While the government and GPs are locked in battle over the provision of extra hours and out-of-hours care, the primary care nurses who have a significant role to play in delivery of that care seem to be locked out from the debate.
Now, a major survey by Nursing in Practice of over 1,400 primary care nurses has revealed that they are divided on this topic.
Fifty percent of community nurses, 52% of health visitors and 57% of district nurses believe things should go back to the pre-2004 arrangements, before the new "GP contract" removed responsibility for out-of-hours provision from GPs. Some believe that move has led to confusion and a drop in standards of care.
On the other hand, 74% of nurse practitioners and 65% of practice nurses, themselves employed by GPs, believe that the 2004 out-of-hours arrangements have had mixed results but that PCTs (primary care trusts) should continue to provide the service and improve upon it where necessary.
One practice nurse from Shropshire explained: "People's expectations of the service is for self-gain only. They do not complain that their bank manager, local MP or solicitor is not available at 8pm, or expect them to be at work then."
However, frontline nurses are united in their opinion on the government threat to hand out-of-hours care over to the private sector. Sixty-two percent of those questioned felt that the introduction of private sector providers poses a major threat to the quality of general practice and to patient care.
When it comes to the private sector "Money is the name of the game!" commented a community nurse from Herefordshire. "I have seen standards fall in the residential homes and home care services."
The Nursing in Practice survey has also revealed that staff shortages, frozen PCT posts, an increasing workload and little recognition of the value of their role have left many primary care nurses disillusioned with the state of their profession.
In fact, the survey shows that 62% of health visitors describe their current morale as low, 36% feel the amount of work-related stress they experience is "unmanageable", and more than half – 60% – would not even recommend a career in the primary care sector. In addition, 55% of district nurses and 45% of community nurses would also describe their current level of morale as low.
With morale so low it is difficult to see how the government will persuade many frontline nurses to get onboard with its proposals for extra hours and out-of-hours care.
Your comments: (Terms and conditions apply)
"I feel that one of the aims of Primary Care is to improve the long term health of the nation. To effectively support clients in their quest to become and stay healthy we surely need to be available out of hours. I do feel that if Primary Care nurses are being asked to provide this service there should be financial incentive for working out of hours. All public services are beginning to make their services available out of hours I am not sure why we should feel we don't have to" - GP practice nurse, Chippenham
"Of course standard of nursing will fall when agency nursing staff takes over, as all they want to do is to finish their shift and they go to the next job without any responsibility. What is wrong with going to A&E when one needs to? Out of hours is for the convenience of the public and often it is abused. I am the public too and of course if there are such services, I'll use them, but if not I will visit A&E when needed, as they are still a walk-in service The more options you give, the more the public wants. The public are never satisfied. For once think. It would be nice for some of us not needing to work those hours, now it is a must, like those dark ages of having to work nights and causing misery to all again" - GP practice nurse, Enfield
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