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Primary care blog: Harsh reality behind community services rhetoric

RCN primary care expert Lynn Young is all for the expansion of community services, but can we translate words into action?

Readers must know by now how enthusiastic I am about the ambitions of the health reforms which float under the brightly coloured umbrella of Transforming Community Services. Sadly it is time to grow up and realise that words can be wonderful and inspiring, but the reality is many miles away from the handsome rhetoric.

OK, it is still early days, but I am in a rush to see fabulous new primary care services, particularly in economically deprived areas where very often good people can only access mediocre services.

And this is not to say that there are many general practices and community health services which strive every day to help bring better health and more enjoyable lives to local people.

Plans and ambitions are a plenty, but it is coming to my attention that, at the front line, it does not feel that improvements are on the way.

Primary care trusts are in confusion and chaos while they separate their commissioning from their providing and struggle to explore the possible options for a new community health organisation.

People are going, moving around, while new folk take up roles designed to deliver world-class commissioning. In the meantime the community nurse and health visitor workforce is running ragged trying to meet ever more demanding community health needs.

We need time, more time and yet more time to properly finish the reorganisation demanded by the Department of Health.

Commissioners need the luxury of being given space to learn their trade. Without this, there will be no world-class commissioning, let alone world-class community health services. Without such an environment, front line nurses can only feel cynical about yet another wave of fundamental change which, in their eyes, is destined to bring little benefit to them or their patients.

We need examples of primary care trusts achieving sustainable progress where commissioners and public health teams have a clear picture of their community’s particular health problems and knowledge of their least healthy citizens.

Where are the plans for community health improvement and reduced health inequalities? It is also of critical importance for conversations to take place between people engaged in workforce development and people working in higher education. If such discussions are lacking there are severe doubts over the TCS reforms having any positive effect on the local population.

I recall writing and saying the following so many times, but here we go again: Ambitious and inspiring reforms bring hope that we could be heading for better times. We also have a vision, which should give us more hope for that better future.

But without the right action, action which brings excitement and good cheer to front line, hard working and dedicated community nurses, reform remains reform and nothing else. Working through tough times can be managed, but to become more cheerful the community needs:

  • more nurses;

  • more midwives;

  • more health visitors;

  • more well trained and supported health care support workers;

  • more allied health professionals.


Readers' comments (2)

  • I agree there is a lot of rhetoric with not much significant improvement in service. Part of my role is liaising with local community nursing teams. They are enthusiastic and skilled, but demoralised by constant change in how they are managed. Two years ago they were organised into "clusters". Now there is talk about being allocated to individual GP practices, and possibly having to re-apply for their jobs. No wonder they become demoralised. The End-of-Life Care Strategy desperately needs their participation if it is to deliver quality services at home, but the teams I know seem to be less involved than they were in the past because of other pressures, leaving the majority of care to untrained carers. I am not optimistic for the future unless there is significant change in real terms as opposed to empty promises and yet more policy documents.

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  • Community care can be transformed . But it requires the formulation of universally agreed minimum standards of community care for physical health , mental health and sociocultural care . It requires holistic care planning in all three of the aforementioned areas for every community service user in the UK .From universal minimum standards and universal holistic care planning , we can then proceed to work out how many of each group of staff we will need to provide this optimum level of community care .Nothing less will be good enough .

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