Key changes to the NHS reforms to widen clinical involvement in commissioning to nursing and hospital doctors will be included in NHS regulations but not be written into legislation, the government has said.
As a result, the government will in future be able to go back on its pledge that nurses have a place on the boards of commissioning groups – the new name for GP consortia – without needing to change the law again.
The original wording of the Health and Social Care Bill would have left it up to clinical commissioning groups to decide their own governance arrangements. Nursing Times, the Royal College of Nursing and other organisations have been calling for this to be changed so that boards were required to include nurses and other health professionals.
In its initial response last week to recommendations from its NHS Future Forum – a group of 40 clinicians set up to advise on changes to the controversial health reforms – the government acknowledged these calls and said it would now require commissioning groups to include at least one nurse, a hospital doctor and two members of the public in their boards.
However, in its full response to the forum – published today – it explained that it would be doing this by amending the bill “to allow regulations to be made specifying certain core requirements” for boards, rather than setting out the requirement in the wording of the bill itself.
It stated: “We propose to require, through such regulations, that, in addition to GPs, there must be at least two other clinicians on every governing body: at least one registered nurse and a doctor who is a secondary care specialist.
“Nurses are closely involved in delivering primary care in general practice settings and in the community, and we have heard from many during the listening exercise that it would be helpful for this expertise to feed into how clinical commissioning groups are run,” it adds.
The government admitted that putting the requirement for nurses to sit on commissioning group boards in regulations, rather than stating it in the wording of the actual bill, would mean it could easily be removed at a later date.
The document said: “Including the detail of core governance requirements in regulations will allow flexibility for the approach to evolve over time in the light of experience.”
The document also reiterated points made in its initial response that the “non-GP members” must not have conflicts of interest with the commissioning group – ruling out nurses who work for local providers with whom the group holds contracts.
However, the new document says non-GP members do not necessarily need knowledge of local health services, suggesting nurses from neighbouring areas will be encouraged to sit on boards.
“It is more important that the nurse and doctor on the governing body bring an understanding of nursing and of specialist care,” the response document said.
Additionally the document reiterates the government’s commitment last week to create more clinical networks and to establish new bodies, called clinical senates, to advise commissioning groups. Nurses are expected to play a key role in both.
Again, these will not be enshrined in law. The government document said the networks and senates would be “hosted” by the NHS Commissioning Board and “will not need to be provided for by amendments to the bill”.
However, a Department of Health spokesman denied that the government would go back on its pledge.
He said: “There is no loophole and we will not go back on our pledge. Our full response to the Future Forum is absolutely clear that we will introduce regulations requiring at least one registered nurse and one doctor who is a secondary care specialist on every governing body. Regulations are legally binding.”
RCN health of policy development Howard Catton said he was disappointed nurses were not mentioned by name in the bill but said the fact it was in regulations was still a “significant stride forward”.
But Mr Catton added that the nursing profession needed to reflect on why it had not automatically been given a place on the board at the start, and said this could be changed by ensuring it now took up its place on boards.
He said: “We can best do that by delivering on implantation. We should not have to campaign this hard.”