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Nurses should lead more community services, says NHS chief exec

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Nurses and midwives could in the future take on a stronger leadership role in community settings, as part of “radical” plans to shakeup healthcare delivery models across the NHS.

Under proposals unveiled today by NHS England chief executive Simon Stevens, clinical leadership in primary and community care will be expanded to include more nurses, therapists and other professionals.

Meanwhile, it will be made easier for midwives to set up their own NHS-funded midwifery services in order to help drive the modernisation of maternity provision.

“Clearly there is going to be a shift from hospital to community service investment over time”

Simon Stevens

The proposals are included in NHS England’s Five Year Forward View, which sets out proposals to save billions of pounds and address the growing budget deficit in the health service.

The  five-year plan – which is authored by the six leading NHS bodies – provides local NHS commissioning groups with seven new options of service delivery to choose from in the future, depending on their area’s needs.

One of the optional models – called the Multispecialty Community Provider – would allow nurses to link up with groups of GPs, other community health services and hospital specialists. It would see the formation of federations, networks or single organisations, which nurses would be in line to lead.

These types of services would “shift the majority of outpatient consultations and ambulatory care out of hospital settings” and could, in some cases, take over the running of local community hospitals, said the report.

NHS England confirmed that more community nurses and primary care staff in general will be needed to deliver this and other changes.

It added that increased investment in new roles as well as schemes to attract nurses and GPs back to the profession were among the “immediate steps” that needed to be taken to stabilise general practice.

Midwife numbers will also be increased as part of a new – yet to be developed – model to modernise maternity services, which will review current provision and ensure funding for midwifery is more flexible.

It will make it easier for groups of midwives to set up their own NHS-funded midwifery services, said NHS England.

Nurses, midwives and other healthcare professionals will need to be trained in news skills so they are able to take on transitional roles, noted the report.

It added that NHS employers should consider how working patterns, pay and terms and conditions can change to “fully reward high performance, support job and service redesign, and encourage recruitment and retention in parts of the country and in occupations where vacancies are high”.

As the economy recovers, NHS pay will need to stay “broadly in line with private sector wages”, the plan stated, to avoid frontline staff shortages.

NHS England expects its new strategy, which largely aims to “expand and strengthen primary and out-of-hospital care”, to cut the projected annual NHS funding gap from £30bn to £8bn by 2020.

This goal would be dependent on maintaining current levels of government funding and an injection of some additional cash to kick start the new delivery models, the report said.

When asked by Nursing Times how many more nurses and midwives were required to support the changes, Mr Stevens said: “It will depend on different parts of the country.

“We don’t have a single number that says there will be a certain number of district nurses or radiographers for example,” he said. “Clearly there is going to be a shift from hospital to community service investment over time.”

“We are going to increase recruitment and make it easier for nurses to return to work”

Bruce Keogh

He acknowledged the long-mooted shift of services from acute to community had been “incredibly slow” so far, with only a 0.6% increase in the number of nurses working in community settings over the past 10 years.

Sir Bruce Keogh, national medical director of NHS England, added: “We are going to increase recruitment and make it easier for nurses to return to work. 

Sir Bruce Keogh

Bruce Keogh

“There is a massive workforce of nurses who have left nursing – people who are often very experienced – and I don’t think we’ve been very good at encouraging them back,” he said.

A major campaign was launched last month to encourage former nurses to rejoin the profession in order to alleviate the current shortage of staff in the NHS.

Health Education England, the national education and training body, plans to spend almost £5m on the Come Back to Nursing campaign. As exclusively revealed by Nursing Times, it hopes to tempt former nurses by paying the full cost of return to practice courses and offering guaranteed placements in trusts.

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Readers' comments (7)

  • The concern here is that unfortunately with the move to a degree only nurse education programme, we have decreased the numbers of potential nurses accessing nurse education. I therefore can not see where the extra nurses will be coming from? There has already been the shift of secondary care to primary care communities, without appropriate workforce planning unfortunately. This is seeing high levels of stressed community nurses who are making the decision to leave nursing all together. We have a ticking retirement time bomb in community nursing, which has seen numbers of DN's decrease year on year. There is certainly a lot of planning and consideration to be made now to address the current issues, let alone the 'new' radical plans (not so radical methinks as they have already occurred, as all in the community setting will vouch for!)

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  • "When asked by Nursing Times how many more nurses and midwives were required to support the changes, Mr Stevens said: “It will depend on different parts of the country".
    In other words-I haven't got a clue but it is a good soundbite.

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  • and paid on the cheap as well, he wont have any idea of how many nurses will be needed , another person with no experience at the
    coal face

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  • This is an acknowledgement that GPs cannot fulfill the role of coordinators of all primary care because they are too busy to explore all the health and social needs of patients, let alone those many others who are not presenting as unwell but still need support. Whether nurses are best placed to undertake this role (and whether they will be permitted by Drs) will depend on a proper analysis of the needs of people - and we must start thinking not of patients but of people or service users who need integrated health and social care pathways. This takes us outside the customary NHS framework. It is quite possible that the role of care coordinators could be taken on by members of various groups - Nurses, Social Workers, 3rd Sector workers etc. Clinical skills in that role will be less important than the ability to communicate with service users and to agree user-focused care plans, engaging users, providers, and ultimately the commissioners who will pay for it. Coordinators will, after all, be supported by multi-disciplinary teams with the specialist skills necessary for diagnoses and interventions. Simon Stevens recognizes that new skills are needed: developing such skills would take valuable nurses away from nursing - is that a sensible move when there are already too few nurses? We must consider the requirements of the new role of care coordinator first, before deciding who should fill it. Health and social care systems are about to be redesigned - lets do it properly, not on the back of an envelope!

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  • Lots of community nurses and specialists already undertake the management of care. This is recognition for what is already happening.
    Care co-ordination is a fundamental part of practice it does not take nurses away from nursing. It is part of nursing.

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  • Yes community nurses Hv,s, and MW's are already used to managing and function with little management input once experienced. I do not believe GP"s are best placed to lead any care co-ordination they work in many cases in quite a isolated way unless one is deemed 'useful' to them personally. I have worked in approx. 8 GP practices in different counties and see very little effort for true multi agency working with GP's other than lip service despite our Hv Team continuing to strive for it. A way to save money would be to have much more nurse practitioners for say different disciplines such as paeds/elderly care. Much of what GP's deal with does not require a GP appt. Use triage in the community

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  • The comments following my previous submission confirm to me the point I made - the perspective of NHS staff is an internal one. CNs and Specialists do undertake the management of care, but almost entirely within the NHS system. How many NHS staff know how to refer a patient/client effectively to, say Alcoholics Anonymous, or debt advice, legal advice etc? How many can help a patient with finding more suitable housing, private counselling with shorter waiting times than IAPT? Health and wellbeing is affected by all of these things and more and the pressure on NHS and social services will only be relieved by an enabling approach that helps the whole person, not just their medical symptoms. That is not to denigrate nurse input which is essential, but simply to recognise its necessary limitations. Social prescribing must become as important as medical prescribing.

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