Health visitors to be allied with SureStart, rather than GPs

23 July, 2010 | By Steve Ford

GPs will not be responsible for recruiting and employing health visitors under the government’s reform agenda, health secretary Andrew Lansley has told MPs.

The health white paper, published last week, set out proposals to hand the bulk of NHS decision making on services and funding to local GP consortia.

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However, health secretary Andrew Lansley said employing health visitors would be outside the remit of GPs, appearing to dash calls for future health visitors to be based in surgeries rather than solely in SureStart clinics.

Giving evidence on his proposed reforms to the Commons’ health select committee last week, he said: “We see it [health visiting] as a health services, effectively a public health service, allied to SureStart. To that extent, it’s not something that GP consortia themselves would need to make a decision about.”

He said the government’s view was that health visiting should be a “population wide, universal service”, provided at the point where a family came home with its baby.

Mr Lansley was speaking in response to a question from committee member and Conservative MP Nadine Dorries who had asked if GPs would be responsible in future for the recruitment of practice based health visitors, as “they used to be”.

It follows a call from Royal College of GPs president Steve Field last month, warning that newly recruited health visitors should not be placed exclusively in SureStart children’s centres. He said there was already a lack of communication between GPs and health visitors who work in the centres, and extra numbers would worsen the situation.

The government’s coalition agreement, published in May, reaffirmed a Conservative pre election pledge to recruit an extra 4,200 SureStart health visitors. Though it cautioned any plans would be dependent on the outcome of the government’s spending review in the autumn.

Despite the government’s intention to increase the number of health visitors, latest figures suggest their numbers continue to show a downward trend.

NHS Information Centre workforce data, published last week, showed the number of qualified health visitors in England fell by 1.8 per cent – from 8,860 to 8,705 – between September 2009 and April this year.

Unite professional officer for health Dave Munday said recruitment was the key issue, rather than where health visitors were based. He said: “I don’t mind who employs them, as long as they are employed.”

He said, despite strong pledges from government on health visitor numbers, no local recruitment was taking place.

A Department of Health spokeswoman said: “The government has committed to increasing the number of health visitors and to focusing on SureStart to ensure all families get high quality services.

“Ministers are currently looking at how best to deliver this commitment, and will be working across government and with partner organisations. Funding, recruitment and management issues will be addressed in due course.”

Readers' comments (9)

Anonymous | 25-Jul-2010 7:50 pm
I agree, having experienced both settings I prefer to be based with GPs. It is better for team working with a defined population. However, some GP premises are not appropriate and some GPs seem to want the HVs there, but then fail to provide appropriate accommodation and clinic rooms. HVs are left between pillar and post with no real home of their own.
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Anonymous | 26-Jul-2010 10:28 am
I trained as a Health Visitor in 1976 and I was initially based in a community centre. Since then I have come to value being based in a GP surgery and feel that this is by far the best option since we are serving the health of the same population as GPs and continuity of care, treatment and safeguarding can best be practiced from an alliance with GPs but by maintaining very good relationships with the community leaders, children's centres and locality teams. Health Visitors provide a Public Health element; we are nurses and as prescribers I feel it is essential and unique that we have our links to the rest of the Primary Care Team as a priority. Why are HVs afraid of being subsumed by GPs? If we work together well as a team there should be mutual respect, not threat. Taking HVs out of Surgeries will be a retrograde step and costly in terms of finding alternative accommodation. I fear we are losing the unique flavour of our profession.
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Martin Gray | 26-Jul-2010 11:00 am
This is the government NOT listening ( as per usual) to those that have been doing the job for years! If this goes ahead then the health visitors recruited and employed will not have the experience to do the job and will be too easily manipulated by the managers ( many of whom will no doubt come from the PCTS and may not be the best people either judging by the way health visitors have been treated in the past).

The link between GPs and health visitors is an essential criteria, if there is any danger to that being eroded further there will be even fewer health visitors as many will just leave the role altogether!!
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Penny Ballinger | 27-Jul-2010 4:12 pm
The kink with GPs should be paramount, at one level the integrity of GP information systems is generally superior to Child Health systems which are now being transfered to management by local authorities. from a logistics point of view GPs are aware of a new registration of a child moving into the area far earlier than information going back to Child Health Depts. Realistically more GP staff are employed registering patients than the often part-time staff in Child Health Depts. By being based in GP surgeries the health visitor is privvy to the use of the GP surgery IT systems, which helps safeguarding children. The ideal positioning of the health visitor is within a GP surgery but with a liaison role with Surestart.
My suspicion is that the evidence base is lacking for moving health visitors into Surestart, and whatever cost-benefits analysis has been instituted is bolstered by a political motive deprofessionalising health visitors and reducing GP influence at a community health level. But wait until the public are able to register at a GP anywhere in the country and watch for worse outcomes in safeguarding as vulnarable families can disappear off the radar of health and social work professionals more easily...
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Anonymous | 28-Jul-2010 6:18 pm
The government have had to step in quickly to prevent HVs returning to GP surgeries as HVs and GPs would prefer.

You can have as many safeguarding policies as you like but without adequate HVs actually seeing people and knowing their defined caseload no progress will be made. The best defined caseload is GP population with all members of the team knowing the patients, as Penny describes.
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Anonymous | 29-Jul-2010 7:01 pm
I work in a gp surgery and recieve the clinical support and updating that i should be getting else where. I have a caseload of 500 plus. where will i be housed? where will my notes be based? there is not enough floor space in my childrens centre for decent clinics for all ages or the room capacity for me to see my vulnerable clients. Who will give me the support i currently recieve from my gp practice when a child is complex? I sometimes have to call the gp to my consulting room to view a client as an emmergency to safegard mother and child, esp in mental health. I suspect the government just wants us under local authority control to use us as glorified social worker assistants, er no! How many health visitors do you think will walk when we need them all? We do not want to leave the NHS and our terms and conditions. Ministers please look at these responses on this nursing site and listen to the front line staff, as you do advocate in these reforms that we are supposed to listen to o?!!!!!!!?
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Claire von Simson | 5-Aug-2010 9:04 am
I have recently just left Health Visiting for various reasons but have never been directly employed by a GP. All my positions over ten years have been through PCTs. However, things may be different elsewhere in the UK. I have always worked in the south east. I recently met a Family Nurse and they seemed to be doing exactly what health visiting should have been - intenstive and supportive visits. Instead we were all lost in the mire of low staffing levels. I was not a fan of corporate caseloads either, as I felt I functioned much better when I was attached to a local GP and went in to the surgery to hold my clinics. Much more personalised and with good continuity. It would be a great shame if Family Nurses were dispensed with. Still waiting with baited breath for the promise of more health visitors and until that happens I will not be returning to that field.
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Gail Walker | 16-Aug-2010 4:52 pm
I dont agree that the best defined population of under 5's is a GP caseload. I believe that the best caseloads are aligned to real communites so that health visitors can work with all the families on estates/individual streets and deliver their public health role. Lets remember that Gp populations are artifical communities based on registrations which has led in many instances to several health visitors visiting the same street. I feel that we need to look at how childrens services across the 0-5 agenda can work together in an integrated way without favouring one above the other. The issue shouldn't be about where staff are based but how they communicate with one another, having good systems in place for identifying vulnerable families, joint action plans for supporting families and good pathways for delivering the healthy child programme. Models of service delivery should consider how good team working can be developed to manage workload demands and incorporate skill mixing and flexi-working in a sensible way.Indivual allocation to GP's was ok 20 years ago but doesnt necessarlity fit with todays agenda.
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Surrita Barrett | 7-Dec-2010 11:57 pm
I am a specialist school Nurse practitioner and I am really concerned that the number of school nurses in Uk has been drastically falling for a long time despite the previous government's pledge to improve this. The new coalition government is even worse as it has acknowledged the existance of school nursing service and seems to have forgotten that children don't stop needing health service provision once they turn 5 years old. What is more saddening is that this government is determined to make our children and young people pay a heavy price for the mistake and misjudgements of some Bankers. Cuts in child benefits, increase in tuition fees, unemployment, cut in housing benefits and so on which all impacts on the health and well being of families including children and young people within those families. I was here when PCTs were created and it has gone full circle because now we don't have PCTs anymore we are going to the acute sector again. GP commissioning haven't we heard this before? Lot of money is being wasted by restructuring NHS services, which will be best spent in stregthening front line services.
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