I was a commissioning nurse before they were invented. In the early 1990s, I was given a unique opportunity to undertake the first development post in my area as a “purchasing nurse”.
Since then, I have watched the development of commissioning as a nurse leader in provider trusts and in commissioning organisations, and listened and contributed to the debate on the nursing role in commissioning.
We have not managed to tell a good enough story about commissioning to nurses. We have not focused enough on service design and improved outcomes
The government consultation paper on commissioning says: “The central theme [is] understanding the health needs of a local population or a group of patients and of individual patients; working with patients and the full range of health and care professionals involved to decide what services will best meet those needs and to design these services; creating a clinical service specification.” It goes on to talk about other commissioning activities such as procurement and quality monitoring.
Nurses are key among the professionals mentioned. We need to seize this opportunity to influence healthcare and health outcomes for our patients, families and communities.
As a nurse commissioner, the clinical and professional knowledge of nurses was invaluable to me. It will continue to be vital: understanding the health needs of local people (step forward health visitors and community matrons); understanding patient group needs (step forward nurses and nurse specialists); designing and developing high quality services (nurses innovators to the fore); clinical specification (GPs, nurses and patients together).
We have the ability to do this. As deputy chief nursing officer, over the past two years I have been privileged to meet hundreds of nurses and other healthcare professionals and seen many innovations and service improvements. I have met nurses using the latest technology to support people with long term conditions in their own homes, and practice nurses providing an ever increasing range of primary care.
I have discussed new approaches to care with nurses in hospitals who are leading programmes that have reduced infections and improved safety, and have seen many, many examples of nurses leading the drive for high quality and productivity.
I believe that bringing these examples and experiences to commissioning can transform and create services that are right for local people. Many practice based commissioners who will lead GP consortia have likewise publicly stated that commissioning is strengthened by involving other healthcare professionals in commissioning and by learning together.
So, I become concerned when many nurses feel they cannot participate in active, clinically led commissioning dialogue. Nurses give me a range of reasons, the most common being: “I don’t understand commissioning and I don’t have the necessary skills.”
We have not managed to tell a good enough story about commissioning to nurses. I suspect that we have focused too much on procurement and the need for separation of provider and purchaser and not enough on service design, improved outcomes and the need for integration.
It is therefore not surprising that nurses do not feel commissioning is a natural match for their skills, resulting in this lack of confidence. We need to address this urgently and equip the profession to be full contributors to commissioning effective services.
As we move to a time when most decisions are made locally, we need strong groups of clinicians working together to improve services. Nurses need to work with GPs and other health professionals to develop understanding and respect for each other’s knowledge, to develop local consortia arrangements that ensure their knowledge is used, to work with local communities about how they will be involved and to think about the values and principles on which decisions will be based.
Community nurses and health visitors need to share their strong local knowledge as part of assessing health needs and bring understanding to designing services that are locally appropriate and acceptable.
Nurses say they want the profession to have greater visibility in national debates on commissioning. The chief nursing officer, working with the national director for commissioning development, is bringing together a national group of nurse leaders who can provide this visibility. The group will look at leadership and the skills in which nurses feel they need to be confident and competent.
As with GPs, not all nurses will wish to be actively involved in commissioning and many nurses will want to be involved alongside their clinical practice. There are and will continue to be commissioning nurses in full time NHS public health and social care commissioning roles. For others, there are new opportunities to combine practice with commissioning and the national group will explore this. For example, nurse led specialist commissioning support services could be developed around the commissioning of community services and intermediate care.
We have the clinical knowledge. We have many of the skills and can learn others. We need to use this opportunity to move the question from, “why would we have nurses in commissioning?” to “how can we possibly do commissioning without nursing knowledge and expertise?”
Viv Bennett is deputy chief nursing officer, Department of Health