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Interview: Mark Jones, Director of the CPHVA

What are your credentials for your new job as Director of the CPHVA?
I needed to have a primary care qualification. Otherwise I assume the CPHVA were looking for someone with leadership and facilitation skills and the vision to take the organisation forward as the one and only organisation for community practitioners and health visitors!
When I started my nursing career I went from clinical nursing roles at Guy's to being a health visitor in Chelsea and Lewisham. I joined the RCN in 1988 as an Assistant Primary Care Adviser and moved up to Primary Care Policy and Practice Adviser before leaving to join the CPHVA this year. I was also the first chair of the RCN Health Visitors' Forum before becoming a member of staff, having nagged the organisation to do more for health visitors.

How is the new job going?
My fundamental "duty" is to position CPHVA as the organisation for community practitioners and health visitors. To do this requires the ability to coordinate our lobbying efforts with government and governmental agencies throughout the UK, build up strong links with other professional bodies, and create strong academic partnerships. Fundamentally, though, the CPHVA must be recognised by all potential members as the organisation of choice and one that can best meet their needs on a day-to-day basis and at times of increased pressure.
The aim is that, by default, community practitioners, health visitors, professional bodies and the government will see the CPHVA as the major player in community nursing and public health practice.

What does the CPHVA do for its members?
We ensure that the views of our membership are represented through lobbying government as we seek to develop a health service best equipped to meet the needs of the people we serve, and provide the best working environment for our members.
Significant campaigns over the past year have highlighted the deficits in NHS IT provision and the abuse of our members regarding transport. We will continue to campaign to ensure that all our members have the tools they need to do their job properly, be this a car, a PC, the right to prescribe, time off for education - whatever.
We have a substantive continuing professional development programme currently majoring on leadership and facilitation skills specifically designed for public health practice. In 2003 this will expand to include clinical workshops for district nurses and health visitors.
We offer a number of conferences and workshops throughout the UK. Our national conference takes place at the end of October in Harrogate. We are expecting 1,500 delegates to attend.

The NHS is being reorganised, with primary care taking a more central role. Has this put extra pressure on your members?
Of course. While it is to be welcomed, the drive to ensure equity of quality care provision throughout the UK via implementation of national standards - notably the English National Service Frameworks - puts tremendous pressure on the primary care workforce, especially nurses and health visitors. In addition, while it is great that nurses are able to develop their roles to take on some aspects of the work of GPs (and do a better job of it), this will only be successful when we recruit more community nurses. Stretching our current workforce is no answer to GP shortages.

Do you think the changes in primary care are for the better?
The changes are by and large for the better. We welcome the recognition that more focus needs to be put on public health issues and that practitioners should have more time to work in partnership with communities. This assists them in changing their environment and their own perceptions to be able to make more health-enhancing choices in their lives. This requires more resources, not just a change in philosophy.

How would you organise primary care if you were in charge?
I would persist with the current governmental model of encouraging local innovation within a national framework. However, the difference would be that appropriate resources would be identified at national level and passed down with clear instruction as to how they should be used to facilitate education, role development and skills acquisition. I believe the primary care workforce is keen to develop to provide the best possible care, but it is held back by the age- old problems of workforce numbers and insufficient time to step back from the problems it is trying to address in order to reconfigure for the future. It is no use asking a busy district nurse for her thoughts on the CNO's top 10 issues for nurses contained within The NHS Plan, when she can scarcely find the time to read her kids a bedtime story.
We need to encourage practitioners to break the mould, try new things, and even to take risks. All of this must be done with due consultation with the public, and decent backup from managers who are keen to support new ways of practice rather than stifle innovation due to fear of missing some target or other.

The CPHVA has just submitted evidence to the pay review body. What are you looking for?
The bottom line is that community practitioners and health visitors should be paid what they are worth. Comparators with police officers, teachers and whoever are just that - comparisons with other jobs. If the government is really keen to see nurses deliver the goods, they need to pay a decent wage. £30k for a health visitor who has undertaken years of study and has a great deal of experience is no big deal. Similarly, a nursery nurse with a degree in child psychology providing a crucial service for the development of children shouldn't get a mediocre wage just because she is not a "registered" professional.
We want Agenda for Change to offer what it said it would - so that innovation, commitment and experience can be rewarded right across the health service, irrespective of job title.  
The government can deliver, and it will have to. The NHS Plan and equivalents throughout the UK are sound in principle, and a lot of good work is being done to implement them. At the end of the day, though, quality work comes with quality pay, and the government must realise this.
Pay is not the only issue. We need employers to wake up to the needs of people with commitments outside the NHS - families, children and other dependants. Policies that offer flexible working and allow people to meet these commitments and enjoy their lives more will pay dividends in the workplace. Big business knows this, and as one of the biggest, the NHS best get on board.

What other issues are the CPHVA currently involved in?
What more do you want!? One thing we intend to develop over the next year is our international profile. Already we participate in international fora in areas in which we have undoubted expertise, such as child and maternal health. We intend to position ourselves as a key player in the global alliance of nurses, midwives and health visitors, and will share our experiences as well as learn from others as the world becomes a smaller place.

At the time of going to press, you are preparing for your first CPHVA Annual Professional Conference as Director (31 Oct - 1 Nov in Harrogate). What are you particularly looking forward to?
I am looking forward to meeting a vibrant throng of 1,500 members keen to learn more, question and participate in building the future of their organisation and profession. I am keen to tell a wider audience what I stand for and how we can move forward together. Of course, tea and cakes at Betty's [a well-known café] has a certain allure!

How do you see the roles of community nurses, health visitors, district nurses and school nurses developing in the future?
Well, that is the 10 million dollar question. The NMC is currently consulting with us on the future shape of the register, and it would be remiss to comment in detail without getting a sound opinion from our members. What I am sure of is that those competencies that we currently recognise in community nurses, health visitors, school nurses and practice nurses will continue to be recognised and made available to the individuals, groups and communities we serve. There is room for change, and I am sure we will see role development, with the creation of new models of service delivery allowing us to provide the best possible care.

Any final message?
Tough as it may seem sometimes, you need to know that the powers that be recognise - at last - that our health service would fail in its aims without the sound bedrock of primary care. As technology improves, people will stay in hospital less often and will be looked after in their own homes. Primary care is and will be where it is at. However, above all, it is becoming evident that the shift to a public health focus that concentrates on helping people and society not to get ill in the first place, and to maximise their life experience if they unfortunately do, requires nursing and health visiting skills above all else. You will never be out of work!

NiP would like to thank Mark for taking the time to answer our questions.