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Community and primary care coming out of ‘deep riven crisis’

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The fall in the size of the primary care and community nursing workforce over recent years has been described by a leading GP as a “tragedy” that the NHS is only just beginning to recover from.

Professor Mike Pringle, president of the Royal College of General Practitioners, noted that there was now greater awareness of the importance of the care given in primary care and community settings.

“We have a really deep riven crisis at the moment within primary care, both in nursing and in medicine. This is a real tragedy”

Mike Pringle

But he warned that, until very recently, the recruitment of clinicians working in these settings had been falling behind their colleagues in acute sector.

“We’ve seen 15 years in which we’ve lost a whole load of the ground we’ve made in primary care and before that,” he said earlier this week at the Queen’s Nursing Institute’s annual conference.

Professor Pringle said: “We’ve seen a reduction in the number of practice nurses – 10% fewer now than at the peak. We’ve seen about a third of community nurses going. We’ve seen general practitioners undervalued.

“We have a really deep riven crisis at the moment within primary care, both in nursing and in medicine,” he said. “This is a real tragedy.”

“That is mixed with the incredible increase in complexity of what we do and the importance of primary care,” he said. “It isn’t now a case of seeing a patient with diabetes – it is a case of seeing people who have got at least two, maybe five major chronic diseases.”

Professor Pringle noted that what such patients needed “most of all” was a health professional to act as their advocate and “look after them as people, not as disease entities”.

“If we lose primary care, if we lose community nursing, what we will end up with is having the most expensive, least effective health system in Europe”

Mike Pringle

However, despite the current time of “gloom and pressure”, he said he was “reasonably optimistic” for the future.

He said the argument over the importance of care provided outside of hospitals had now been won with policy makers, notably NHS England and the Department of Health.

“They know that if they do not have a vibrant, strong, primary care then the secondary care system cannot survive,” he said. “If we lose primary care, if we lose community nursing, what we will end up with is having the most expensive, least effective health system in Europe.”

But he cautioned that, while the argument in favour of primary and community care had been won, sufficient resources had “not yet flowed” to these settings.

“If we can make the political rhetoric be turned into political action, then I think we will be in five years’ time stronger than we are now and in 10 years’ time we’ll be back to the central, pivotal role that we used to have in the whole health service,” he said.

“We’re beginning to make progress and I think between us we can really deliver the sort of service that this country needs,” he added, suggesting that clinicians needed to “talk up primary care and community services”.

“I’m actually, despite what I said earlier, reasonably optimistic”

Mike Pringle

Professor Pringle also highlighted that the RCGP and the QNI planned to work closely together in future, in recognition of the current focus on policy community settings  

It is a “real pleasure” for the RCGP to be working with the QNI, he told delegates at the conference, which was held at the RCGP’s headquarters in London.

“We’ve got a really vibrant agenda between us and both organisations have committed to supporting patients and their carers… to make sure we deliver the best care we can,” he said.

QNI chief executive Crystal Oldman said: “It’s brilliant that we are going to be working together more closely with the RCGP, and soon we will be releasing the results of a national survey of general practice nurses.”

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Readers' comments (4)

  • not true

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  • what's not true?

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  • There is going to be a move to nursing people in their own settings. It's much cheaper and produces better patient satisfaction when attended by a team of qualified nurses who assess what the INDIVIDUALS want and need, and then organise various providers including social groups, social services, family, friends and relatives to make it happen.

    If the current system were so great there wouldn't be an exodus of nurses and a huge dependence on providers, some of whom are genuine and organised in selling person centred care, and some of whom badly damage care standards given by nurses and received by service users. May the decent ones survive and those providing systemic neglect and abuse go under.

    I only hope nurses scared of change and, under the present system, now lacking confidence in their own abilities, can think back to their studying days and what they went into nursing for, and realise that this could be the chance they've waited for - to actually practise caring for and nursing people to really improve their health. How many have that now?

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  • michael stone

    Anonymous | 3-Oct-2015 10:36 am

    '... what the INDIVIDUALS want and need ...'

    Yes, it is 'the patient as a person' that gets lost in 'systemic behaviour', isn't it ? I liked your post a lot.

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