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Is this the right time for nurse entrepreneurs?

Marilyn Eveleigh
Consultant Editor

To deliver a visionary health service there is a need for nursing to influence how services should be redesigned and delivered. Care closer to home/in home, improved access, earlier hospital discharge and an emphasis on holistic care are what patients and carers need, and what the government has called for. Nursing is comfortable with these concepts and skilled to provide.  

The Wanless Report, Our Future Health Secured, reinforced the importance of nursing to shape a healthy population, reduce modern day lifestyle risks, and build confidence and knowledge in the public to manage their own health.

In 80% of all healthcare episodes, a nurse is involved. This gives us great insight into the efficiencies and quality of care involved in the patient's journey. In addition, nurses closely identify with all sectors of the population - unlike medicine, which largely draws from social groups 1 and 2, the nursing workforce comes from all social strata.

NHS commissioners are continually looking for different ways and new providers to offer more tailored and efficient healthcare for patients. Scanning nursing vacancies will reveal the emerging presence of the private provider competing with the NHS for staff to deliver their services. These companies and entrepreneurial businesses are contracted to provide care to NHS patients: they cut waiting lists, deliver to set standards and have sound business skills. Such competition is considered to be a catalyst for the improvement in traditional NHS services. A safe monopoly is said to bring about complacency and dulls the imagination for improvement. Yes, the current healthcare market is ripe with encouragement and opportunities for nurses to set up as independent providers.

In my experience such national vision and announcements tend to have a more mundane interpretation. There are indeed new private healthcare providers - but in reality few services are provided by independent nursing entrepreneurs. There are a handful of Personal Medical Services (PMS) where nurses employ a doctor on a sessional basis, there are a few nurse-run social enterprise organisations, but there is scant private nursing practice and only a small band of independent nurse consultants offering clinical services. Why is this? The market is open, the public love us and we have great organisational skills.

Anecdotally most nurses do not want to take on the responsibility of being a new and alternative provider. They have been shielded from the business world having been trained in the paternalistic rigidity and hierarchy of the NHS - where rules and conforming are expected and adhered to. There are few entrepreneurial nurse role models and being a pioneer is yet another responsibility to attach to the mothering or carer role most nurses already carry. Young nurses lack the confidence and experience; the more mature do not want new risks at a time when they want to wind down. The lack of clarity around indemnity cover in new models of care does not help.

Setting up as an independent provider feels too risky for nurses who would be required to put a detailed business plan together. Nurses report having no solid funds or financial means to raise a bank loan for this investment - and the present economic climate means this will not be forthcoming for many years.

Just managing spiralling domestic, mortgage and heating costs are challenge enough - there are reports that 19% of nurses have taken on a second job while others are taking all the overtime on offer. So far, the NHS has not felt the insecurity of the impending recession; being a public servant at least means there is a salary coming in.  

There will be an inevitable knock-on effect on the NHS. Services will be scrutinised as equipment, medication, energy and staff costs increase. I predict the first may be a review of the spiralling cost of NHS Direct - a formal political report has put the cost at £25 per call - and one-third of all calls are immediately referred to a GP or A&E.

Whatever the next year brings, it will not see the blazen pioneering spirit of nurses leading with new energy, design and commitment to patient care. The caring attributes of nursing will always prevail - but nurses need to look after themselves and their own to be able to serve their patients well.