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Practice comment

Nurses need to be at the heart of commissioning if NHS reforms are to meet patient needs


As the white paper heralds a new era for healthcare commissioning, Malcolm Thomson urges all nurses to become involved in shaping future services

How many of us started our nursing career at 18 with the thought “I want to eventually become a commissioner”? Few if any I should imagine. Then again, do you know exactly what a health service commissioner does? That is a question only you can answer.

When I entered nursing 20 odd years ago I had no idea of the challenges and opportunities that would be facing our profession today. No longer are nurses expected to be followers – today we are independent and autonomous practitioners, and many progress to the highest level in their organisations. The recent white paper (Department of Health, 2010) presents some real opportunities to take this further; it will enable nurses to influence and shape the future of the NHS – if they take these opportunities.

Our skills as nurses - our clinical knowledge, our patient focus and our role as patient advocate - make us well placed to shape the development of services for our patients. As nurses we can have a credible legitimacy when designing services – we understand the language, both clinically and managerially – and for those people who are going to hold the purse strings in the future (GPs), we will certainly be able to work in bona fide partnership.

I have been lucky enough to be part of a commissioning team in one role or another for 12 years, both in practice based commissioning (PBC) and in the primary care trust, enjoying successes as well as being challenged by failing or ineffective projects. However, without my background in clinical nursing, I would never have been able to develop these services in such a way to advocate them to GPs to benefit their patients today.

I remember sitting in countless meetings developing the specification for a much needed pulmonary rehabilitation service. Without my understanding of the clinical evidence and patients’ needs and demands, I know I would not have been able to push it forward. I could walk the walk as well as talk the talk with GPs and other professional colleagues. Our discussions could get very heated but together we understood the reality of patient care – I was a legitimate clinician and this ensured my ideas had added credence. My biggest strength was my patient knowledge and my forthright advocacy of their needs, having led patient engagement sessions.

Any nurse, whether in a community or acute role, can take part in the development of services. Your local knowledge of service capability and patient need makes you the ultimate critical friend to the commissioning GP. Practice nurses are particularly well placed to lead on patient centred projects that are specific to their local population and health inequalities, while those in a specialist medical or surgical ward have a sound understanding of the quality care needed founded on a sound evidence base specific to their specialty.

Today GPs want, and certainly will need, your assistance as they start the difficult task of taking over the reins of local commissioning of these complex services.

I personally have fallen into commissioning but I know if I was starting my career today I would want to be part of this exciting challenge. The future of nursing will need commissioning (to some degree or other) to be part of everyday practice for each and every nurse and not seen as a specialist task.

MALCOLM THOMSON is programme manager, care closer to home, South Staffordshire Primary Care Trust


Readers' comments (3)

  • I have the 'pleasure' of being responsible for the commissioning of services for my patients. I work as a CPN for older adults so as you can imagine I have to commission quite a bit. One home care visit once a day for one person generates 66+ pages of paperwork and can take anywhere up to 9+ hours to complete. If I go back the following week and the situation has changed, I have to do the whole lot again. If people like Mr Thomson believe that this is an 'exciting challenge' for some one with my qualifications then I beg to differ. I did not train to sit in front of a computer.

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  • Phil Dup

    Well said Anonymous above - just what the NHS needs - MORE PAPERWORK!
    This Thompson bloke wants ALL Nurses to get involved.
    Hmmm yep ok mate - I miss breaks and get away late from work (all unpaid) regularly but I'm sure the Trust could find even more paperwork for me to do in order to help this 'commissioning' stuff.
    Roll on the collapse of the NHS so we can rebuild from scratch without the chaff.

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  • Nurses need a say, managers do not know the working enviroment. I did agency work in a new hospital a few weeks ago in London, the lay out was bad-no signs, at the sinks you use either cold water to wash your hands or hot- not both, you have to lean over the worktop and get back pain, all the staff toilets have disability taps and are small and you wet your trousers, and dignity of patients is non existant. Oh ans with my 30 minute break it took me 14 mins to walk there and back.

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