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Commissioning decisions: nurses need to speak up!

Lynn Young
Primary Healthcare Adviser

Working in healthcare involves coping with constant and radical reform, and this results in considerable changes being made. Furthermore the measures that have recently been laid down by ministers are likely to lead to a fundamental shift in both culture and service provision. The NHS we have known, loved and grown thoroughly accustomed to - despite its many flaws -  is to be transformed, or so today's politicians are boldly telling us. Basically, robust commissioning, which is to be carried out by the new PCT and practice-based commissioners, is to be the focus of attention, rather than the provider organisations, and they, in their wisdom, have been given the dual role of redesigning services as well as keeping within budgets.
The RCN has been running a series of workshops on commissioning with the aim of helping frontline nurses understand the process and feel more equipped to get involved. Many nurses have reported to the RCN that they are finding it difficult to discover where the practice-based commissioning (PBC) meetings are taking place, let alone get involved. It seems impossible to believe that adequate and informed commissioning decisions can be made without a significant level of informed and wise nursing input. The timescales for commissioning developments are all topsy turvy anyway. The PCTs, which are supposed to have the function of ensuring that multidisciplinary PBC clusters are in place and well supported, will not be operating properly until October 2006. Mergers are busily taking place, and a large number of PCTs are still without a chief executive. This is making it really difficult for nurses to obtain their place at the PCT and PBC tables, simply because the essential part that PCTs should be playing in this activity is, in most areas, missing.
However, it is not all bad news on the commissioning side of life. One PCT has reported to the RCN that managers are working hard to achieve better integration between the practice and district nurses so that, together, they can ensure that their voice is heard at the commissioning table. But how can the right commissioning decisions be made where the nursing voice is silent?
The government has certainly made bold decisions regarding its intentions on healthcare. While state funding of healthcare is to continue and services remain free at the point of need, the drive to bring in the independent sector, in the form of alternative providers, is strong. It is easy to imagine that there will be many a brownie point for those PCT chief executives who quickly deinvest their community health services and invite other providers to tender for business. So far, it is quite clear that organisations are not waiting at the PCT doors to offer their community health services, but in time this picture could change. No, the focus of interest lies with general practice and walk-in centres. Companies such as Netcare, Care UK and United Health Europe are seeking general practice and walk-in centre contracts and have succeeded in securing a couple. Nurses need to accept that future healthcare means a diversity of providers and that contracts of employment are therefore likely to diversify. The RCN is now challenged with working to ensure that, where nurses are transferred to an alternative provider organisation, terms and conditions of service are maintained and possibly improved.
The white paper Our health, our care, our say demands greater community health capacity and capability - and quickly!(1) A significant number of nurses currently working in hospitals may well seek new opportunities in the community, and programmes will need to be made available so that the necessary skills and knowledge can be acquired. In the meantime, let's nurture our senior community nurses so that they have the energy and motivation to act as superb mentors and gurus to the new generation of nurses, some of whom may have the joy of nursing me in my more mature years …


  1. Department of Health. Our health, our care, our say.  London: DH; 2006.