Campaigning for a Sapphire Nurse - Application process

The application process

Most enquiries to Epilepsy Action about the Sapphire Nurse scheme come from neurologists, paediatricians or managers of specialist services. However, enquiries are also received from GPs, existing epilepsy specialist nurses and Epilepsy Action branches.

Sequence of events

• Initial enquiry received by Epilepsy Action and information pack made available.
• Draft business plan produced and sent to Epilepsy Action. For most paediatric posts, a completed Roald Dahl’s Marvellous Children’s Charity application form is required.
• Epilepsy Action sends a copy of the business plan to the sponsors when relevant.
• Business plan reviewed by Epilepsy Action and appropriate changes made.
• Business plan submitted to trust by the applicant.
• Written conformation of ongoing funding by the trust sent to Epilepsy Action.
• Job description and person specification sent to Epilepsy Action by the applicant.
• Job description and person specification reviewed by Epilepsy Action and returned to the applicant.
• Meeting between Epilepsy Action, the consultant, a representative of the trust and Epilepsy Action’s sponsors where relevant, is arranged to discuss the post.
• A decision is made by Epilepsy Action and the sponsor, where relevant, as to whether the application is successful or not. If the application is successful then:
• Job advertisement submitted to Epilepsy Action for review and comment.
• Post advertised by the trust.
• Interviews take place, with a member of Epilepsy Action staff on the interview panel.

This is the ideal application route, however there are variations between trusts.

Understanding the trusts

The trust has to give a written undertaking to Epilepsy Action that they will fund the post permanently once pump priming ceases. Obtaining this is the hardest part of the whole process.

It is important to understand the structure of the trusts, as this will almost certainly be the focus of your campaign. There are two types of trust, the primary care trust (PCT) and the hospital trust. The hospital trust is sometimes referred to as the acute trust.

The PCT

PCTs are responsible for deciding exactly which health services the local population needs (e.g. GPs, hospitals, dentists, pharmacies etc) and for guaranteeing these services are provided. Each PCT covers a specific geographical area. A district general hospital may be the main hospital for several PCTs.

It can be more complex if the nurse is going to be funded by the PCT/PCTs after the initial funding by Epilepsy Action. The reason for this is as follows:

Example:
A district general hospital has within its catchment area, a population that covers five PCTs. An epilepsy specialist nurse is needed but this is only recognised by two of the PCTs. This gives rise to two possible outcomes.

• The two PCTs are only prepared to contribute one fifth each of the nurse’s ongoing salary. The result is that a new post is not created.
• The two PCTs are prepared to fund the whole of the nurse’s ongoing salary. A new post is created but the two trusts insist the nurse only sees patients from their PCTs. This creates a dilemma within the hospital. The clinics held by the neurologist in the hospital cover patients from all five PCTs. If the nurse holds clinics within the hospital, the neurologist can only refer patients from the two PCTs’ catchment areas to the nurse.

The acute trust

The acute trust is financially responsible for the district general hospital. It obtains most of it’s funding from the PCT. If it is the acute trust that will fund the nurse after the initial funding by Epilepsy Action, then the nurse will be able to see all the patients that are within the catchment area of the hospital.

Which trust to target

There is a growing trend for Sapphire Nurses to be community based while in the past they were hospital based. There are several reasons for this.

• By holding clinics at different locations within the community, it makes it easier for patients to attend
• The nurse can see more patients by holding clinics in different locations
• By educating GPs and GP practice staff, the nurse creates a network of clinicians who can deal with the needs of people with epilepsy
• A nurse who is involved in the community may be able to offer advice on community, social and financial issues to people with epilepsy and their carers

As a result of this, most applications for Sapphire Nurses are made by PCTs and not by acute trusts. It is important to bear in mind that even if the Sapphire Nurse is based in the community, they would need to receive clinical supervision and guidance from a named doctor.

• Epilepsy Action Sapphire Scheme booklet for PCTs and health care professionals