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Sidelining nurses 'bad for commissioning'


There are fears nurses’ fledgling role in NHS commissioning could be sidelined by moves to put GPs in charge.

Health secretary Andrew Lansley is planning to move responsibility for commissioning services from primary care trusts to groups of GPs by 2012.

Before the election, now health minister Anne Milton told Nursing Times nurses would also have a “crucial role” in commissioning, with GPs potentially “devolving” responsibilities to them.

But the Department of Health has yet to confirm whether or how that will happen.

Royal College of Nursing policy director Howard Catton said the college was clear “commissioning needs to be multiprofessional” but the government’s language had so far focused on GPs.

Mr Catton said improving care while keeping costs down in coming years would rely on areas with heavy nursing involvement – such as long term condition management, prevention and better coordination between hospitals, community services and social care.

He said: “These are all areas that nurses are intimately involved in and are critical to the success of.

“Nurses have great reach into the communities where they live and work. If you are commissioning services your starting point needs to be an understanding of the community.”

Jan Proctor-King, cardiovascular tutor at the primary care training centre in Bradford, and Primary Care Cardiovascular Society board member, said that in practice the extent of nurse involvement was likely to be down to the “local initiative” of GPs.

She also warned breaking commissioning down into small groups could put at risk areas where the “big picture” was important, such cardiovascular services which are currently planned through regional networks.

However, Ms Procter-King said GPs would be looking for efficient models of care and would not be afraid to scrap poor ones – which was both a “threat and an opportunity” for nurses.

She said: “GPs are going to look very much at keeping people out of hospital. Nurse led models that can show people they keep people out of hospital will have opportunities to develop and expand.

“Just having services and particular kinds of nurses because we have always had them won’t be enough to keep them. GPs will be prepared to make difficult decisions.”


Readers' comments (3)

  • Nurses need to stand up for themselves more. We need people in these posts who will argue and fight for the Nursing profession, demand the roles that we deserve. Not bend over and politely ask for “crucial roles” to be “devolved” to us by the allmighty GPs! (I mean how patronising is that!)

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  • The problem is that GP's don't understand the role of District Nurses many think that we cycle round taking blood pressures and that when we are in the office we are doing nothing. New teams that spring up such as rapid response and long term conditions evaluate their own services and come up with figures for how many people they have kept out of hospital - DN's also keep people at home but this, at least in my trust is not being evaluated. An expansion of DN teams to do the LTC and rapid response work in the areas they know and work would be a lot more cost effective and involve a lot less trumpet blowing and meetings.

    DN's offer a fantastic responsive, skilled and cost effective service that could be a model for many other services. The reason that we have been around for a long time is because we are so good - longevity is not a reason to condemn a service.

    My trust has audited our work -but as the audit showed how hard we work it quickly disappeared. More recently patients opinions were sought on DN services, again we got a glowing report - I don't think this is what was wanted but the changes that will stifle our services continue to be pushed ahead by a few GP's who want a service that puts them first not patients.

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  • GP's are set to be in charge of the acute trusts as well as the community as I understand the current moves.

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