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Nurses should be handed more power in remodelled primary care

  • 3 Comments

Nurses should take on key new leadership roles in primary care, according to a major report on securing the future of the sector.

It calls for a “resolute focus” on good health and self care rather than disease management; which would be supported by two new roles – a community health connector and a senior community nurse.

The report, published by the NHS Alliance today, maintains that GP services are at a crossroads and need fundamental change to meet the needs of patients and “re-energise a tired and demoralised primary care workforce”.

This includes making the most of the expertise of community and district nurses, and ensuring greater co-ordination of nursing care between practice and community teams and social services.

“As health professionals and as the general public, we need to think and act responsively and responsibly to help restore the NHS”

Mike Dixon

The report stresses the need to attract more nurses and doctors into primary care, highlighting challenges such as the dramatic 40% drop in the number of district nurses in the past 15 years and that a disproportionate number of practice nurses are now aged over 50.

It also flags up the fact there is no clear career route into practice nursing and that training placements in general practice are “unusual”.

The report suggests GP practices could be at the centre of new “communities of care”, but adds extra funding would be needed to make this happen.

One of the first steps should be to put senior community nurses in charge of co-ordinating health and social care for frail and older people with long term conditions, according to its authors.

“Many patients, particularly the frail elderly, are receiving care from both a practice team and community nurses, and may have social care needs as well as health ones,” said the report.

“The interaction between these healthcare professionals, and their colleagues in social care, is important in maximising patient wellbeing and avoiding deterioration and potential hospital admission,” it added.

It said one option would be to have community healthcare staff attached to, or linked with, a practice or small group of practices.

The report also called for the creation of a community health connector post for each area to join up work with other local services to address “social factors” affecting wellbeing.

This role could be taken on by a nurse who would be expected to work alongside education, housing, transport, charities and local businesses.

The report – titled Think Big, Act Now: Creating a Community of Care (see PDF, top-right) – is based on six months’ research including consultation with a range of primary care professionals.

Dr Michael Dixon, chair of the NHS Alliance, said the research suggested GPs, nurses and others were “open to new ways of working”.

NHS Alliance

Mike Dixon

“But new ways of working also rely on new ways of thinking and doing,” he said. “As a system, as health professionals and as the general public, we need to think and act responsively and responsibly to help restore the NHS and all the people associated with it to good health.”

This would include ensuring at least 10% of the overall NHS budget went into primary care and the introduction of a General Practice Development Fund, he said.

  • 3 Comments

Readers' comments (3)

  • michael stone

    The second and third sentences of the Foreword are:

    'We must start implementing solutions
    to the challenges, rather than continuously analysing them. Procrastination is no longer an option.'

    I 100% agree about moving to solutions, instead of endlessly describing problems which are often well understood - but it is very difficult to achieve joined-up and balanced behaviour across 'the NHS', because in practice it seems that 'defending my own patch' keeps pushing itself to the fore.

    For example, the following extract from the above, looks rather like 'a no brainer' (at least in as much as one person should be co-ordinating the care): but that doesn't necessarily mean it will actually happen:


    One of the first steps should be to put senior community nurses in charge of co-ordinating health and social care for frail and older people with long term conditions, according to its authors.

    “Many patients, particularly the frail elderly, are receiving care from both a practice team and community nurses, and may have social care needs as well as health ones,” said the report.

    “The interaction between these healthcare professionals, and their colleagues in social care, is important in maximising patient wellbeing and avoiding deterioration and potential hospital admission,” it added.

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  • Can't we just consolidate good practice? Some of us already do this without the new and fancy title. I for one am fed up of money going to me posted to do what we district nurses could and would do if the resources were put into our teams. The drop in DN numbers is from bad management decisions in the past which are just swept under the carpet.

    I wish that management and meeting time was audited and subjected to results based pay.

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  • Is this not the community matron role. I was fortunate to hold such a position 2005-2007 as a nurse practitioner and prescriber and we did just what this suggests....

    Living in Australia now. Sad to read the demise of the NHS. Nurses are well supported and well staffed here.

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