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GP consortia need you: nurses have a key role in the new NHS

Marilyn Eveleigh
Consultant Editor

With the revelations in the recent NHS white paper, I had anticipated a rollercoaster ride for healthcare and nursing. But I was not prepared for the frenzy that seems to be around - created by the extent of the proposals, the speed for change, the uncertainty at all levels from chief executive to frontline worker, fuelled by continual speculation.

The government will reveal more in a paper due at the end of October, after widespread consultation and representation from employers, workers, politicians and Joe Public. Meanwhile, I observe committed healthcare workers losing sight of the bigger patient picture and becoming anxious about themselves and how they will fare in the reorganisation. The healthcare media appear to compound the negatives. Does grim news makes better reading?

Undoubtedly, nurses are feeling the pressure of frozen vacancies, unfilled posts, downgrading jobs and the increasing use of unqualified workers. Staff are aware of the 45% target reduction in NHS management costs; organisations are losing productivity or becoming destabilised as staff morale plummets. Managers cannot give reassurance and comfort to staff as they do not feel reassured or comforted themselves. Even GPs are concerned about the impact on their time of commissioning consortia involvement and the potential change in responsibility and personal income.

Moreover, 22,000 nurses in primary care provider and commissioning organisations will be affected by the abolition of the strategic health authorities (SHAs) and primary care trusts (PCTs). A significant number are worried about their jobs, loss of their NHS employer and change of employment terms and conditions if foundation trusts and the private sector dominate future healthcare provision. Much as we moan about the NHS, the threat of privatisation makes us moan more.

Yet the security and advantages of public-sector employment have been diminishing over recent years. This included the change to the NHS pension scheme: recently those over 50 have been given the option to adopt the new rules and regulations of the 2008 pension changes. The default NHS retirement age of 65 is being scrapped in October 2011. Nurses have not felt the need to be employed fulltime in the NHS: many work part-time as an agency nurse in the trust where they are employed.

Now, in anticipation of future workforce reductions, the NHS in England has offered staff wishing to resign up to a year's salary to voluntarily vacate a post to enable redeployment for other staff facing redundancy. It has conditions and risks, but many senior nurses could be interested. Unfortunately the decision must be made between mid-September and the end of October 2010 - too early for the new NHS structures to be clearer and help those nurses losing their jobs in PCTs and SHAs to make a judgement. Whose bright idea was that?

About 200,000 of the 670,000 registered nurses are more than 50 years old; 30,000 nurses and midwives in London and the South East are due to retire between 2007 and 2017, and there is a similar trend nationally. At the present time, anecdotal evidence suggests experienced nurses and senior nurse leaders will leave the NHS tempted by their pension, the mutually agreed resignation scheme and the wish to leave the pressures of a reorganising healthcare system.

This is unfortunate. The nursing workforce is core to redesigned services, and nursing skills are needed to deliver the healthcare goals, whether in an NHS organisation, a not-for-profit social enterprise, a council or a private company.

Nurse involvement and strong leadership are vital to implement effective change. This reorganisation needs nurses more than ever to support GP commissioning consortia in determining population needs and ensuring quality standards and efficient outcomes. The government considers that GPs “know their patients”, hence the development of GP consortia; but nurses are involved in 80% of healthcare consultations - that means we too know a lot about patients' needs.

The NHS white paper is an opportunity for nurses to influence and be part of the commissioning of care by GP consortia. We must step up to the challenge to be heard.