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Jane Warner

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'Primary care is stymied by contradictory policies'

When I started my nurse training, I came under the spell of the Portsmouth Sinfonia, an outfit whose enthusiastic but cacophonous renditions of popular classics were underpinned by one key rule. Players could only play an instrument on which they had no technical ability whatsoever.

Thirty years on and I am wondering whether the movers and shakers in the NHS were also fans, because they seem hell-bent on creating discord and confusion with their continual plans and targets.

It strikes me more forcefully than a stick on a kettledrum that we are turning a well-tuned orchestra into something that doesn't even deserve a round of applause, let alone a standing ovation.

It's as if healthcare workers were led by a conductor whose baton is flailing so wildly that melody and tempo have been thrown to the winds, and the only remedy is to hold committee meetings, listen to sectional interests and write reports to consider whether there should be more batons, more conductors or more meetings. Consider some of the recent contradictions in primary care.

The NHS exhorts us to lead healthy lives, and blames and shames patients who cannot or will not comply but where does the idea of patient autonomy and clout fit in?

Our NHS, Our Future vaunts individualised care, and where better to practise this than in the primary care sector? Yet we are promised polyclinics, where treatment and diagnostics are arguably more extensive but where our patients could be caught within an impersonal system, accompanied by privatisation via the back door.

Then there's talk about improving the management of patients with long-term conditions. Is this why the community matron scheme is being cut back? Or why specialist nurse roles are being lost? I only ask out of genuine puzzlement.

As a practice nurse, how can I make sense of any principle stating that we need to embrace both stability and change in equal measures?

And as if that weren't crazy enough, consider the plight of many independent and supplementary nurse prescribers. We were the professionals who dutifully undertook further rigorous development in order to give patients quicker access to medicines. We have paid to record our qualification with our statutory regulatory body but thanks to the disorganisation within reformed PCTs and the reduction in strategic level prescribing leads, it is not unusual to have to wait endlessly for an up-to-date formulary and prescription pads.

Like most, I try to do my job to the best of my ability but if I can't work in harmony, I'd appreciate a bit of peace and quiet.

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