Wide variations in the status of nursing in the new NHS have been uncovered by Nursing Times, sparking fresh concerns about the future influence of the profession in England.
Nursing Times has carried out the first investigation of how nursing is being represented on clinical commissioning groups, which are starting to take over NHS funding decisions and are set to formally replace primary care trusts from April 2013.
Our investigation has found a “very mixed picture” of arrangements for including nurses on the boards of the influential new GP led bodies that will decide how the bulk of NHS funding is spent.
Some have appointed inexperienced nurses, others appear to have made stop gap arrangements and others have yet to even appoint a nurse.
The government reluctantly ordered clinical commissioning groups to include a nurse on their board last year in response to Nursing Times’ Seat on the Board campaign and similar calls from the Royal College of Nursing and the Commons health select committee.
Nursing Times has now collected information on nurse representation at 71 emerging clinical commissioning groups, comprising around a third of CCGs (see below).
Of those nurses that have been appointed to CCGs, around half are also currently local PCT nursing directors or nurse managers. This is the level of seniority called for the Royal College of Nursing and hinted at in latest Department of Health guidance.
However, it is unclear whether these appointments are merely transitional arrangements and whether these nurses will stay on after their PCTs are abolished.
But 18 CCGs appear to have made no arrangements for a nurse post on their board – the government has said they will have to appoint one before April 2013. Meanwhile many other CCGs have earmarked a post for a nurse but not yet filled it.
There are also a large number of nurse practitioners and practice nurses, which the RCN has previously warned may not have sufficient experience for the job.
A small number of CCGs have even appointed a nurse from a local service provider, such as a hospital or community trust, to their board. This is despite such appointments being against the government’s rules because of a perceived conflict of interest between the commissioner and provider. As a result these nurses will have to be replaced in the near future.
Lastly, there are some managers with a nursing background who are taking on the most senior roles in CCGs, such as chair, chief operating officer and accountable officer.
Responding to the investigation’s findings, the RCN indicated it would monitor nursing input to CCGs when they sought approval to take on their full powers. The authorisation process, which will be run by the new NHS Commissioning Board, is expected to happen between July and December.
RCN policy director Howard Catton said: “We will take a view of whether the arrangements being proposed are compatible with authorisation, and will not be shy about saying where we have concerns.”
Mr Catton said Nursing Times’ analysis highlighted that in many areas nurse involvement in CCGs was minimal.
He said: “We have a very mixed picture. A lot of the current [board] nurses could be there in an interim capacity, and we are hearing that many CCGs are thinking about sessional arrangements. That could mean the nursing role is only a superficial overview.”
Unison head of nursing Gail Adams said she was concerned CCGs would not take on senior experienced nurses.
Andrea Gupta, a nurse and manager who is chair of St Helens Health CCG, also warned of a lack of nurses interested and qualified – for example with board level and commissioning experience – to take on the roles.
Ms Gupta told Nursing Times there was a lack of training and development available for potential candidates.
She said: “It is fine calling for the board nurse to have a set of skills and competencies but there are not any development mechanisms in place [to give them that].”
She said it could lead to problems filling the roles.
|Nurse job/background||% of total|
|PCT nurse director or senior nurse||49.1%|
|Nurse post not yet appointed||16.4%|
|GP based nurse practitioner||9.1%|
|Practice based commissioner nurse/manager||7.3%|
|Director or staff at local provider||5.5%|
Based on 72 CCGs which provided information to Nursing Times, of which 53 had a nursing post on their governing body.