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Nurses win local power


A nurse will sit on the board of every local NHS commissioning body, the government has said in its revised health reform plans - confirming a victory for Nursing Times’ A Seat on the Board campaign.

However, only certain nurses will be able to apply for board places, as the government has banned local hospital and community nurses due to their “conflict of interest” in decisions over the funding and redesigning of their services.

In your areas, you have to think about how you might organise yourselves to support each other to make yourselves available for these roles

The government last week announced a range of changes to be made to the Health and Social Care Bill, following its “listening exercise” on the controversial reforms.

Prime minister David Cameron signalled the changes in a speech earlier this month.

The move to require GP-led consortia - now known as clinical commissioning groups - to have at least one registered nurse on their governing body was demanded by Nursing Times’ A Seat on the Board campaign. This was supported by 1,300 people in a petition as well as by a range of influential bodies, including the Royal College of Nursing.

A government document summarising the changes said the bill would be amended to “provide greater assurance” that commissioning would involve a wider range of health professionals than just GPs.

It follows concerns that health professionals, including nurses and hospital doctors, would be excluded from key NHS decisions as the original plans did not mandate whether commissioning groups should have boards or who should sit on them.

The latest government document states the boards of commissioning groups must from now on include two members of the public and “at least one registered nurse and one doctor who is a secondary care specialist”.

However, it adds: “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.”

A Department of Health spokeswoman said that this would prevent nurses from sitting on the board if they worked for an organisation that had a contract with the commissioning group.

However, she said this would not apply to nurses employed by practices in the commissioning group, because contracts to provide GP services would be held by the NHS Commissioning Board and, as a result, there was “judged to be no conflict of interest”.

The opportunity to sit on the board of a commissioning group is also open to hospital and community nurses working in neighbouring areas.

The government’s announcement is in contrast with recommendations made by the Future Forum - a group of 40 clinicians set up to inform changes to the bill - that said commissioning groups should not be compelled to have nurses on their boards.

However, ministers did back the forum’s call for nurses and other health professionals to form “clinical senates” in each area.

Announcing the changes, Mr Cameron said: “We have listened, we have learnt, and we are improving our plans for the NHS.”

Senior nurses welcomed the greater inclusion of nurses and called on the profession to grasp the opportunity. 

Queen’s Nursing Institute director Rosemary Cook said: “It looks as if the government has listened and learnt, as they say, and leaned at least a little bit towards a more collaborative approach to improving health services.”

The NHS Alliance’s Nurses in Commissioning Network lead Ursula Gallagher told nurses: “In your areas, you have to think about how you might organise yourselves to support each other to make yourselves available for these roles.”

RCN general secretary and chief executive Peter Carter said he was “very happy” with the outcome.

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 healthcare at every level.”

Crossbench peer Baroness Emerton, a former nurse who sat on the Prime Minister’s Commission on the Future of Nursing and Midwifery, said nurses taking board roles would need to be both knowledgeable and politically aware.

She said: “It’s essential they are trained for the job and that the job is defined.”

Dame Donna Kinnair, a senior nurse involved in commissioning in London and also a former member of the Prime Minister’s Commission on the Future of Nursing and Midwifery, welcomed what she described as the “broadening of leadership for commissioning consortia to include nursing”.

“After all, we must include the right sort of leadership to ensure that those with long term conditions are looked after properly,” she told Nursing Times.

Andrea Gupta, nurse lead and business manager of the StHealth Consortium in Lancashire, said she had found it difficult to find nurses for her board: “The main problem I find is lack of developmental opportunities for nurses. We have management courses for managers and GPs but this is not the case for nurses.”

What people are saying

“There is still more work to do to. Nursing Times and others have lobbied hard for these opportunities, so we have to put our money where our mouth is now”

- Ursula Gallagher, NHS Alliance Nurses in Commissioning Network lead

“This is as huge as the implementation of the NHS in 1948. We need to make the profession aware of the opportunities”

- Baroness Emerton, former nurse and member of the Prime Minister’s Commission on Nursing

“Nurses should be on the board for the right reasons, not a tick box exercise. There has been too much of that in the past and it is now time we did things for the right reasons”

- Andrea Gupta, nurse lead and business manager, StHealth Consortium

“It looks as if the government has listened and learnt, as they say, and leaned at least a little bit towards a more collaborative approach”

- Rosemary Cook, Queen’s Nursing Institute director


Readers' comments (4)

  • michael stone

    This still appears very odd.
    The boards will include various people, who are presumably chosen by the GPs, and 2 laymen (with a strong ‘conflict of interest’ role) plus a hospital doctor and a nurse. I will call those 4 people, the ‘statutory group’.
    The statutory group, appears to include a doctor who is at arms length from the GPs, and presumably the 2 laymen must also be ‘arms length’, so those 3 people are ‘free from the influence of the GPs’. If a hospital nurse were the fourth member of the statutory group, all 4 would be ‘independent’, and could presumably introduce both lay and ‘clinical but non-GP’ perspectives into decision-making. But if a Practice Nurse who works within the GPs’ practices, is one of those, then I find it difficult to believe that the nurse could be ‘genuinely free from influence’ by the GPs ?
    This is not to say that such a nurse could not be on the board OUTSIDE of the statutory group – one of the other members the GP Consortium (old term – but more sensible) places on the board.
    But the idea that a conflict of interest only involves one party (in your article, the service providers) isn’t correct: one side is the GPs for whom the commissioning is being done, and the other is the secondary service providers. In my mind, logically, all 4 of the statutory group, should be independent of both ends: so you could not have a Practice Nurse who worked within the GP Consortium, nor laymen registered as patients with it, nor a layman who provided something like accounting services to any of the GPs. Unless you stick to those rules, this protection against conflict of interests, and also the introduction of ‘wider perspectives’, seems to be lost !

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  • michael stone

    mike, try to calm down - your last post makes me worry about your blood pressure !
    But unless the 'concept' behind both lay and wider-clinical input on commissioning boards, is fully defined and firmed up, it will definitely only be 'a victory' for GPs !
    I agree with you - it is not, at present, a 'proper victory' !

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  • michael stone

    I was scanning The King's Fund site earlier today, and one of their writers started his up-date about these reforms with the following:

    'The lines on the map are gradually snapping into place. The NHS Commissioning Board has announced the full list of clinical commissioning groups (CCGs) seeking authorisation. There are 212 in all, covering populations of between 68,000 and almost a million. These are not the commissioning groups most people imagined back in 2010 – they are far fewer and, on average, far larger.'

    I definitely gained the impression, that the idea was to make commissioning more responsive to the needs of individual GP Practices and the needs of their particular patients, which would have implied quite small 'local-level commissioning decisions'.

    These CCGs are actually the size of large towns to large cities, not 'closer to the patient' at all, so far as I can see. Which still makes me wonder, if this is all in reality an attempt to deflect criticism of any problems caused by inadequate resourcing of the NHS in the future, towards GPs and patients, and away from the goverment - and, although I have neither the time nor inclination to study the reforms in great detail, it now looks so layered and muddled as to be a confused disaster-in-waiting, to me ! I certainly, think that more decision-making power could have been transferred to GPs, without this level of disruption and reform to the system.

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