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Shock, horror and dissent in the community

Lynn Young
Primary Healthcare Adviser for the RCN

This article is a much needed follow on from my previous one (NiP 2005;24). For the first time in a long while there has been massive resistance to government health policy - and, some of us would say, "about time too!" Since 1998, primary care has been swallowed, coughed up and regurgitated in the form of primary care groups, primary care trusts, new GMS contracts, strategic health authorities, and  a huge number of various projects and initiatives. Now we have wholescale PCT mergers upon us - which, although anticipated, are jolly hard for those involved in the negotiations.
On top of this upheaval we include a very warm invitation to a whole range of potential alternative providers of primary care to muscle in and take on providing services that PCTs cease to provide.
Many people are publicly talking about the selling off of the family silver - sentiments I wholeheartedly share - but there is some good news: a slowdown in this nonsense has been called for.
It is indeed a wonderful thing when government and its advisers listen to angst and despair from their chief executives and other healthcare staff and react in a sensible way in order to limit the damage caused.
At the end of July, Nigel Crisp, the Chief Executive for the DH and NHS, wrote a letter and paper setting out the form of the decided changes and the deadlines for them to be set in place. There was uproar from significant people and then, lo and behold, another letter appeared from John Bacon, Group Director, Health and Social Care Services Delivery, stating his messages following "considerable feedback from the NHS community".
Basically the current messages from the centre are that the government has not set a template on the size and form of the newly merged PCTs but they must be closely attached to local authorities and very strong on commissioning power. There are warm messages on the need to engage with the local NHS and other stakeholders, and it has been acknowledged that frontline staff have had much to say on the proposals to remove PCT provider function.
There is also a reminder to anxious people that PCTs do not need to relinquish their provider function until December 2008 - and, believe me, many unexpected events will happen before then, so who knows?
But, community nurses do need to look out for the white paper Your Health, Your Care, Your Say and ensure that their views are strongly given on how they think services should be provided in the future.
Nurses and other staff employed by PCTs are being invited by the government to be properly engaged in the discussions, which we are told will decide how care should be provided. We are now able to give you details on how you can contribute to the public debate on how people want to receive care from community health and social care organisations. A Your Health, Your Care, Your Say website has been set up that will enable you to keep up to date with the consultation process and all the issues relevant to this huge transformation about to take place within health and social care. You can access the online survey from this website address: www.nhs.uk/yoursay
Community nurses are key to this consultation being more than lip service, and with so much at stake the RCN is asking nurses to take the time to share their views on the future design of service provision outside hospitals. It may bring greater strength and credibility if groups of nurses gather together and send collated views. Intelligent and informed effort from nurses will have maximum impact and hopefully put pressure on the government to do the right thing for the public, patients and the community workforce.