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Comment: Twenty years on, it’s time to fill the skills gap

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Education for Health celebrates its 20th anniversary this year. So much has been achieved in the management of airways disease since the former National Respiratory Training Centre was established back in 1987 – but there is still much more to be done.

Next year there will be a new edition of the British Thoracic Society/Scottish Intercollegiate Guidelines Network guidelines, the quality and outcome framework will be revised with some potential changes for the respiratory indicators and, in 2009, the National Service Framework for COPD will finally become a reality.

Nurses have become central to the delivery of respiratory care in both primary and secondary settings, as well as all the various configurations of in-reach and outreach care. Twenty years ago, the only specialist respiratory nurses were in large teaching hospitals and were mainly dealing with TB. As for practice nurses, there were fewer than 800 in the country, undertaking mainly treatment-room work and only within the interested dynamic practices were they involved with respiratory care.

As part of its anniversary year, Education for Health decided to undertake a survey on the role of practice nurses in respiratory disease and on how services are now organised in primary care. This was indeed intended to be a celebration of its work. In many ways it turned out to be just that, as more nurses work autonomously in advanced roles in asthma and COPD than ever before.

At the same time, however, the survey revealed some worrying findings. Large numbers of practice nurses are working in advanced roles. However, many of them do not have accredited training, particularly those working with patients with COPD. The authors concluded that the low level of accredited training presents clinical governance issues for both individual practices and PCTs.

As a result, Education for Health launched a Charter for Patients with Long-term Conditions at a House of Lords reception in October, detailing what care to expect from their practice nurse. This is available from Education for Health: It has also produced information for nurses and practices on how to put a business case together for funding and support for training is also available on the website.

Monica Fletcher, PGCE, BSc, FAANP, NP Dip, RN, is chief executive, Education for Health, Warwick.

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