Nurses have the “experience and opportunity” to play an important role in the commissioning of future models of care that are more centred round the needs of the patient.
Nurses working in primary and community care in particular should be involved in commissioning, said Louise Patten, nurse and chief officer at Aylesbury Vale Clinical Commissioning Group.
“Demand is like the M25. If you build another couple of lanes, they’ll get filled up”
Ms Patten, a district nurse, was speaking recently at the Queen’s Nursing Institute annual conference, where she gave a presentation called “nurses can influence commissioning”.
She asked the audience of community nurses how many were currently involved in commissioning, of which around 25% said they were. In reply, she said “all of you, really” should be involved.
“I do find it quite incredible that in my job as I talk to my clinical commissioners… that the majority of the clinical commissioners I deal with around long-term conditions and end of life are not nurses,” she said.
“That’s where I think I’m really surprised,” she said. “You’ve got such experience and opportunity to help me understand how we commission services in a different way.”
In particular, Ms Patten highlighted the “key role” that nurses could play in what she called values- and outcomes-based commissioning.
She highlighted the example of a patient with a hip problem, who under normal commissioning rules, would be referred for an operation. He experienced complications and, as a result, a “long, slow rehabilitation”, which impacted on his ability to leave his house and socialise, and subsequently his mental state.
“You’ve got such experience and opportunity to help me understand how we commission services in a different way”
Using outcomes-based commissioning, centred on the patient’s individual needs, she suggested that it might be decided it was more important to the man to be able to visit his twice-weekly bridge club than have slightly improved mobility from surgery.
“Nurses have an absolute key role in helping us understand that and giving patients permission to say that, just because a consultant says you have to come in and have your hip operation, you don’t have to,” said Ms Patten.
She said conversations between clinicians and their patients on what was of most value to that person were “hugely helpful” for commissioners to hear about, noting that nurses could act as a “broker” on behalf of their patient.
She promoted the idea of “self-management”, where patients with long-term conditions were encouraged to take more responsibility for their own care, rather than constantly relying on under-pressure services.
“Demand is like the M25,” she said. “If you build another couple of lanes, they’ll get filled up. But it doesn’t actually solve the problem.”
“It never ceases to amaze me that patients think we’ve got all this IT access and all this link-up already”
She suggested nurses had a “key responsibility” helping patients to feel more confident managing their conditions themselves and assisting them in making choices.
“It’s about giving people permission to take that forward – giving them permission to be as independent as they possibly can and starting to look at value-based decisions around what patients want for their own health and wellbeing rather than what we think they should have,” she said.
Ms Patten also highlighted the potential role of digital technology, but suggested a different approach to those tried before to improve the use of IT systems across the NHS.
“It never ceases to amaze me that patients think we’ve got all this access and all this link-up already. Why haven’t we?” she said.
A solution, she said, would be to use new “cloud” technology that would enable internet access to live with the patient rather than the community nurse.
“The best thing to do is to work towards patients with their own ‘cloud’ that has all the information, regardless of who they need to see,” she said. “The patient can then permit whoever they need to look at their information and look after them.”
“We should really be giving PE teachers objectives to reduce the average weight of their Year 10 students”
Ms Patten also advised district nurses to delegate where possible, describing them as “orchestra conductors” that were in short supply.
“Try and delegate as much as you can,” she told delegates. “What we’ve got to do is have you at the front, leading that orchestra of community teams, multidisciplinary teams, voluntary workers, and social carers.”
In addition, she called on community teams to “get their teeth into” providing support to care homes to help keep patients out of hospital.
However, Ms Patten told delegates that the future was about preventing poor health in the first place “really from a very early age onwards”.
“For nurses it’s about nursing in schools,” she said. “We should really be giving PE teachers objectives to reduce the average weight of their Year 10 students.”