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The pace of NHS change is scary - and yet exhilarating

Marilyn Eveleigh

Is it my imagination, attitude or age - or have the last few months been littered with promised changes in healthcare services that will affect all primary care nurses but are happening outside our control? The NHS is undergoing rapid reorganisation, with new policies, politics and "potentials" being announced on a daily basis.
It started with the planned change from Primary Care Groups (PCGs) to Primary Care Trusts (PCTs), effected on 1 April 2002. Traditional contacts and services provided by Health Authorities to practice nurses and GPs disappeared overnight, and for many practice nurses there is little clarity with the new PCT as to where educational resources or professional support for the PN role will come from. Things will no doubt become clearer over the next few months as Directors of Nursing/Lead Nurses are appointed. Meanwhile, there is some concern that there will be a paralysis in nursing developments while PCT organisations settle down - and I hope that new general practice nursing services will have the appropriate infrastructure, training and funding to deliver the high standards patients are rightly led to expect.
The first of the new nurse prescribers' extended training has started. These prescribers are not the community district nurses and health visitors who were the original nurse prescribers - they are nurses in palliative care, minor illness/injury centres and local nurse specialties where it has been identified that prescribing independently from an extended formulary would aid patient services. This is in addition to the nurses working under Patient Group Directions (PGDs) who provide prescription-only medicines. Unfortunately the use of PGDs is widely variable across the country. It's getting confusing as to which nurses can prescribe or supply what, when and where. Are patients any clearer?
New details of the GP Contract are filtering out, and there is to be wide consultation and a series of ballots by the profession on what they want. The 24-hour patient care commitment of GPs is likely to go, and PCTs will provide the service by employing GPs to cover out-of-hours. GP services will be negotiated and paid according to what the practice decides they can manage - from basic sickness care to screening and health promotion and/or chronic disease management. The practice nursing and community nursing role will be expected to adapt accordingly.
Then there was the Chancellor's April budget, which raised taxes to fund NHS improvements. NHS Direct, the nurse-run telephone contact service, will cover the whole country, daycase surgery will increase from 50% of all operations to 75%, the private sector will be included in the "NHS family", there will be more doctors and 35,000 new nurses will be recruited. Unfortunately, official estimates put the present UK nurse vacancies at 9,000 - and the average stay for an overseas nurse is only 18 months. There are high expectations of this greater funded NHS - and you and I are part of it.
The National Practice Nurses Conference in March in Belfast concentrated on the clinical basics the profession provides. The conference next year in Liverpool must review some of the employment implications and changing roles that hail from these recent changes.
Despite all these changes, the role for nurses in primary care has never looked so bright!