing the frequency of visiting, identifying the most beneficial areas of programme content and assessing if early graduation is an option.

As we delve deeper into what this tool might look like, four key questions have emerged which I feel are critical to help shape our thinking.

1. How do we personalise in a way that is equitable and replicable?

Ultimately we’re looking for a tool that ensures the FNP programme is consistent, whether the client is in Bolton or Bristol, and whoever her family nurse is. We need something that reduces subjectivity, not only for our evaluation work in the rapid-cycle testing phase, but for the integrity of the programme at scale.

2. How do we ensure we’re not simply adding in another layer of assessment?

Family nurses already undertake a huge amount of assessment with clients. If we add something in, should we take something out?  Could we create an opportunity to pull together information which nurses already gather through FNP, rather that reinventing the wheel?

3. How can we ensure any tool we develop supports the multi-layered collaboration that is critical to FNP – between client, family nurse and supervisor?

Something that is visual can help illustrate what’s going well and other areas that need work. Any tool we use should help facilitate and represent conversations between client and family nurse, as well as between family nurse and supervisor.

4. How do we ensure we retain focus on both client and the baby?

The reality is that FNP serves both mum and child, as well as the father or partner in many cases. The intergenerational quality of its impact is one of FNP’s great strengths, borne out in early positive indications about child development in the Building Blocks study.  Ensuring the baby remains at the heart of the work, alongside the client, is critical and this must be reflected in any assessment tool we use.

There’s no question that personalisation reflects the values we work to in FNP.  In many ways family nurses think in this way already. Agenda matching, for example, is all about asking: what’s the client’s agenda, what’s the nurse’s agenda, and how do we align the two? 

What we can do now, through ADAPT, is to formalise this sense of personalisation more broadly and consistently, informed by evidence and using rapid-cycle testing to evaluate its impact.

By Sarah Tyndall, Clinical Advisor and Educator in the FNP National Unit. 

For more information about ADAPT and other FNP Next Steps projects, visit: fnp.nhs.uk/evidence/fnp-next-steps.