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There's changes afoot, and it's not all good news ...

Lynn Young
Primary Healthcare Adviser for the RCN

Being a thoroughly and often infuriatingly optimistic person by nature it is unusual for me to write in sombre mood. I have always believed that nurses need to read upbeat and cheerful articles - what good does misery do for nurses trying to do their best under difficult circumstances?
But I do have a responsibility to inform nurses about what our politicians have been plotting and what their latest demands are on overworked nurses.
The latest from Whitehall is a real humdinger, and is all set, in my humble view, to bring havoc to an already turbulent world of primary healthcare.
Primary care trusts are about to halve in number and lose their provider function. All have been ordered - yes, ordered - to remove 15% of their management and administration costs so that £250m can be saved. And the other demand is that the new and somewhat larger PCTs will be required to align themselves far closer to local authorities - truly integrated social and healthcare services lie ahead.
Strategic health authorities have much to do, as they are charged with ensuring that before mid-October their PCTs are reviewed and measured against a set of government-defined criteria, and that all reconfiguration is completed by October 2006. The timescale is onerous and unrealistic. Politicians have a huge amount to answer for when they place demands on NHS staff that take attention away from patient care and on to relentless reorganisation and redundancies.
So, what is all this going to mean for the frontline nurses working hard in the community? Many PCT-employed nurses will be transferred to yet another organisation, with all the upheaval that this entails, and GP-employed nurses will inevitably feel the impact as anxiety is certainly contagious.
And, readers, there is more: Ms Patricia Hewitt, Secretary of State for Health, has declared that all PCTs must have practice-based commissioning in place by the end of 2006, not 2008 as previously agreed. All this, in my view, spells chaos and is the government vehicle for welcoming plurality within primary heathcare and an end to the monopoly of traditional general practice.
The order from above is that PCTs should provide services only if there is no other adequate provider tendering for business. Some areas could experience a range of alternative providers, such as nurses managing a model (eg, alternative or specialist personal medical services); the private sector, such as Boots or Tesco; or, more realistically, United Health from the USA, which has experience in managing long-term conditions.
We have all grown up with private or independent hospitals being available for those who choose to pay more for their healthcare, but independent primary healthcare has for the main part been unknown within the UK. A note of caution, though: politicians may issue orders, but they may not get what they want. Providing good primary healthcare is complex and untidy. General practice, although not perfect, has a long and proud history of keeping the public satisfied, along with the army of NHS-employed community nurses.
I want to offer the very best of luck and indeed support (if they want it) to those feisty nurses who wish to set up their own companies and bid to be the local provider of primary healthcare services. However, the reality is, I fear, 12 months of anxiety among NHS staff who are having radical and unnecessary change imposed upon them.
In my experience, relentless and rapid reform does not serve staff or patients well. The RCN is currently exploring ways of diminishing the possible damage these latest policies may cause, but at the same time considering how we can best help nurses who want to grab the new opportunities as fast as they can.