Not enough thought is being given to community practitioners, Unite union has said.
The country's largest union said that the Department of Health was "leaving community nursing and health visiting out of the intellectual loop".
Unite made the comments about two new documents commissioned by the Department of Health, Nurses in Society and State of the Art Metrics for Nursing: a rapid appraisal.
Obi Amadi, Unite's Lead Professional Officer, Policy and External Affairs (pictured), said: "These new reports are aimed at how nurses might realise the vision outlined by health minister, Lord Darzi earlier this year; however, the emphasis is skewed far too much towards the acute sector.
"The government has continually stated the importance of community nursing for its family-friendly agenda, but this is not always translated into policy. We feel that consideration of the community nursing role is being intellectually sidelined."
She added: "As always, we are more than prepared to work with government to restore community nursing services to local communities and end the debilitating culture that is prepared to see - according to the NHS's own workforce statistics - "a health visitor job being lost every 27 hours"."
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Do you think that the government is sidelining community nursing and health visiting? Your comments: (Terms and conditions apply)
"We are currently undergoing a district nursing review to bring the service in line with current government recommendations. Many district nurses have spent time collecting data, and making suggestions and recommendations to inform and improve practice despite being constantly short staffed and overworked. The recognition for this seems to be planned reduction in district nurses and a minor reduction in costs in comparison to the wider picture. Can district nurses really inform practice and change?" - Name and address supplied
"I believe the fact that the specialist practitioner role has been eroded due to the loss of the university qualification is having an impact on the quality of community nursing teams. At a time when more complex patients are being nursed in their own homes we are experiencing a reduction in qualified, experienced community nurses." - Name and address supplied
"Definitely. As a community nurse, our workload is getting bigger and more complex, yet our man hours are getting less and less. Nobody ever finishes on time, and as we are short staffed, no one ever gets time owing back. The NHS is saving lots of money with the good will that is still left in a very demoralised team." - Name and address supplied
"Only if we let them! Community nurses need to be more proactive in their responses to policy direction. You can hide behind a busy caseload but sometimes you need to seize the initiative. Find key people in the PCT to talk to and prove we have ideas and are intellectually able to match the managers and commissioners! My advice is seek support and recognition from where you can and go from there." - Sue Spencer, Durham
"We are constantly hearing that we must be flexible, creative and enthusiastic. How can overworked tired demotivated staff be ENTHUSIASTIC?" - Margaret Duddy, Greater Glasgow and Clyde
"I am very fortunate to be a clinical champion in the commissioning PCT NHS County Durham. I am one of 15 frontline clinicians from a range of disciplines who are striving to inform the commissioning agenda. The role is in its infancy but has good potential. We do not have a PEC anymore but clinical champions fulfil a strategic role informing the board. Our work is
linked to the Darzi workstreams. Sometimes it is up to nurses to find a route to contribute and without a doubt our numbers of community nurses never seem enough to deliver on the ever changing agendas. I should add that I also have a fulltime diverse health visiting caseload too!" - Hilary Earl, Durham
"I am very interested to know – how current/accurate is the claim that a health visitors job is being lost every 27 hours? And when we will be down to our last health visitor? I do think that there is a tendency to sideline community but that things are getting better in this respect, with the push for care closer to home and the emphasis on health visiting and supporting families in so many of the relevent policies. As a worfkforce we need to be flexible, creative and enthusiastic to sieze the opportunities on offer at the moment and to prove our worth by demonsrating improved outcomes and improved quality of services." - Deborah Futers, Cannock
"It certainly feels like it. Practising community nurses are now working principally either under GPs or within provider arms. Although GPs can influence commissioning they are understanbly focused on their own professional needs and responsibilities. Provider arms are now at the mercy of commissioners who commission according to government targets and GP demands. Since the government seems to have a very poor understanding of the potential contribution of community nursing, nursing has not been invited to the commissioning table and thus has little direct influence in the commissioning process." - Name and address supplied
"Yes, we work long hours. No one asks us for our opinions even though we are on the front line." - Name and address supplied
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