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OPINION

Add value to care by getting involved in commissioning

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The Nursing Times A Seat on the Board campaign offers nurses a great opportunity to show their worth.

Instead of asking the question: “Why should nurse leaders have a seat at the top table of a commissioning organisation?” and reverting to a defensive argument, we have the opportunity to clearly articulate the added value that nurses would bring to a consortium board.

‘We must challenge the thinking that GPs are the only professional group able to lead the health white paper changes and recognise nurse leadership within commissioning’

Nurses are a key group in the multidisciplinary team and should have a say in how taxpayers’ money is spent on healthcare. However, I am not naive enough to suggest that our profession is a homogenous group.

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Healthcare is delivered by many professionals along the care pathway. If you ask patients, they want confident, competent practitioners who make them feel safe and treat them with respect.

To date, the profession has not encouraged roles in commissioning organisations as a career choice. Yet, with these new challenges, there is a real opportunity to add value to patient care.

If, as a profession, we are to embrace the changes in Liberating the NHS white paper, we must challenge the thinking that GPs are the only professional group able to lead these changes and recognise nurse leadership within commissioning.

A Seat on the Board campaign aims to champion nurses by persuading the government that it should be mandatory to have at least one nurse on every consortium board.

Commissioning healthcare faces four major challenges: improving the health of the population; ensuring a high quality of care in all settings; managing costs and delivering savings; and managing the transition to clinical commissioning.

You don’t have to look too far to find examples of nurse leaders in these areas. Nurses have been involved in: public health planning and delivering population models of preventative care; quality standards and monitoring; service redesign; change management in primary care and care homes; establishing governance systems; and safeguarding adults and children through interagency and partnership working.

Nurses have also been involved in reviews and investigations into care failures. Findings inform changes and offer transparency and objectivity to the public, patients and carers.

Nurses lead service improvements that enhance quality of care and contain costs. These include prevention and management of falls, risk assessment, venous thromboembolism treatment and pressure ulcer prevention, all of which reduce harm to patients and save taxpayers’ money.

Nurses, with their expertise, have much to offer commissioning. Their key skills fall into four distinct areas: putting patients first; being an entrepreneur; working in partnership; and leading multiprofessional teams.

Nurses manage complex healthcare pathways, putting the patient first. They are the only professional group who manage 24 hour continuous care in many settings. Because of this in depth knowledge and experience, they can create opportunities for change rooted in service improvement.

Many develop entrepreneurial skills to try new ways of working and tackle problems that affect patient care. In the future, healthcare needs will cross many boundaries and disciplines. This approach is core to good holistic nursing care in provider and commissioning organisations.
Nurses need to further develop their confidence in influencing individuals and stakeholder groups such as patients, managers, non-executive directors, medical leaders, social services, the police and voluntary organisations. Working in many different teams and leading them through change is how we will improve both care and job satisfaction.

The main responsibilities of commissioning are to: buy good quality services across the care pathway to meet all the different population needs; and make decisions about not buying services.

Commissioning teams have the details of all the individual organisations involved in a patient’s care pathway, from primary care to tertiary specialist care. The challenge is to ensure all parts of the care pathway fit together to deliver holistic care.

This area needs to be further developed as nursing roles in commissioning have evolved in quality assurance and risk management. One of the main benefits of a more local approach is that the multiprofessional networks can work together on innovation and service improvement using the learning from quality assurance and risk management.

Nurses should embrace the changes by getting involved locally and demonstrating their contribution. Experienced nurses recognise good care and have the skills to lead teams that are organised around patients and not professionals - a persistent challenge to all in healthcare.

If we fail to take this opportunity, the profession’s added value and a chance to retain the learning from primary care trust models will be lost. Good quality patient care remains central to decision making, whether that is for an individual patient care level or across a population.

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