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CNO tells nurses to carve out a role in GP-led NHS


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.”


Readers' comments (36)

  • 'Must be monitored for how well they are involving Nurses'??? How patronising is that!! We SHOULD be involved on principle!

    It is nice to see Beasley living up to her reputation as being absolutely useless in demanding a Nursing seat at the table too. It seems as if she is just holding her hands up and saying 'nothing I can do'.

    She is absolutely right that it is US who must make our voices heard though (although I see she doesn't quite take her own advice here!)

    We MUST now take on a more senior role in health care alongside Doctors and GP's. We must demand that our clinical expertise and experience is listened to.

    Only Nurses themselves can do this.

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  • Natalie Jewell

    Nurses need to show some initiative and take this opportunity to take on more responsibility. They have so much to offer but it is passed over and it is nurses' acceptance that doctors and managers will tell them what to do that keeps nursing in this rut.

    We need to make our voices heard and be proud to do so.

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  • I whole heartedly agree with Mike. The CNO is useless and full of empty words - just waiting for her retirement date. When is she going!!!

    Commissioning and GP led services are another challenge, and Trusts should cease this moment to capitalise on the strenghts nurses have. Practice nurses and Nurse practitioners are clearly going to play a pivitol role but the CNO hasn't really ever supported this aslect of nurses - seeing them as the poor relation.

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  • Well shes got her Damehood, only her massive pension (unlike ours)to go.
    All this is a ploy by Government to privatise by stealth All Public services. Like wise with the 'big society' When they all go pear shape the Government can then say 'not our fault, blame the volunteers, GP's, school Governors, etc etc.

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  • Natalie Jewell says that nurses need to show some initiative to take on more responsibility. Well I for one as a community nurse have loads of responsibility and more keeps getting forced on me by the trust, With no extra pay. I am not interested in the cheap schemes that increase my workload for little or no recognition.

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  • Anonymous | 20-Jul-2010 1:27 pm, I think you are missing the point slightly. What Natalie has said, and I agree, is that now is the time for Nurses to take on a more senior role, not to pile more responsibility on ourselves, but to take charge of our profession and demand a role and status equal to that of a Doctor in this new NHS. Yes that means more responsibility for some, but it will also mean for the rest of us, if it is used correctly, better status, working conditions, better pay for our skill and qualifications, more say in the care we give to our patients, etc etc.

    But only if we ALL speak up.

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  • The whole GP consortia concept is lunacy... 80b to people supposed to be concerned with directly treating parients It didn't work last time and is likely to open a world of pain this time. Will we next see the entire defence budget handed to a squaddie, for their interpretation for how to spend it.....

    Nurses need to hold their own now...

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  • Nurses in General Practice, have pushed forwarded government demands,they greatly enhance the quality of care in GP surgeries and yet very few have been given partnership rights, or agenda for change terms and conditions.

    In the area where I work they are not being consulted on commissioning. Who is going to regulate the GP's?, what is going to happen with practice nurse training and regulation. Already Practice nurses are out in a limb, with the provider/comissioning split. I can't see large numbers of nurses wanting to join our ranks and being employed by GP's/consortia. It may sound a great opportuity -for GP's to fill their pockdets. The past 20 years of Practice Nursing has not pushed the nurse forward, the GP's have all the power and do not other health professionals unless delegating.

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  • There has been a report released "NHS Unlimited? Who is running our GP services?"

    It shows that more GP's are being run , commercially. They are to have more control over the NHS so essentially we are being run by commercialised outfits. Voila, private NHS.

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  • To be fair Anonymous | 20-Jul-2010 3:36 pm, as an ex squaddie myself I'd have a great time with the defence budget! Ha! Tally ho!

    Sriously though I agree with Anonymous | 20-Jul-2010 4:44 pm who raises a few decent points.

    It is the Nurses who are delivering the quantity and quality of care in the NHS, so where the hell is our input on the budget? We shouldn't have to ask for it cap in hand, we should be bloody DEMANDING it!!!

    And I totally agree on who exactly is going to regulate the already powerful, overpaid and underworked GP's?

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