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Our future employment: time to raise the level of debate

Lynn Young
Community Health Adviser

This is an excellent time for practice nurses to think long and hard about their professional future. You need informed views on how your particular discipline's expertise can best be provided in the new primary healthcare and general practice world. Time given to holding local discussions is not a luxury but a necessity. And remember, good-humoured disagreement, as long as it is respected, is healthy and helpful. It is a way towards achieving progress, so start talking with your colleagues about all aspects of future PN employment. Exploring a variety of views and discussing them in an open and friendly way can help expand our minds and look at life in a different way. The result of a new mind set could be a group compromise and agreed action plan, which can lead to a positive result - all achieved because interested people have taken the time to talk openly in a friendly and safe environment.

The current big issue for PNs is, of course, the state of your future employment - it is in your and the public's interest to rapidly raise the level of debate.

Way back in 1986, via the Cumberlege report,(1) it was suggested that PNs and the care they give to their patients would be better served if they were employed by an NHS organisation (in those days we had community units), rather than by independent GPs. The more mature readers may recall the uproar from the then much smaller PN workforce - a mere 8,000 compared with today's 18,000. The message sent to the RCN at that time was that PNs wanted to remain employed by GPs. But primary healthcare has changed and will continue to change - quite dramatically so.
PNs are frequently out of sync with their community nurse colleagues and other local PNs. Annual pay rises are not always received, cost-of-living supplements are rarely given, and time out for continuing professional development and PCG/T activities is not freely provided.

This story is shared throughout the UK, but by no means within all general practices. A large number of GPs have proved themselves to be excellent employers. However, despite the constant pressure and campaigning from the RCN, GPs are still able, if they wish, to resist paying their PNs their annual pay increases. Primary legislation giving GPs independent status is still very much in place and is not going to be dumped in the near future.
But there are other transformations afoot in primary healthcare that offer PNs interesting options which they need to seriously consider. The tide could be turning in the form of the minority but significant number of disgruntled PNs and new primary care organisations. If as a PN you believe that your employment conditions are less attractive than other PNs or community nurse colleagues employed by the PCT, now might be the time to take more positive action.

Perhaps unhappy PNs should consider lobbying their PCT with regard to transferring their employment from their GP to the new organisation - but only because this is what they want, not because the RCN believe it to be a good idea! This course of action may not yet possible in your area, but we need to think about what possibilities the near future holds. We all need to believe that in the future all PNs will receive their annual pay rise automatically, but being realistic, not pessimistic, this may have to come from the PCT, not the traditional GP. In 1986, PNs were very sure about what they wanted. In 2002 this crucial part of the primary healthcare workforce may believe it is in their best interest to be employed by their PCT.
Over to you … let the debate continue, and remember, primary healthcare can have a mix of PN employers - both PCTs and GPs. The simple difference in the future is that PNs could have a choice.

1. Department of Health. Neighbourhood nursing - a focus for action (Cumberlege report). London: HMSO; 1986.