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Influencing the new NHS

April 1 passed relatively quietly for me; gone are the days when the first of the month was always celebrated at home with - 'pinch and a punch for the first of the month - no returns'! However, April 1 this year should have reminded all of us of the mammoth changes it heralds for the NHS. Have you considered what they might mean for you, your practice and those you care for?

For some, these are particularly historic changes - for example, school nurses will now be commissioned by local authority (LA) public health departments. One would like to hope that commissioners will understand the collossal impact that a well-resourced school public health service can make to children's lives, and in turn to society. Until we get enough trained school nurses individually linked to every secondary school and cluster of primary schools many won't be aware of their potential. Unless school nurses take advantage of their new status and lobby their new commissioners, LA councilors and local health and wellbeing boards for more investment in their services, the profession may find little actually changes. Usually the best way of being strong as a workforce is through your professional body. My advice to school nurses locally is to meet with your new commissioners at the earliest opportunity and offer to work in partnership to deliver the recommendations of the Department of Health School Nurse framework. Such local relationships will ensure that your agenda is shared with those who hold the power and purse strings.

So what are the opportunities for district nurses? Most GPs really value your services and will want to invest in enhancing them. Like health visiting, district nursing has suffered massive change and disinvestment in recent years. However once again you have some powerful national friends. The Department of Health are working on a District Nursing pathway and the Queen's Nursing Institute is supporting and enhancing that work. Make yourselves aware of this work and if one of the GPs you work with happens to be involved with local commissioning, talk to them about it, and the needs of your profession. Tell them about the barriers you come up against when wanting to deliver optimal care, and offer solutions. GPs have already pledged their desire to keep more sick people out of hospitals, but they certainly can't do that without a strong district nursing service.

As practice nurses work so closely with GPs, and are employed by them, it might be presumed that they are another group with new opportunities. I think these could come, but most practice nurses work in isolation from peers so may need to link with one another via local professional body meetings to be able to be really influential. Once again though, like district nursing, your profession is pivotal in community care. What could enhance the services you offer, what additional training do you need, are there new and innovative developments you would like to see in your practice? Now should be a good time to articulate any ideas for improving care or the efficiency of service delivery. For once GPs are in the driving seat of commissioning but they will be less successful if they don't listen to nursing colleagues.  

And what do the changes mean for my profession, health visiting? Well we are in an interesting situation. Due to the drive to increase numbers of health visitors, commissioning of our services will stay in the NHS until 2015 when it moves to local authority. As with school nursing, health visitors can see this as being an opportunity, however they must make sure that it is. Very influential in determining the shape of local public health services will be the health and wellbeing boards. It is essential that both health visitors and school nurses communicate with these early in their history. Offer to do a presentation about your services and what they can offer the local community, explain how you work and the value of upstream investment to reduce later expenditure.  

The bottom line is that we are all in this together. You may be very encouraged by what you can achieve.