OPINION

'A seat on the board for nurses is in sight'

14 June, 2011 | By Jenni Middleton

The weeks of listening to health professionals during the government’s self-imposed “pause” in the NHS reforms are, it seems, promising to bear fruit for nurses.

Finally, the government is starting to wake up to the fact that nurses provide the greatest amount of patient care, will influence patient experience and outcomes and should therefore have a significant influence over how NHS money is spent.

The signs have been there for some time - health secretary Andrew Lansley and prime minister David Cameron began talking about “clinical commissioning” instead of “GP commissioning” at media events, and the inclusion of nurses in the listening exercise all pointed to a rethink around nurses’ roles.

But then on Tuesday last week, Mr Cameron finally promised that nurses would have a role in commissioning and it is not unreasonable to believe the government may make having a nurse on boards mandatory. Let’s hope so. After all, our A Seat on The Board Campaign has been fighting for this since last autumn.

The RCN backs our campaign and although some nurses are sceptical about the importance of a seat, we believe it is a strong start. Some fear it is tokenism and that one nurse will not be able to influence decisions. But, nurses have manoeuvred their way onto the radar of those crafting the reforms thanks to their fighting spirit (the RCN Congress vote of no confidence), and debating prowess during the listening exercise. Having a seat on the board means nursing’s voice will be heard for the benefit of patients.

But let’s think about other allied health professionals. I recently met a journalist from a pharmacy journal, and she talked of how desperately her readers wanted to be involved in commissioning. They may get that wish, but so far have not been mentioned in dispatches. So let’s count our blessings. For us, it may not be time to pop the corks, but maybe it’s time for a tiny cheer.

Sign our A Seat on the Board campaign at www.thepetitionsite.com/1/seatontheboard/

Readers' comments (24)

mike | 14-Jun-2011 3:47 pm
I'm getting tired of repeating myself, why is it that those who represent us feel that 'one seat on the board' is enough? It is a token bone thrown to the dogs to keep them quiet, that is it. We - as Nurses - should be running the NHS EQUALLY with ALL professionals.
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Anonymous | 19-Jun-2011 9:50 pm
GP's are not interested in having any nurse input into commissioning at board level - I have been told in no uncertain terms by more than one GP on more than one occasion that commissioning is 'all about money and specifically money possibly going out of their pockets' so why should we have any input ! So even if a nurse has a place on the board (token gesture or not) we had better not fool ourselves into thinking that the rest of the board (probably all GP's) are going to take any notice of our opinion.
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Anonymous | 20-Jun-2011 4:07 am
what does it matter what GPs think about nurse input? why should it be GP led at all? Does this not need to be an equal partnership between all healthcare professionals involved to prevent any sort of financial abuse and certain groups lining their pockets at the expense of patients and other professionals?
It can be argued that GPs have all the overheads to pay for in running their surgeries but then an overall re-examination of funding GP practices is necessary.
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mike | 20-Jun-2011 8:20 pm
Anonymous | 20-Jun-2011 4:07 am well said, I absolutely agree!
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Anonymous | 21-Jun-2011 10:13 am
it might be more appropriate to choose a different and more general title representing all healthcare personnel and take GP out of it so that they do not have, or even misguidedly think they have, the monopoly on this.
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DH Agent - as if ! | 21-Jun-2011 3:00 pm
I have just been 'slagged off' in another debate:

Anonymous | 21-Jun-2011 2:19 pm

Michael Stone

Please be considerate enough to leave the NT sites for nurses to comment and debate with one another in order to advance in a more rapid and constructive manner as this is important to us and we also have severe time constraints.

So, the posts in this one are 'more reasoned than mine' ? And, don't patients have an interest in their care as well ?

Anonymous | 21-Jun-2011 10:13 am

They have indeed, made the names more confusing: they should have stuck with 'GP Consortia' to describe the groups of GPs which join together to purchase secondary sevices, and 'GP Consortia Commissioning Boards' to describe the boards which actually do that commissioning.

Anonymous | 19-Jun-2011 9:50 pm

I was under the impression (doubtless GPs will attempt to turn this into window-dressing) that the primary function of the 2 lay members of the boards, is to ensure that the GPs cannot themselves profit from the way the 'secondary services money' is used. I still think, if the nurse within this group of 4 people who must be on those boards, is arms length from the GPs, as the hospital doctor must be according to the rules, and the 2 laymen must also be arms length from the GPs (not their patients, or accountants, etc), then that is the only way these boards could 'work properly (assuming their role is to introduce wider perspective, and to check on probity).

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Anonymous | 21-Jun-2011 3:42 pm

"So, the posts in this one are 'more reasoned than mine' ? And, don't patients have an interest in their care as well ?"

I agree but it is also helpful for nurses to have this platform to debate with other nurses about their own issues which also affect patient care and if patients are here discussing their own issues as well it just becomes highly complex and possibly without any useful outcomes. Everybody's comments on their views are welcomed on the site by nurses but not when they become too excessive and dominate the whole debating process. NT is after all predominantly a nursing magazine written for nurses and for the advancement of their careers.
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Anonymous | 21-Jun-2011 7:14 pm
michael stone | 21-Jun-2011 3:00 pm

What on earth are you talking about?
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DH Agent - as if ! | 22-Jun-2011 11:37 am
Anonymous | 21-Jun-2011 3:42 pm

I only comment, if I truly believe that my point(s) has validity. I never comment in things purely of interest to nurses, and not to me or patients (there is a difference - I am 'seriously involved' in an ongoing discussion of certain issues with the BMA, etc and I am very informed re that particular debate) such as pay and conditions.
But to be at all useful, any comment I make needs to be understandable to its typical reader, who is a nurse: of necessity, it is often unavoidable that I explain why my 'perspective' is different from 'yours', or else my points will be misunderstood because of issue which involve 'assumed similarity of perspective'.
And, I don't 'write' like many nurses write (not always true ' when he isn't ranting, 'mike' has a very similar style to mine) but perhaps that is because I have a doctorate, and 'think like a scientist' ?
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DH Agent - as if ! | 22-Jun-2011 11:48 am
Anonymous | 21-Jun-2011 7:14 pm

I am not sure that I understand your question.

But, does it involve this ? These 'commissioning boards' are to spend money which is for secondary care (the hospital stuff, not directly provided by GPs themselves). It used to be PCTs who 'purchased/commissioned' those secondary services, but under this new arrangement, there will be 'commissioning boards' which do the commissioning, and there will be a commissioning board for every 'group of GPs who join together to purchase secondary services for their own patients'.
This is not 'GP's money' being spent, it is 'patients' money', and there is a danger that somehow the GPs will try and manipulate the commissioning process, so that the GPs profit from the decisions made - the 2 lay persons on the board, are supposed to be preventing that from happening.
I do not quite understand, why the 'statutory nurse and the hospital doctor' are also there - but, to me. it seems weird if those 2 people are not also 'at arms length from the GPs' (because I thought they were supposed to 'introduce a wider perspective into decision-making, than the GPs would themselves introduce').
If that is not what you were asking me about, I will give you another answer if you make your question clear (at the risk of being 'attacked' again !).
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Anonymous | 22-Jun-2011 12:10 pm
Actually Michael by giving GP's a budget to spend I would argue has already privatised the NHS as they are outside of the NHS. Also, as the commissions are only measured on results the other end of the process budget can easily become the GP's profit. Maybe the governement need to insist that the GP's are 'not for profit' organisations?
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mike | 22-Jun-2011 12:26 pm
Anonymous | 22-Jun-2011 12:10 pm that is a very good point and I tend to agree. GPs by their very nature are already biased, which is why it sticks in the craw a bit when they insist hospital Doctors and Nurses cannot be so. Also, what about community or primary care Nurses? What is their role, if any?

Michael, you are right, GP's should not be allowed in any way to profit from this, unless those profits are DIRECTLY and VISIBLY put back into patient services or staffing.

Anonymous | 21-Jun-2011 10:13 am I absolutely agree too. The term GP consortia is just not helpful. GP's play an important role in healthcare and I respect them as colleagues, but they are not the be all and end all of healthcare.
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DH Agent - as if ! | 22-Jun-2011 3:37 pm
Anonymous | 22-Jun-2011 12:10 pm

The change in terminology, from 'GP Consortia' to 'Commissioning Groups' is very 'confusing'.
But, there is a difference between GPs doing what they are supposed to be making their living from - their own direct care of their patients - and this new role, of 'doling out the money for hospitals'.
The 'boards', the composition of which has been left vague, deliberately, are not distributing primary care money: the 'theory' was always that the GPs had a better grasp of what secondary services needed to be purchased, for their patients, than PCTs did. That connection between the GP Consortia, and anyone who it can place on its Commissioning Board, is the 'potential conflict', which the composition of the boards, needs to guard against (which was not present when PCTs did the commissioning). In theory, as far as one can tell by reading the stuff published to date (which is vague and not entirely clear) the 2 laymen on those boards, are principally there 'to prevent GPs from 'trousering' any of this money which is being spent on secondary care: any nurse on the board who wasn't worried about 'voting against the GPs' could introduce similar protection.
But, we need to know exactly how it is to be ensured, that these 2 lay members, and the statutory nurse and hospital doctor, are to be made entirely independent of direct influence by the GP Consortia, and if the views of those 4 people cannot invariably be 'over-ridden' by the other members of the board (assumed, for some reason, to be GPs - it could equally well be people the GPs felt could do the job for them, such as Practice Mangers, etc).
There are no proper details about how these boards are to be made up, etc - they have been pushed into the NHS Regulations as opposed to being described in the Bill itself - and any protection, or loopholes which will allow GPs to exploit the system, lie in those undisclosed details.
There are also complicated arrangements for 'senates' etc, which will have various nurses and other experts on them, and which will have a role in somehow influencing how the Commissioning Boards actually work (I can't be stronger than 'somehow influence' because, as usual, the details have not been made clear).
The Goverment is 'fudging' and 'obfuscating' over the details, apparently in the hope that people will go away without looking too closely !
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DH Agent - as if ! | 22-Jun-2011 3:52 pm
mike | 22-Jun-2011 12:26 pm

If the profits were fed back into patient care, they would not be part of the GPs' profits, would they ? They would just be 'savings, within the system'.

I don't agree, about your problem with the term GP Consortium. This is distinct from questions about the power of Practice Nurses. The GP Practices, as I understand it, will loosely join together into much larger groups, and then negotiate secondary services on behalf of all of the GPs: but it isn't their money being spent, and using GP Consortium accurately describes the nature of the GP collaboration, and GP Consortium Commissioning Board would make it clear that this board's ONLY function, is to oversee the purchase of the secondary services.
There is no reason why practice nurses, cannot be involved with GPs, in their 'internal discussions' about what secondary services, need to be purchased, in order to best benefit the patients ! People seem to be missing this, but the Commissioning Board is NOT the place to haggle about 'what needs to be bought for our patients' - the board needs to START with that information, then work out how the necessary secondary services, can best be purchased. Perhaps with the introduction of 'wider perspectives' as well. There will, in practice, be 'boards' within the GP Consortia, BELOW the Commissioning Board - it couldn't possibly work, otherwise !
Keeping that commissioning 'clean' - ie not guided by the financial interests of the GPs in the consortium - is the bit which is tricky, and is being fudged over at present.
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mike | 22-Jun-2011 4:44 pm
I see your point Michael about the term GP consortium, but that is the exact reason why I do not think they should be in overall control at all. There should be instead an 'NHS consortium' say, with a GP representative making up one small part of a whole, that includes senior hospital Doctors, senior hospital Nurses, community Nurses, pharmacists, etc and perhaps an independent non clinical manager in a smaller role.
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Anonymous | 22-Jun-2011 4:49 pm
I think in general the push to hold GP's as gatekeepers for all healthcare is driven partly as they are generalists by nature, partly as they reduce the secondary care power and partly as they are already outside the NHS and small business holders themselves (some smaller than others). Anybody else who manages to get on a board is there for information purposes.
I would say that secondary care specialists do some fantastic stuff but I think that the direction of change is to accommodate the general healthcare at a less specialist level funded by taxation as we're all living longer, alongside a topped up more specialist and higher cost top-up funded through insurance companies.
That's how 'Dave' can get away with saying he will not privatise the NHS and continue funding it.
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Anonymous | 22-Jun-2011 7:07 pm
michael stone | 22-Jun-2011 11:48 am
from
Anonymous | 21-Jun-2011 7:14 pm

Michael
When I asked about what on earth you were talking about; please re-read the first part of your post where you appear to be addressing a comment made about you somewhere else. I'm not 'attacking' you. I only drop by some threads, so I'd prefer not to have other stuff confusing the subject.

Bottom line. The idea for GP consortia should be dumped completely. It's a bad idea, poorly thought out and it will be disasterous.

And Michael, as well as my nursing degree, I have a masters in Physics and have no problem understanding or being understood by other nurses. It's not a scientist v nurse thing (many nurses have a BSc and/or MSc. An increasing number have a PhD). This is a site where the contributors are mainly nurses, and they come here for discussion with their peers. That could be the problem for you if you are not a nurse, and may be why you feel you are being 'attacked' or 'slagged off'.
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Mags | 22-Jun-2011 7:16 pm
Let's not bother "counting our blessings". The current plans for NHS reforms are descending into cobbled together chaos. Scrap the whole thing and have proper (non-political) consultation with ALL involved in the NHS. Take time about it and get it right. It will cost less in the long run and we will have a better NHS.
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DH Agent - as if ! | 23-Jun-2011 9:38 am
mike | 22-Jun-2011 4:44 pm

mike, this is very complex, and the 'sense of it' is in the details, which are being obfuscated and avoided.

Clearly, GPs should have knowledge of their patient's secondary needs (for say hip-replacements) and changing 'trends' faster than anyone else, and in that sense moving commissioning closer to GPs is logical. But if you do that, you need safeguards to stop GPs from profiting themselves, from the commissioning decisions - the bit nobody has entirely described yet.
Of course, even with the above, hospitals will still get emergency admissions, so that money will need to be allocated separately from GP commissioning - nobody can properly argue about this, without the details the Goverment has pushed into the NHS regs, or onlt 'hinted at' !
There are these 'senates', etc, which SOMEHOW are supposed to extert SOME TYPE of influence - EXACTLY how much, and how, I don't understand !
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DH Agent - as if ! | 23-Jun-2011 9:48 am
Anonymous | 22-Jun-2011 7:07 pm

Thank you. That is clearer. As it happens, I think I get attacked because I sometimes disagree with some expressed opinions, and some nurses take offence that as a layman I 'have the cheek' to disagree with them. Conflicting opinions from other nurses, do not seem to attract the same venom.
But this debate about commissioning - and I tend to agree with you, this idea has not been properly thought out, and has the scope to be a disaster: but remember that the motive is partly to spend less money on services, and for the Goverment to say 'you decided how to spend the money, not us' - does involve laymen.
Why I irritate some people, is because I joined this site to try and find out what nurses believe the law is for certain EoLC issues (just posted in Forums, Older People, as a series of pieces under 'Musings part 'n'' - I simply cannot get nurses, to give me straight answers to those questions !) and I tend to 'use any excuse to stray' into that.
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