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The move to PCTs promises positive gains for nurses

Marilyn Eveleigh
Editor

In April 2002 all primary healthcare will be provided by Primary Care Trusts (PCTs). This is the biggest organisational change of the NHS for GPs and community health services since its creation in 1948. Each Health Authority, which currently determines county-wide health needs, will be replaced by a PCT that will establish national health goals as well as local health priorities for its population. PCTs will be responsible for employing community staff and providing services. They will subcontract GPs and support GP-employed nursing and administrative staff. They will work in partnership with other community services, such as social services, welfare agencies and housing, for the health and wellbeing of the population they serve. It is a huge task. New goals, new roles, new leaders, new staff, new locations - new uncertainties!

Reflecting on the forthcoming changes, I would hope to see realised the following gains for all nurses in general practice:

  • Consistent named nurse leaders/advisers to keep the coalface nurses updated with organisational changes.
  • Clarity concerning education and training opportunities and the budgets to support them.
  • Supportive measures to lighten the load for nurses. This includes the provision of Patient Group Directions for some prescription-only medicines that nurses administer.
  • Mechanisms to reduce risk and isolation for nurses working in the general practice setting. Protected paid time for Clinical Supervision with a chosen supervisor would be at the top of my list.
  • Developments around the new group of nurses identified in the extended list of nurse prescribers. In addition, where and when the training of these prescribers will take place.

But there is a very mixed and unequal picture throughout the country. A few established PCTs have some of these points sorted, but others have not made decisions yet. They are still getting their nurse directors, development and clinical governance leads and nurse advisers in place - and the array of new titles is getting very confusing!

For those Primary Care Groups who are to become PCTs in April 2002, the application to the Secretary of State for Health for approval is taking up most of the energy of the few staff they have. Individual nurse support often appears scant as discussions tend to centre around the whole nursing "workforce" as a resource to deliver healthcare.

So who is looking after the nurses as individuals through this change? Who supports them regarding future career and educational plans? Who guides them through the maze of professional responsibilities and risks they encounter every day? Who advises GPs on nurses' hours that should be allocated to meet the pressures of government and patient demands? These are the burdens readers tell us they are experiencing now.

Uncertainty is difficult at the best of times - but it does offer opportunity. To support nurses, especially practice nurses, at this time, Nursing in Practice has created a unique resource - the NiP Network - to give guidance on issues that impinge on them as individuals. NiP Network comprises nurse advisers, experienced nurses and specialist contacts who are willing and able to offer advice on clinical, employment and career issues - or point people in the right direction for local answers! See page 126 of this issue for further details of this enterprising new initiative.

The above comments may seem unfair to some organisations that have been able to cushion the effects of uncertainty. If so, please do write and tell us how you did it so that we can spread the word …

In the next issue I shall attempt to expand on identified gains for nurses in the move to local healthcare organisations. Until then, I and all of the NiP team wish you and yours a Merry Christmas and a Happy (and, we all hope, Peaceful) New Year.