The Family Nurse Partnership (FNP) is a licensed programme. One way of looking at this is to think about the comparison with prescription drugs - these are licensed to be used to treat specific medical conditions, to be given to a particular group of patients at a prescribed dose.  In FNP, families benefit most when the programme starts early in pregnancy, where the number of visits and content delivered is as set out in programme model and where the clinical methods and approaches of FNP are used well. 

A complex community-based intervention such as the FNP programme has far more licensing requirements than just the eligible population and ‘dose’, but the principle is the same. If the programme is not delivered in the way that is set out in the license agreement, then it is also less likely to realise its intended benefit.  Licensing requirements may also be updated to reflect new learning and the delivery context.

Licensing requirements: Core Model Elements

The licensing requirements are known as the ‘Core Model Elements’. These are the key ingredients of FNP. Delivering FNP according to the Core Model Elements provides confidence that the programme is being well replicated and is more likely to result in the same outcomes to those found in the US research trials. The Core Model Elements relate to clients, nurses, supervisors, administrative support and the implementing organisations.

The FNP Core Model Elements are supported by evidence of effectiveness based on research, expert opinion, field lessons, and theoretical rationales. They have been adapted for the UK setting as a result of the formative evaluation and experiences within UK FNP sites, and have been approved as the UK licensing conditions by Professor David Olds at the University of Colorado.
 

FNP Core Model Elements

Clients

Voluntarily

All FNP clients participate voluntarily in the programme.

High-risk mums

Eligible clients are high-risk, first-time mothers only (i.e. low resource mothers or teens). To enrol young mothers, sites use the eligibility criteria set out by the FNP National Unit.

Enrol 60% by 16th week of pregnancy

Sites should enrol at least 60% of clients onto the programme by the 16th week of pregnancy and 100% no later than the 28th week.

Same family nurse

As far as possible, clients are visited by the same family nurse throughout their pregnancy and the first two years of the child’s life.

Family Nurses

The below criteria make up the core elements of a family nurse.

Qualifications and registration

Prospective family nurses must be registered with the Nursing and Midwifery Council (NMC), educated to a degree level, and meet the family nurse person specification.

FNP learning programme

Nurses must complete all elements of the FNP clinical learning programme and deliver the intervention with fidelity to the FNP model.

FNP visit guidelines

Follow the FNP visit guidelines and use the programme theories, their learning, professional knowledge and judgment to individualise them to the strengths and challenges of each family, apportioning time across defined programme domains.

FNP supervision

Actively participate in FNP supervision as specified and apply the theoretical framework that underpins the programme, utilising current clinical methods.

Caseload

Carry a caseload of no more than 25 families per full-time employee.

Work substantially on FNP

Work at least three days per week (22 hours per week) as a family nurse.

Exclusivity

Work exclusively in the FNP programme unless agreed with the FNP National Unit.

Data collection

Nurses should collect data about activities, visit content, mothers and children according to the schedule and procedures specified by the FNP National Unit. They should use data reports to guide clinical practice, inform supervision and demonstrate programme fidelity.

Supervisors

The below criteria make up the core elements of an FNP supervisor.

Registered and qualified

Be registered with the NMC, at least equivalent in education and training to family nurses, preferably to Masters level, and meet the person specification requirements.

Clinical and supervisory elements

Complete both the clinical and supervisory elements of the FNP learning programme.

Supervisory load

Carry a supervisory load of no more than eight individual family nurses (per full-time programme supervisor).

Carry a small clinical caseload

Supervisors should carry a small clinical caseload (a minimum of 2/3 families).

Work substantially on the FNP programme

Work at least four days per week (28 hours per week) in FNP. In expanding sites, it is possible to employ additional supervisors on fewer hours, with the agreement of the FNP National Unit.

One-to-one clinical supervision

Provide one-to-one clinical supervision to each family nurse on a weekly basis (pro rata for part-time nurses) preferably in person but by telephone where travel constraints limit nurse or supervisor mobility.

Team supervision meetings

Conduct at least four team meetings per month - two to discuss programme implementation, and two case-based meetings to identify client challenges and solutions.

Help nurses learn

Facilitate the learning of each family nurse in the team, including developing an individualised learning plan for each nurse and leading the team based learning activities, as specified in the FNP learning programme.

Accompanied home visits

Make a minimum of one home visit every four months with each nurse for field supervision purposes.

Use programme data

Use programme data reports to assess and guide implementation, inform supervision, enhance programme quality and demonstrate fidelity.

Administrative support

Each site will employ a Quality Support Officer (QSO) for at least 0.5 whole time equivalent (WTE) per 100 clients enrolled to help family nurses and supervisors with administrative duties. A QSOs core elements are outlined below.

Assuring data completeness and quality

Ensure that data about family nurse activity, visit content, mothers, and children are entered into the local database completely and accurately on a timely basis.

Office support

Provide general administrative and office support to the team.

Psychological consultancy

Each FNP team will have an appropriately qualified and skilled psychological consultant who will offer monthly consultancy as set out in the FNP Management Manual.

FNP Advisory Board

The FNP Advisory Board is responsible for the following systems.

Support and structure

Ensure adequate support and structure is in place to support family nurses and supervisors to implement the programme and input accurate data into the FNP Information System in a timely manner. They should also ensure safeguarding supervision and systems are in place in accordance with the FNP Management Manual.

Clinical governance

Ensure clinical governance arrangements are in place for programme implementation, which includes regular review of FNP clinical guidance and updates to the Management Manual.

Quality improvement measures

Review programme implementation and ensure quality improvement measures are put in place to promote continued enhancements in programme delivery.

Implementing agencies

The below criteria make up the core elements of an FNP implementing agency.

Reputation

Implementing agencies should be located in and operated by organisations known in the community for being a successful commissioner, and provider of prevention services to low-income families.

Advisory board

Convene a long-term FNP Advisory Board, chaired by a senior commissioner, that meets at least quarterly to promote a community support system to the programme and to promote programme quality and sustainability.