The GP led groups set to take over the bulk of NHS decision making must be monitored for how well they are involving nurses - but it will also be up to the profession to make its voice heard, the chief nursing officer for England has told Nursing Times.
The government set out plans last week in its white paper - Equity and Excellence: Liberating the NHS - for groups of GP practices to be responsible for planning services and deciding how to spend the vast majority of NHS funds. They will replace the commissioning role of primary care trusts, which will be scrapped in three years.
One of the main opportunities and challenges for nurse leaders is to work locally to get to the right position [in commissioning]
Dame Christine Beasley said these GP consortia, once in place and operating, should be checked to see if they are following the government’s principle that they should include other professions.
In an exclusive interview with Nursing Times, she said it was “extremely unlikely” that the groups would be legally required to involve nurses - for example, through a place on their board - because health secretary Andrew Lansley was set on “local decision making”.
She said: “In a system that is all about local decision making, the chances of us prescribing any real detail about a GP consortium, like who should be on it, are extremely unlikely.”
She pointed out that the white paper said commissioning should involve different professions and said this was something that consortia “need to demonstrate”.
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Dame Christine said: “There are some principles whereby we [will] look at how [the consortia] deliver, and demonstrate they are working in a multidisciplinary way. [But] we will clearly not be saying, ‘You have to do this’.”
As a result, Dame Christine said, it should become one of the top priorities for local nursing leaders to ensure they remain involved in commissioning.
“One of the main opportunities and challenges for nurse leaders is to work locally to get to the right position [in commissioning]. That is going to be the challenge with very few rules from the centre.”
However, Dame Christine said she wanted to see a nurse on the national NHS commissioning board, which will set standards and have some powers over GP consortia.
She also told Nursing Times the profession could influence the government’s plans, as it had with the accident and emergency waiting time target, which has been relaxed after calls from the Royal College of Nursing.
She said: “There are real opportunities for nurses and other clinical staff to influence as we begin to put flesh on the bones [of the plans].”
Nurse leaders from all sectors of the profession have called on the government to make sure nursing has a strong role in the GP groups, potentially with a board post, as is currently required for all hospital trusts including foundation trusts.
RCN policy director Howard Catton cited forthcoming legislation, due in the autumn, as an opportunity to do this, warning that in recent weeks the government had appeared to increasingly focus its plans on GPs at the expense of other professions.
He said: “We will be looking for an opportunity in the Health Bill or in guidance to make sure nurse and other professional involvement really happens in practice.
“Politicians and policy makers have slipped easily from talking about all primary care professionals being involved to just GPs. That leads me to say we do need something to make sure it really is multiprofessional.”
Sheffield Teaching Hospitals Foundation Trust nurse director and chief operating officer Hilary Chapman, who is also the nurse representative on the NHS national quality board, said she thought it would be “advantageous” to require consortia to involve nurses.
She said: “PCTs have been obliged to have a nurse on their board. There are many elements of care that nurses have a very important insight into.
“If it is not going to be the case [that nurses will be commissioning], we will have to find other ways of working.”
Barbara Stuttle, executive nurse at NHS South West Essex, said the white paper offered “enormous opportunities” for nurses but warned they would have to show they had the “credibility” to take on senior roles.
She said: “Nurses can enhance commissioning decisions as much as GPs but they have to believe their voices are worth listening to.”
Jo Pritchard, joint managing director of the Central Surrey Health social enterprise and formerly a PCT director of nursing and primary care commissioning, said: “We want to avoid the danger of following just a medical model of commissioning. Who is going to provide the safeguarding around early years, around complex elderly wellbeing?”
Ms Pritchard, who also sat on the Prime Minister’s Commission on the Future of Nursing and Midwifery last year, said: “Some areas of the country have been following good practice on this but it’s absolutely not the national picture and I hope nursing expertise is a requirement.”