Practice nurses face being caught between moves towards providing more holistic care to patients with long-term conditions and local surgery policies of limiting consultations to one problem.
The conflict between local policies designed to deal with current pressures and future national aspirations to redesign services around patients was highlighted last week at a major community nursing conference.
NHS Confederation chief executive Rob Webster told delegates that the holistic nature of care provided by community and primary care nurses should be a key feature of the future models of care provision currently being piloted by NHS England’s “vanguard” sites.
Speaking at the Queen’s Nursing Institute’s annual conference about, he noted that community nurses often “turn up for one thing but there are lots of other things to do and we mustn’t lose that in the clamour for change”.
- New nursing strategy to retain 6Cs at its ‘heart’, says CNO
- QNI plans to help new generation of community nurse leaders
- Community and primary care coming out of ‘deep riven crisis’
“I think we’re increasingly winning the argument that services need to look at patients and communities first,” he said.
“If we recognise we’re a guest in their life, they are not guests in our organisations… and if we organise around their needs not out professional egos… then we can create new dynamics in care… we can create more joined-up care, more care that meets the needs of people today,” he said.
He added: “For the 18 million people with long-term conditions who look after themselves…if we provided better self-supported care, better technology we’d get better outcomes. For the three million with three or more long term conditions, we need to join services up around them.”
“There’s inner tension between the expectation of what you feel you should be doing and what your organisation is very clearly stating is their approach and philosophy”
However, a member of the audience highlighted that many practice nurses faced a “tension” between providing more patient-focused care and local surgery rules responding to increasing pressures on consultation time and patients turning up with so-called “shopping lists of problems”.
She said many nurses worked in settings where there was a sign up saying “one patient, one problem”.
“[GP practices] almost have a very negative view if you go beyond that and deal with other issues,” she said. “That’s a real challenge.
“There’s inner tension between the expectation of what you feel you should be doing and what your organisation is very clearly stating is their approach and philosophy,” she said. “Support for general practice nurses with that tension is absolutely key.”
She suggested there was a need for evidence to support nurses in arguing that “actually it is better use of time and resources to broaden” the consultation from its initial focus.
“The really difficult thing I’ve got to ask you to do is keep operating in one system, while preparing to work in another”
Mr Webster acknowledged it was also a problem faced by community nurses through the use of “time slots for district nurse visits, which can mean they are very task-focused rather than holistic”.
However, he suggested that things would get better in future, as new models of care were rolled out under NHS England’s Five-Year Forward View plans.
“The big challenge for everyone in the service at the moment is that we are trying to deal with the pressures of today and think about creating a new set of services for tomorrow,” he said. “The really difficult thing I’ve got to ask you to do is keep operating in one system, while preparing to work in another.
“We’re really committed to saying: ‘let’s think differently about the way we deliver care so that we don’t just see people with multiple conditions for one thing when they’re worried about something’,” he added.
Mr Webster also highlighted the importance of supporting nurses and other staff during what he said was likely to be a “decade of change”.
“We know staff in the NHS are the most stressed public sector workers,” he told delegates, noting that if NHS leaders wanted them “to drive forward change… then we need to look after you.”
“What we must do is provide emotional support, resilience, wellbeing for all our staff”
Reducing stress levels would result in “better decisions, better value, better outcomes, and better services”, he said.
Highlighting the emotional pressure faced by nurses, Mr Webster described his experience of going out with staff to visit patients while in his previous role as a community trust chief executive.
“I just really worried about the patient all the time,” he said. “I’d be thinking afterwards, I wonder how so and so is getting on now because they’re on their own at the moment. I used to do that after just a day.
“How do you carry that all the time, how do you have the emotional resilience,” he asked delegates, noting that staff had told him they mostly relied on peer support.
“It’s not good enough,” he said. “What we must do is provide emotional support, resilience, wellbeing for all our staff.”