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Comment: Embracing integration

Collaborative working is the future of health and social care, but how will primary care and community nurses find the transition?

Over the past decade there has been continual and tireless effort being applied to preventing unnecessary or inappropriate hospital admissions, with a consensus that patients will be better cared for in their own home with the effective forms of support.

There is no doubt that if we can achieve this for those patients with conditions that can be treated at home, we will help to not just reduce the enormous financial pressures being felt in the health system at the present time but also provide care that is more convenient and comfortable for people.

The 'Better Care Fund' initiative is the latest driver for this change to occur and one that Healthwatch fully supports as the key to a creating a truly consumer-focused health and social care system.

However, the implications of the changes could of course just increase the pressure in other parts of the system, and as primary care nurses will be at the forefront of the changes, adequate time and resources will be needed to ensure there is a workforce that is prepared for the potential massive change coming.

Traditionally there has been very distinct organisation and professional boundaries between nursing teams, practice nurses, advanced nurse practitioners, district nurses, health visitors and school nurses to name just a few, each with their own working cultures. Even when there is a willingness to work across those boundaries, day-to-day pressures can get in the way.

Practice nurse appointments are often as fully booked as the GPs these days, and with district nurses and health visitors rushing around trying to get as many patients crammed on their lists as possible, lunch times are a thing of the past for many nurses. This situation is being made worse by added responsibilities such as data collection, which for many nurses, often gets in the way of seeing the next patient.

It is difficult to imagine how nurses can suddenly change practice to accommodate the new ways of working suggested in Better Care Fund proposals, which will mean working in a more collaborative way, crossing not only nursing boundaries but other disciplines such as occupational health, physiotherapy and social care services while ensuring the patient has the highest quality coordinated care package.

We cannot take for granted the planning that will need to be put in place for integrated working to be effective, and this will take time and commitment from all nursing teams and will be heavily reliant on great leadership of those teams.

Change can be a painful process for some individuals particularly if they have been working in one area of practice for some time, which is often the case in primary and community nursing. This is a vital factor that needs careful consideration as the changes will not be effective unless there is 100% commitment from everyone concerned.

If my experience in primary and community nursing is anything to go by I believe if the nurses are supported and involved at every stage of the change process they will be the lynchpin to the success of integrated services and putting patients at the very heart of our health and social care system.