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Nurse expertise may be overlooked as PCT structures get more complex

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The increasingly complex nature of primary care organisation will make it harder to ensure nursing is involved in strategic decision making, nurse leaders have warned.

The increasingly complex nature of primary care organisation will make it harder to ensure nurses are involved in strategic decision making, nurse leaders have warned.

Primary care trusts have no legal obligation to listen to nurses at board level, despite the growing importance attached to nurse-led services, such as telehealth, in the shift to providing more services in community settings.

But all acute and foundation trusts must have a director of nursing as an executive member of their board, meaning they have full voting rights on the trust’s decisions.

Primary care trusts are not legally bound to have a nurse as one of the five executive members of their board. They are required to have access to clinical advice from their professional executive committee – two members of which sit on the board as non-executive members – but PEC membership has traditionally been dominated by GPs.

According to an RCN report published in April, at least 20 per cent of PCTs do not have an executive director of nursing with voting rights on their board. The college called for this to be addressed to “ensure the voice of nursing is properly represented within the governance of the NHS”.

Queen’s Nursing Institute director Rosemary Cook suggested the introduction of new models of care, such as social enterprises, and the splitting of PCTs into providers and commissioners made it very hard to ensure stronger nursing representation.  

She told Nursing Times: “As the organisations commissioning and providing NHS services become increasingly diverse, it will be impossible to mandate any specific position for anyone. That doesn’t alter the fact that the vast majority of care is delivered by nurses.

“Any organisation involved in healthcare would be foolish to try and deliver services without strategic nursing input. I think that NHS, independent, charitable and other organisations will discover this for themselves,” she said.

RCN head of policy Howard Catton said he felt there was a lack of understanding by PCTs of the importance of nursing to their commissioning decisions. “Commissioning is about measuring population health needs and finding ways to address this. The core of nursing sits very close to what commissioning is, hence the argument for having nurses at the top table” he said.

He added that not having executive nursing directors on every PCT board was a “very stark example” of wider problems for nursing within the structure of NHS management. He cited the lack of a clear pathway for nurses to senior management positions.

But David Stout, director of the NHS Confederation’s primary care trust network, said it should be up to PCTs to decide how they included nurses in their board make-up. He said: “There are lots of ways of getting clinical advice into board meetings.”

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