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”
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”
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.
“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.