Transforming Nursing, Improving Care

When Katie Barnes '89, MPH, RN, CPNP, FFACH, started the Salford Children’s Community Partnership (SCCP) in the U.K., children had 10 minute appointments and were often referred to the hospital for further evaluation.   Barnes, executive director and founder of Kids’ Health Matters (a social enterprise established to improve the health care of children in the U.K.) obtained government funding for the three year Salford pilot in order to test out her hypothesis that embedding pediatric expertise into the British general practice model would reduce emergency department visits and short stay admissions; improve quality, and make important savings for the National Health Service.

“When the project began, pediatric primary care didn’t exist – in the U.K. model, primary care is delivered by general practitioners (GPs) who care for you from cradle to grave,” Barnes recalls.  “Nurse practitioners are also relatively new to the U.K., so this project was a double whammy – advanced nursing practice and pediatric primary care; it is a very simple idea but it is ground-breaking for the U.K.”

Barnes began her work in Salford by insisting that appointment times be doubled to 20 minutes. Then, she set aside an observation room where children could be observed if required - another way to avoid sending kids to the hospital. She started stocking basic medicines for common pediatric ailments like diarrhea or asthma, and showing parents how to use these treatments in the clinic.  “We knew from previous research that families were often going straight to the hospital, bypassing the GP in order to get pediatric expertise.  This was swamping EDs and wasn’t good for kids, families or the NHS budget.” 

While her approach was unorthodox in Salford, the project won over families who were thrilled with the pediatric-specific care that was close to home and with immediate appointment access. In the first year of provision, short-stay pediatric admissions costs dropped 40 percent and quality ratings soared; thereby providing evidence of Barnes’ original premise that “if you get the quality right, the savings will follow.”  Her pilot won the 2103 General Practice Awards and was nominated for several others.  In addition, the model is being evaluated for roll-out in other communities across the country.

Barnes secured the original £450,000 grant for the Salford pilot project as a way to demonstrate the benefits of using pediatric nurse practitioners in primary care. And, as a founding member of the Paediatric Advanced Nursing Group, Barnes also worked to establish the first MSc Advanced Paediatric Nurse Practitioner (APNP) degree program in the U.K., a credential that previously didn’t exist.

For her contribution to improving the quality and availability of pediatric care in the U.K., Columbia Nursing will bestow Barnes the Distinguished Alumni Award for policy and education. She is being honored with a select group of alumni who have made outstanding contributions to the nursing profession through their work in research, clinical practice, education, health policy, or humanitarian efforts.

To Barnes, proving the benefits of APNP-delivered care is just the beginning. She has just founded, with two pediatrician colleagues, the first UK-based organization whose primary remit is to improve the care delivered to children in ambulatory settings.  “Ambulatory means walk in and walk out, so our newly formed faculty of Ambulatory Child Health will focus on improving just about all aspects of care for kids.”  With the U.K.’s long tradition of general practice, Barnes knows this will be a hard sell, but she’s not about to back down. “I have worked twice as hard to get a stone to move, and it is worth the effort,” Barnes says. “If you want to do more for the patients in your exam rooms, you have to participate in policy decisions and not be afraid to get involved in politics. As a nurse, to help the greatest number of patients you use your clinical practice experiences to inform health care policy.”

Barnes says she always wanted to be a pediatric nurse practitioner. She dreamed of following in the footsteps of a close friend’s mother who was nurse practitioner. After completing the pediatric NP program at Columbia University School of Nursing, Barnes worked a series of jobs in New York City, including stints providing mobile vaccinations for the Children’s Aid Society and creating a laboratory review and case management process for the NY Children’s Health Project. Then, she picked up and moved to Guatemala to work in immunization logistics for a non-governmental organization, Proyecto Ak’tenamit.  From there, her career took an unexpected path.
“I got to the U.K. by following my passion – both in my career and in my life,” says Barnes. She met her future husband in Guatemala, and followed him to East Anglia, where her Irish citizenship through her relatives back in Boston made it possible for her to continue work as a nurse. But even though her lineage made it legal for her to work in the U.K., Barnes quickly realized that her American education as an advanced practice nurse wouldn’t easily translate into the type of clinical work she was qualified to do in the U.S.

When she arrived in East Anglia in the late 1990s, the notion of advanced practice nursing wasn’t well developed outside of London and nursing specialties like pediatrics that were based in primary care were unheard of. “Now, there’s really a groundswell, and advanced practice NPs are very much part of the lexicon, along with the idea that nurse practitioners can provide specialized pediatric care in a variety of settings,” Barnes says.  “Most days I can’t believe my luck; I have had tremendous opportunities to use my clinical practice as a springboard to improve health care for children by pairing it with child health policy development and advanced practice education – I’m not sure it gets better than this.”