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The future of our community

In this new feature, we invite prominent figures in primary and community care to write on a topic that they feel passionate about. To start us off, Cheryll Adams from Unite/CPHVA talks about the future shape of community practice

Cheryll Adams
Acting Lead
Professional Officer

I'd like to suggest that every registered nurse and health visitor should take some responsibility for moulding the future of their professions. At no time during my career has this been as important as it is now. If we don't speak up on behalf of our professions and our clients, then others, often with less insight, will decide the future shape of community practice.
There are number of issues on the policy table which could have a momentous impact on how you practise in the future. Have you engaged in discussions in relation to the move of more patients to the community for assessment and treatment, for health visiting activity to be based in children's centres, or considered the potential impact of the "skills for health" work, which is breaking down tasks across healthcare into discrete steps and measurable competencies? The intentions of these pieces of policy are commendable. But is healthcare that simple? Can your activity be broken down into tick box steps or is there some other very valuable component that is harder to measure and worth speaking up for? Of course there is. Clinical practice is both an art and a science, and skilled decision-making is based on not just education and training, but on experience at the coalface, so called "tacit" knowledge. What's more, no two encounters or patients are the same and we adapt our practice to provide as client-centred a package of care, support or intervention as we can.
Consider for a moment the impact of skillmix on determining successful outcomes and exemplary care for our clients. This is high on the policy agenda as it is expected to save money. We all know it can deliver very positive outcomes, but you need to get the mix right. Essentially in healthcare, as in life, you get what you pay for! Water down professional skills too far and the client may be the recipient of a very much less than adequate package of care.
Someone recently told me of a situation where a community nursery nurse (CNN) had been supporting a family for six months on behalf of an overstretched health visitor. One day the health visitor received notification of domestic violence. When questioned, the CNN said that she hadn't been aware of any emotional problems, but her training prepared her to focus on the child's needs, not on those of the mother. Compare this to health visiting practice where the whole family and even their environment is the focus of the health visitor's much more holistic approach.  
Unfortunately due to the advent of inappropriate skillmix (rather grade mix) in many health visiting teams some health visitors no longer know and have a relationship with their clients. As the health visitor knows, such relationships provide an opportunity for early interventions in vulnerable families where postnatal depression, domestic violence or child protection could arise. On the other hand an intensive input, such as helping the mother breastfeed her child, may be unsustainable for a health visitor, and the CNN is a more appropriate person to take on such work. It's a question of "skill balance" as well as "skillmix".
It is time for community practitioners to become conspicuous in leading, not following, the agenda for community care and the NHS. If you and your colleagues are unhappy at the potential consequences of any proposed changes, you must say so. Be clear on your facts and try to provide evidence for your concerns. If your managers don't listen, then share your concerns with other local professional groups such as GPs and paediatricians to gain their support, talk to your professional body, and perhaps with your local MP, who has been elected to serve the population. You will be surprised at how successful you can be.

Your comments: (Terms and conditions apply)

"I am sorry, but after nearly 20 years in community nursing I became so disheartened with 'the way forward' that I have resigned and now work (happily) in a GP surgery." - Name and address supplied