Health Secretary Alan Johnson and Schools Secretary Ed Balls have just published a £372m plan aimed at reversing the spiralling problem of obesity. But low morale and disillusionment among the primary care nurses in the front line of delivering the care could compromise the initiative.
A major survey by Nursing in Practice of over 1,400 primary care nurses has revealed that staff shortages, frozen PCT (Primary Care Trust) posts, an increasing workload and little recognition of the value of their role have left many primary care nurses questioning the state of their profession.
Primary care nurses are often the first contact for individuals wishing to lose weight. They offer treatment, diet and lifestyle advice as well as much-needed support to the overweight and obese. They are vital to the success of any obesity strategy. Health visitors alone have a huge influence over the early years, helping parents and children to lead healthier lifestyles.
But the survey reveals 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. Worrying figures for the government who will be relying on this profession to underpin the new strategy.
Unite/CPHVA Acting Lead Professional Officer Cheryll Adams said: "It is enormously worrying, but predictable, that 60% of those polled would not recommend a primary care sector nursing career – and this is a searing indictment of very poor NHS management philosophies which have allowed this culture to develop." Unite/CPHVA (Community Practitioners' and Health Visitors' Association) is a section of Unite, the third-largest trade union in the NHS.
Survey results also showed that it is not just health visitors who are feeling discontented – 55% of district nurses and 45% of community nurses would also describe their current level of morale as low.
Lynn Young, Primary Care Adviser at the Royal College of Nursing, is not surprised by the survey results: "Community nurses and health visitors are tired of constant organisational change, which in itself achieves little improvement in patient care. In fact, quite the reverse – public funds are used to support irrational change, rather than frontline services."
For practice nurses, the ticking-box process involved in achieving QOF (Quality and Outcomes Framework) points – the annual reward and incentive programme detailing general practice achievement results – was the biggest complaint.
One practice nurse described how "number-crunching has taken emphasis away from giving the patient quality care", while another expressed disgust that, to achieve maximum points, "a patient should be rung up by a HCA [Health Care Assistant] and asked if they are feeling suicidal, or when they last had an epileptic fit".
Pay was another emotive subject, with most primary care nurses feeling underpaid and undervalued:
• 64% of district nurses felt their remuneration was "unfair" and that, as specialist practitioners being shouldered with more and more responsibility, they should be on Agenda for Change (AfC) band 7 or even 8, earning the equivalent salary of a head-of-year teacher or police sergeant.
• 56% of health visitors said they were paid an unfair wage and that, considering the responsibility and accountability that came with the job, all health visitors should be AfC band 7.
• 52% of community nurses considered their remuneration to be "unfair", with most feeling that AfC band 6 would be more appropriate for their level of responsibility.
• 53% of nurse practitioners in primary care considered their remuneration "unfair". As one nurse practitioner said: "I see patients with undifferentiated and undiagnosed conditions, I am a nurse prescriber and I do not think AfC pay bands reflect clinically on this level of work." Most were looking to be on AfC band 8.
However, in contrast, and perhaps because they are not paid by the NHS (they are paid directly by GP employers), 61% of practice nurses felt that their remuneration was "fair" and reflected their current workload and level of responsibility.
"Comments made [in the survey] by PCT-employed nurses on pay are harsh, making the RCN even more aware that a 2008 pay deal needs to be far more generous than that awarded in 2007," said the RCN's Lynn Young.
This was echoed by Nursing in Practice Editor-in-Chief Elaine Linnane: "We are keen to investigate our readers' views and feelings and to represent them and their interests in our media and the media at large. That's why we took advantage of our large readership to canvass their opinions in the survey and obtain a true representation of them. Yes, we aim to promote best practice and improve patient care. But we also feel it important to reflect the nurses' views and interests and bring them to the attention of the media and hence the public and the powers-that-be with a view to improving their working lives too."
Your comments: (Terms and conditions apply)
“Morale in school nursing is at an all-time low. Nurses in a certain trust have still not been banded, yet we are expected to cope with all changes thrust upon us. Health care assistants are also employed, without any clearly defined role, more money wasted. Sadly nursing is being destroyed by nurses” – Name and address supplied
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