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Be prepared, you're going to need a lot of energy in 2004

Lynn Young
Primary Healthcare Adviser for the RCN

Do you know what the government is up to and what may come your way in the near future? I anticipate it will not be too long before your everyday practice is challenged!

The new GMS contract is currently knee deep into the preparation phase and on the glorious 1 April 2004 it should be ready for an even more glorious takeoff. Traditional general practice is about to be severely challenged, and with this huge transformation (or implosion if it all goes belly up) comes vast opportunities for feisty and talented nurses to play a more important part.

Practice partnerships, setting up limited businesses, providing out-of-hours services, making home visits when appropriate and being the lead players in the management of chronic disease - all are about to be the stuff of nursing. Not for the faint-hearted, but, when you have a quiet moment, take a look at how far nursing has travelled since the mid-90s. Who, for example, would have anticipated that nurses would be managing so many aspects and domains of the NHS in 2004?

The Secretary of State for Health, Dr John Reid, spoke at the Chief Nurse's conference at the end of last year. No, I did not attend, but working at the RCN has its advantages - it enables you to rapidly receive all relevant press briefings, announcements and important speeches. Dr Reid said that, "Nurses need to be all they can be." He wishes to see a whole new generation of entrepreneurial nurses who are strong enough to take risks and be creative about implementing different ways of service provision - all with better care for patients and health improvement in mind.

He also referred to the GMS contract and made special note of nurses' ability to provide enhanced services and employ more doctors - in a similar way to Catherine Baraniak, who is still doing wonderful things in her PMS Pilot in Derbyshire (see next issue of NiP for a report from Catherine on how she is getting on).

The drive to promote more patient choice and challenge senseless rules and hierarchies is unstoppable. We simply need the courage to carry on - although we must ensure that we keep patient care and health improvement at the very centre of our thinking and action.

Independent prescribing is to expand further - yet more sensible action. Ten new medical conditions and another 30 medicines are to be added to the nurse prescribing formulary. Emergency and first-contact care have been added, and the Home Office has recently agreed to nurses having the right to prescribe a number of controlled drugs. Nonmedical prescribing is about to become mainstream, rather than innovative, and it cannot be too long before our associated health professional (AHP) colleagues will be joining nurses with their very own prescription pads.

Great emphasis is being put on Nurse Executive Directors and other senior nurses to make desirable change happen, and for them to share their power with colleagues. All nurses require the necessary confidence to challenge the old turf wars, which have no place in a modern healthcare system. Strong multidisciplinary teamwork has to be alive to the sound of music if patient care is to be of the very best, but that is not always easy to achieve.

We all work with difficult colleagues and those who do not embrace change with any enthusiasm. But the nursing genie has been let out of the lamp, never to return. Too many nurses have been at the cutting edge of service redesign for too long for informed people not to believe that nurses are capable of running the NHS! But this smacks of territorial speak. Nurses can only improve healthcare when they work well with doctors, AHPs, social care workers, patients, the public and managers - we are all in this together.

Look out for new out-of-hours services - surely a vehicle for testing different models of care. Nurses may well be working much closer with paramedics in the future - another relationship to get to harmonious grips with!