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New NHS chief: Advanced nurses key to future of NHS care

The new chief executive of NHS England has said he wants to “accelerate the redesign of care delivery” and change traditional staffing models to include more senior nurses.

In one of his first speeches since taking up the post in April, Simon Stevens said that while in some cases services needed to be concentrated, he believed in others they could be redesigned to make facilities such as district general hospitals more viable.

Speaking at the NHS Confederation NHS management conference in Liverpool he said he wanted to “accelerate the redesign of care delivery… Rather than constantly debating the reorganisation of our management tiers, let’s now ask the more profound questions about how care is actually being delivered”.

Mr Stevens, who spent 10 years running international health insurance giant UnitedHealth before taking up his current role, said the NHS needed to “tear up” silos between primary, secondary and community services and rethink why things are done in the way they are.

“I’ve been struck by certain features of how we organise care. While we tend to regard them as self-evident, they are in fact just contingent choices whose original rationale is now either forgotten, irrelevant or on balance unhelpful.”

He said existing staffing models should not be allowed to dictate how care is delivered if that is not in the best interests of patients.

“That’s why some would like to see more general physicians or ‘hospitalists’ working alongside consultant specialists. Together with advanced nurse practitioners, sessional GPs, and networked staffing arrangements with neighbouring trusts.”

His comments come as many smaller hospitals struggle to find enough doctors to staff services safely due to the trend for increasing sub-specialisation over recent years. Some organisations have argued this means they need to close services or merge with other organisations.

Mr Stevens added: “I am definitely not suggesting a wholesale reorganisation of medical training and staffing across England.

“What I am arguing is that medical training and staffing should not drive the wholesale reorganisation of district general hospitals across England.”

Readers' comments (6)

  • How senior? It seems to me the more senior they are the less time they spend with the patient and more time spent at meetings.

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  • He presumably means senior clinical nurses, not managers, therefore they shouldn't be spending too much time at "meetings", but a certain number of meetings are necessary for all senior clinicians, for example, ensuring good clinical practice is in place, liaising with other agencies, informing commissioners, case conferences, vulnerable adults meetings, linking with pharmacy, primary care, education, workplaces etc etc are examples of useful meetings and it's not sensible to dismiss and criticise "meetings" in general, implying they're a waste of time. Some are, but most aren't! The person who says "it seems to me "etc, should really try to find out exactly what does happen at meetings, then come up with some constructive ideas if they feel that things could be done better...More senior nurses providing direct patient care is what has been cried out for and it seems this is being promoted at last.

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  • Anonymous | 5-Jun-2014 8:08 pm

    "...it's not sensible to dismiss and criticise "meetings" in general, implying they're a waste of time. Some are, ..."



    http://www.1erdegre.ch/blog/2014/03/24/linterview/

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  • How refreshing though to read his view that it is time to stop re-structuring managment layers and focus instead on clinical care delivery. Couple with clinically led commissioning this could be a good time.

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  • michael stone

    I suspect that the 'more senior nurses' thing is related to the 'more care in the community/at home' objective: I'm guessing he means that he wants district nurses to be very good at spotting and quickly treating problems in [especially] elderly patients, so that many less of these elderly patients end up in hospital [from 'preventable' causes].

    Of course, that plan relies on having enough district nurses, as well as DNs being good enough to provide that care and prevention: as several pieces on NT have pointed out, the likely requirement for more DNs if the emphasis is to be on primary care, seems to have been rather overlooked so far.

    Although as a cynic (which the DT told me last week leads to dementia), there is a lot of 'integrated working' mentioned in the piece - I'm not so sure that this integration is always observable in real-world NHS behaviour.

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  • Advanced Nurse Practitioners are mainly clinically focused, ie. hands on care. Not managers, in the main, managers are not so highly trained in clinical diagnostic skills, if at all. Yes they will be employed more in the community but not solely as the skills are required in all areas. Whether ANP's can be cast as senior nurses is debateable, the ANP role and skills are very different to nursing.

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