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Exclusive: Merger mooted for district and practice nursing teams


Merging district and practice nursing teams is an almost inevitable consequence of moves to improve community health services, according to leading health professionals.

The idea of having the same nurses perform crossover roles is already being considered in some areas, Nursing Times has learnt.

“I can see it working well in all sorts of practices, whether that’s a rural or inner city practice”

Ruth Holt

Ruth Holt, director of nursing at South Tees Hospitals Foundation Trust, revealed it was one of several different models likely to be explored in her area in coming months, as part of efforts to re-shape and improve community services.

“There is an opportunity for us to look at one person doing the role of both practice and district nurse to offer more continuity to many patients,” she said.

“District nurses have their own set of skills, as do practice nurses, and they are both highly skilled in what they do,” she said. “But if you think about it from the patient’s perspective, then it’s about having a seamless service where they can been seen at home then followed up in specialist clinics at GP surgeries by the same person.

South Tees Hospitals NHS Foundation Trust

Ruth Holt

“I can see it working well in all sorts of practices, whether that’s a rural or inner city practice,” she told Nursing Times.

Ms Holt said the concept was not about cutting back on staff, as more nurses would be needed for the drive to move more services into the community.

“The starting point has to be what’s right for that particular practice population, and that would mean sitting down with the teams and working out how to do it,” she said.

Her comments come as the new five-year plan for the NHS in England – Five Year Forward View – called for a radical shake-up of services in community and primary care in order to facilitate the provision of more service outside hospital.

“I accept there are all sorts of tribal and historical reasons why it might take a bit of time to come about, but it has to be the right way for the future”

Mike Dixon

Meanwhile, the pressing need to increase co-ordination between healthcare settings was one of the key conclusions in a recent report by the NHS Alliance, which suggested community teams could be linked to practices.

Alliance chair Dr Michael Dixon told Nursing Times there was “an enormous case” for bringing together district and practice nursing teams and it should be the “default position of integrated nursing”.

Dr Michael Dixon

Dr Michael Dixon

“My housebound diabetic patients and those with pulmonary disease would be greatly helped by the practice nurse being able to give her expertise in the home, and vice versa,” he said.

However, the idea may alarm some community nurses who see the two roles as very different and would be concerned about being employed directly by GP practices.

“District nursing and general practice nursing are two very distinct and specialised areas of practice,” said Anne Pearson, director of programmes at the Queen’s Nursing Institute.

“At a basic level there may well be an overlap of skills and knowledge, but both specialties are very different in the breadth and diversity of the expertise required.”

Dr Dixon acknowledged there was likely to be resistance. “I accept there are all sorts of tribal and historical reasons why it might take a bit of time to come about, but it has to be the right way for the future,” he said.

Anne Pearson

Anne Pearson

“This is about local district nurses and local GPs sitting down with practice nurses and others and saying: ‘couldn’t we do this better?’ It’s something that needs to be locally determined and not foisted on people,” he added.

But Marina Lapuri, professional lead for primary and community care at the Royal College of Nursing, highlighted that practice nurses and district nurses had two distinct employers – GP practices and the NHS. “If teams merge, then does that mean they would only have one employer,” she asked.

She added that a key challenge in bringing together practice and district teams was the fact they did not work with the same populations.

“Community nurses are geographically based while the practice nurse is based on the GP register, so it’s going to be very challenging and difficult to merge those,” she said.

“It is down to the nurses, doctors and other health professionals to design services that work best for their local communities”

Jane Cummings

Stephen Phillips, a senior lecturer who leads the MSC in community nursing practice at Huddersfield University, said there was potential for joining up practice and district nursing teams, but he also expressed concerns.

“One of my biggest concerns is around the education and support for district nurses, because I haven’t seen that from GPs in the past with practice nurses,” he said.

Nurses would also be worried about job security, he added. “There’s a feeling that the contracts practice nurses have with GPs are a lot more flexible, and that it’s a lot easier to remove and replace a practice nurse,” he said.

In a statement for Nursing Times, chief nursing officer for England Jane Cummings suggested the idea could be taken forward where it was agreed locally.  

Jane Cummings, Chief Nursing Officer for EnglandJane Cummings

“The NHS forward view is clear that England is too diverse to pretend a single model of care should apply everywhere and it is down to the nurses, doctors and other health professionals to design services that work best for their local communities,” she said.

She added that nursing staff plaid an “incredibly important role in breaking down barriers” between settings that have “hindered personalised and co-ordinated care for too long”.


Readers' comments (7)

  • michael stone

    You can already see, within the above, the way that what might loosely be called 'care based on what makes best sense when viewed from the patient's perspective' rapidly runs up against 'services from separate/different provider organisations'.

    This is a significant problem, and it becomes more problematic, the more complex the care requirements and overall situation of an individual patient.

    But I've no idea how it can be solved - it isn't new, and it goes back to the year dot, it appears.

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  • I suggest that community providers employ practice nurses and provide them back to GPs.

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  • Yes, then the commissioners would be able to react to local situations when purchasing services.

    Midwives already do this in many areas. They provide services in health centres or surgeries in liaison with GP's, but are not employed by them.

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  • This appears to be a good idea but in reality I feel this would be difficult to actually provide. The main problem is that PNs and DNS are employed by two different service providers. As a practice nurse, I'm employed by the GP partners. Most practice nurses are specialists in chronic disease management or family planning; DNs I respect for end of life care and tissue viability expertise and I'm ashamed to say I don't know what other specialities they provide. There are also issues around professional indemnity, the RCN does not cover PNs anymore, my employer pays for me to be a member of the MDU. This merger has been mooted from the 1990s - yes I've been around for a while- I don't think I will see it happen before I retire, and that is a long way off unfortunately!

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  • Why can't we forget history? We all started similar basic nurse training before branching out to develop areas of expertise. Why not embrace these differences? Community & primary care staff will find their skills compliment each other particularly in long term conditions, care of the elderly, end of life and dementia care. The patients will benefit by being optimally cared for in their own communities, hospital admissions of these groups of patients will be reduced. One, NHS, body would be required to be the overall employer, nurse training across the board would be current, monitored to ensure release for essential updates. Come on let's look at a 'can do' improvement to patient care in the community.

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  • Yes if it was employed for the right reasons with each nurse keeping to their own speciality but delivering care both in clinic and at home and not just to address staffing shortages at particular times eg District nurse rings in sick - oh no problem we'll just give the practice nurse her workload etc and visa versa.
    Seems to me its another way of providing blanket cover and soon the specialisms will be diminished in favour of the "Jack of all trades master of none" approach.

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  • I believe PN's should be integrated with heath visitors. This would give more seamless coverage for the under 5's and the elderly.
    The amount of knowledge a practice nurse needs spans the community nurse and the HV.

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