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Consortia must have nurse on the board, government confirms


There must be a registered nurse on the board of every GP led commissioning consortia, the government has said in its revised health reform plans – marking a victory for the Nursing Times’ Seat on the Board campaign.

The government has today announced the amendments it will make to the Health and Social Care Bill, following the “listening exercise” sparked by concerns from clinicians about the proposed reforms.

The move to require consortia – which will now be known as clinical commission groups – to have at least one registered nurse on their board, or governing body, was called for by Nursing Times and a range of other influential bodies, including the Royal College of Nursing.

A government document summarising the changes to the bill states: “Commissioning consortia will continue to be groups of GP practices, but we will make a number of changes to provide greater assurance that commissioning will involve patients, carers and the public and a wide range of doctors, nurses and other health and care professionals.

“To reflect this stronger emphasis on wider professional involvement in commissioning decisions, we intend to use the term ‘clinical commissioning group’ to describe these local NHS organisations.”

The document adds: “We do not intend to prescribe in detail the wider professional membership of the governing body [of the commissioning group], but it will have to include at least one registered nurse and one doctor who is a secondary care specialist.

“They must have no conflict of interest in relation to the clinical commissioning group’s responsibilities, eg must not be employed by a local provider.”

Boards will also have to include two lay members.

The government’s announcement overrules recommendations published yesterday by the Future Forum – a group of around 40 clinicians and other healthcare representatives set up by the government to inform changes to the bill – that said consortia should not be compelled to have nurses on their boards.

However, the government has accepted other recommendations made by the forum on wider clinical involvement and advice in the commissioning of NHS services.

The revised reform plans say that clinical networks, such as those that exist for cancer, will be expanded to cover more specialised areas and be given a “stronger role in commissioning”, in support of local clinical commissioning groups and the new overarching national body the NHS Commissioning Board.

Additionally, ministers want nurses and a range of other health professionals to form “clinical senates”. They will have a major say in whether a commissioning group should be allowed to form in a certain area and will also advise commissioning groups on whether their plans and strategies are sound.

The government document states: “We will enable doctors, nurses and other professionals to come together in ‘clinical senates’ to give expert advice, which we expect clinical commissioning groups to follow, on how to make patient care fit together seamlessly in each area of the country.

“Clinical senates will have a formal role in the authorisation of clinical commissioning groups. In addition they will have a key role in advising the NHS Commissioning Board on whether commissioning plans are clinically robust and on major service changes.”

Announcing the changes to the reforms at Guy’s Hospital in London today, prime minister David Cameron said: “We have listened, we have learned, and we are improving our plans for the NHS.”

He added: “The fundamentals of our plans – more control for patients, more power to doctors and nurses, and less bureaucracy in the NHS – are as strong today as they have ever been. But the detail of how we are going to make this all work has really changed as a direct result of this consultation.”

Nursing Times launched its Seat on the Board campaign in December 2010, calling for it to be made a requirement for consortia to have a nurse on their board.

The campaign was launched in response to concerns that the nursing profession would lack sufficient influence over future NHS funding decisions made by the GP led consortia which are due to take over from primary care trusts in 2013.

Over a 1,000 people have signed a petition supporting the campaign.

Royal College of Nursing chief executive and general secretary Peter Carter welcomed the government’s pledge that nurses would have a guaranteed place on commissioning boards.

He said: “The RCN has been saying from the outset that nurses have an unparalleled range of skills and experience to enable them to improve health care at every level, and we are very pleased that the government has recognised the difference this will make to patients.”

However, he added that while “many of our concerns have clearly been taken on board… there is a great deal more to do”, highlighting the pressure on frontline jobs.

“These reforms have to be absolutely right if the NHS is to face the challenges ahead, especially at a time when the service has been tasked with saving up to £4bn per year,” he said.

Unison general secretary Dave Prentis reiterated his union’s position that the Health Bill was beyond repair and should go back to the drawing board.  

He said: “The government is creating a Frankenstein Bill that should be thrown out now. The fact that the government is accepting the bulk of the Future Forum’s recommendations, simply underlines just how damaging the Health and Social Care Bill was and is to the NHS.”


Readers' comments (15)

  • fantastic news! let's see what it will mean in practice...

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  • Oh. Wow. Yippee. A Nurse. What a victory. Yay. I have wet myself with happiness.

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  • michael stone

    This was a waste ot typing, then !

    I have just sent this to my DH contact (we are discussing something else): perhaps you should push, for this sort of compromise ?


    I know this isn’t your area, and DC and AL have probably already got this sewn up. And, I’m offline so my terminology will be wrong here, and I have not looked at the Bill.

    But, judging by the initial posts on the Nursing Times website, etc, the absence of a recommendation that nurses should automatically be on these ‘steering boards’ (can’t remember the term) has provoked responses which make my ‘Meldrew Moments’ look quite restrained.

    The report wants input from lots of different professionals, but claims, in essence, that so many would wish to be on those boards, that they will not all fit. So why not, have ‘core’ and ‘rolling’ membership, enshrined in the Act (perhaps variable by secondary law) ?

    If these boards have, for example 8 members, why not specify that 5 or 6 must be certain types of person, but the other 2 or 3 must rotate (presumably every 12 months or 2 years, I suppose) between a list of categories ? I’m not sure, exactly who wants to be represented, but will not fit – but 2 obvious categories who might be given a place on the ‘rotating list’ would be ‘hospital nurse’ and ‘community nurse’. So, if there were 6 rotating seats, any particular board would have a community nurse on it, for one-sixth of the time (actually, if there were 3 rotating seats, and only 6 categories, for half of the time !). Etc. And, provided you made sure these appointments were phased across the country, then at any given time, all of these professional groups would have representation on some, if not all, of these ‘steering boards’.

    Please feel free to pass it on, if you think it makes sense,

    Regards Mike

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  • Wouldn't it be lovely if they turn out to be on the board for other reasons than being married to one of the GPs

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  • michael stone

    It does say this above;

    “They must have no conflict of interest in relation to the clinical commissioning group’s responsibilities, eg must not be employed by a local provider.”

    One hopes, that nepotism will be stamped on !

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  • I'm getting mixed messages here, first there is a token Nurse, then there isn't, then there is, then there isn't.

    Why the hell is it acceptable for others to choose whether our profession is included in the running of the NHS or not? We should not be 'included', we should be RUNNING the consortia EQUALLY by right!

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  • now cam is making a big issue of listening! how many patients' lives are going to be adversely affected before the gov make up their minds actually to act and make any positive changes

    cam made up his mind quickly enough about giving away millions to foreign aid

    it seems he is just seeking exercises to demonstrate to the public who is in charge, but very little else at the moment

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  • Anonymous | 14-Jun-2011 3:45 pm that foreign aid bill runs into BILLIONS!!!! EVERY YEAR!!!!! Imagine the improvements if that money was simply used to fund staff Nurse staffing levels instead.

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  • michael stone


    This from the DH response to the Future Forum's recommendations (it's on
    the DH website so in the public domain)

    "Governance and accountability for commissioning groups

    • Every commissioning group will have a governing body with decision-making
    powers, to ensure that decisions about patient services and use of
    taxpayers’ money are made in an open, transparent and accountable way.
    There must be at least two lay members, one with a lead role in
    championing patient and public involvement, the other with a lead role
    in overseeing key elements of governance such as audit, remuneration and
    managing conflicts of interest. One of the lay members will undertake
    either the role of Deputy Chair or Chair of the governing body. If
    Deputy Chair, the lay member would take the Chair's role for discussions
    and decisions involving a conflict of interest for the Chair.

    • We do not intend to prescribe in detail the wider professional membership
    of the governing body, but it will have to include at least one
    registered nurse and one doctor who is a secondary care specialist. They
    must have no conflict of interest in relation to the clinical
    commissioning group’s responsibilities, e.g. must not be employed by a
    local provider.

    • To enhance transparency and accountability, governing bodies will be
    required to meet in public and publish their minutes, and clinical
    commissioning groups will have to publish details of contracts with
    health service providers.

    • The authorisation process for clinical commissioning groups will ensure
    that they have robust governance requirements consistent with Nolan
    principles and are accountable and transparent. This will not be a
    one-off test: the NHS Commissioning Board will hold commissioning groups
    to account for this on an ongoing basis. "

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  • michael stone

    mike | 14-Jun-2011 3:03 pm

    PM on Radio 4 has just 'got this wrong', as it appears has almost everyone else.

    It seems that a nurse, a hospital doctor and 2 laymen, will have to be on some sorts of bodies which somehow 'oversee' the GP commissioning groups, as far as I understand it.

    I have no idea how how those people are chosen, or what actual POWERS this body will have, over its GP Commissioning Body - but, there seems to be this 'new group', and THAT is te one with compulsory laymen and nurses, on it.

    Unless I am wrong - I suspect, I am right, but I ahve had very little 'checking time' (but I do have a DH contact, and I think I'm right).

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