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Where will our practice nurse leaders come from?

Calling all practice nurses! Please read this article! This may be in your interest.

Marilyn Eveleigh
Consultant Editor

Now that I have got your attention I want to pose an important question for you to consider. In your PCT, who is the leader that supports and represents practice nursing in the locality you work in?

I ask the question because the remit of primary care trusts (PCTs) is changing. In a new competitive market PCTs are dividing their functions into:

  • Those of a commissioner or purchaser of services to a required standard for the local population.
  • Those of a provider of those services that the PCT will hopefully purchase for the local population.

This division is likely to have a knock-on effect for leadership of the practice nursing workforce - and your professional development.

In answer to the question above - if you can identify a leader, I bet it is a practice nurse employed by the PCT. S/he may only be employed for a small number of hours a week - but they provide an identity and link with the practice nursing (PN) workforce.
  
At a June 2008 meeting at the RCN hosted by the general practice nursing section of the Working in Partnership Project (WiPP), over 50 nurses attended by virtue of being employed by a PCT to support practice nursing. Note, there are 190 PCTs in the UK. The amazing thing for me was the roles and responsibilities of these nurses/leaders, which included:

  • Providing professional and clinical support to practice nurses and their GP employers.
  • Providing practice nursing workforce and employment advice.
  • Providing and managing PN educational programmes, some of which were free and others charged at market prices.
  • Liaising with, and developing training for PNs with the local college/university.
  • Managing trained practice nurses who are provided to GPs for a fee or free (this was only provided by a small minority).

These are clearly the roles of a "provider of services". A healthcare provider receives funding within the contract from the PCT to cover staff training and professional/employment requirements. The functions are fundamental to the successful delivery of the contract they have with the commissioning PCT.
Yet GPs are independent contractors. Each practice is independently commissioned by the PCT to deliver General Medical Services (GMS) and the Quality and Outcomes Framework (QOF) - and practice nurses are their employed workforce. Theoretically, each GP practice is responsible as a healthcare provider; funding for the elements listed above is included in the GMS contract. In reality, however, through tradition and for practical purposes, all PCTs have provided their numerous GP contractors (small businesses) with practice nursing workforce support.

However, this support began to be questioned, and in many cases disappeared altogether, with the 2006 PCT reconfiguration. Some local self-managed practice nurse groups secured PCT funding, others precariously finance themselves. An increasing number of PCTs have no identified practice nursing support at all.

Some nurses employed by PCTs indicated at the WiPP meeting that they also undertake QOF verification visits to practices, advise on clinical care for PCT local enhanced services, and monitor standards and the quality of care. This is a commissioning role.
 
If PCT commissioner and provider functions are separating formally by April 2009, where will practice nursing support sit? Will the PCT provider of community nursing services want to deal with general practice issues and employment? Will it bring them an income or help them deliver on their contract? What if a new private company wins the community nursing contract? Who should support practice nursing where the majority of practice nurses are directly employed by independent contractor GPs?
 
I pose these questions to encourage you to seek out where your practice nursing workforce leadership and development is to come from in the future. I do not have the answers.

I have three challenges for practice nurses:

  • If you have a PCT practice nursing leader, ask them if they are to be in the provider arm of the PCT (supporting role) or in the commissioner arm (monitoring services role).
  • Support and access whatever your existing PCT practice nursing lead offers - be it meetings, clinical supervision, training events, clinical advice or workforce support. If practice nurses don't know or use their leadership, the PCT will not provide it.
  • If GPs value the role of a practice nursing lead for their employed PNs, they (and you) could commission it through PBC - practice-based commissioning. Influence them to do so if there is no clear lead or resource to support the PN workforce.

Your comments: (Terms and conditions apply)

"The searching questions posed in this article comes at a critical time for me as I am soon to engage in my new role as facilitator in practice nurse development. Thank you for this article, it has given me quite a lot to think about." - Frederica Reid, South Staffordshire