Encouraging nurses out of retirement plus a package of targeted support for community care and district nurses could help address the NHS crisis, a think tank has said.
Policy Exchange launched a manifesto on Monday that is aimed at the next Prime Minister, who will be announced on 5 September.
The document, What do we want from the next Prime Minister? A series of policy ideas for new leadership: Health and Social Care, contains 16 policy ideas – eight focused on the current pressures affecting access to services and eight that look to put the NHS on a sustainable longer-term footing.
One of its suggestions for stabilising primary care in the short term is to launch a re-entry scheme for retired nurses and GPs.
The report said that about 19,000 nurses overall left the register between September 2020 to 2021, with one of the reasons cited being low staffing levels. It acknowledged that efforts were already underway to encourage recently retired nurses back into the workforce.
But it also suggested introducing greater flexibility in the NMC readmission process, and introducing a consistent, national policy on the pension rules associated with ‘retire and return’ – as this is currently inconsistently applied across the NHS.
Sue Boran, director of nursing programmes (innovation), at the QNI told Nursing in Practice that it was vital to consider flexible solutions to staffing needs.
‘Speaking to recently retired nurses about why they decided to retire can provide useful intelligence; asking on what terms would they consider returning, even part time, will help employers provide the right terms and conditions and working environment,’ she said.
However, a survey by Nursing in Practice earlier this year found two-thirds of nurses working in general practice were thinking about leaving the profession within a year, with many saying they feel overworked and undervalued.
Invest in community care
The Policy Exchange report also said that action was required ‘to avert a collapse of emergency care over winter’ and that the PM would need to urgently free hospital bed capacity ahead of this winter.
And that could be helped by investing more heavily in community care, it said.
‘The ‘least bad’ option will be to shift as much in-patient care to remote settings as is reasonable without compromising patient safety,’ said the report.
The report recommends a massive scaling up of virtual wards over this coming autumn and winter, to free up hospital beds and reduce bottlenecks in emergency departments.
Although work on this has started, the report said it does not go far enough.
NHS England has called for ICSs to establish 40 to 50 virtual beds per 100,000 population by December 2023. This would equate to around 23-25,000 virtual hospital beds in the community across England and is supported by £450m in funding.
But the report said there were issues around shifting complex care from hospitals to community settings ‘where the district nursing workforce is particularly depleted, losing nearly half of its workforce from 2010 to 2017’.
It calls for additional investment such as ‘video conferencing capability to allow for enhanced remote monitoring, and greater emphasis on senior nurse leadership within the virtual ward rounds’.
There should also be a package of targeted support for community care and district nurses who will support the hospital care team, said the report.
One immediate measure would be to uplift the NHS mileage rate from the current 56p per mile for the first 3,500 miles to cover the first 10,000 miles, after community nurses have reported that the current reimbursement does not cover car running costs.
This would reflect increased petrol prices, and that nurses may have to adapt their working practices to reach a wider number of patients in virtual wards.
Whilst Ms Boran welcomed the suggestion to make fuel imbursement fairer, she said that ‘real investment in the community nursing workforce’ was needed for the long-term success in any virtual ward policy.
‘Virtual wards need to be managed within the community, rather than serving as an outreach service from hospital, if they are to be effective in supporting individual and population health, and able to meet current and future demand,’ said Ms Boran.
‘Investment in the District Nursing Specialist Practitioner Qualification (SPQ) would be a positive step to make that leadership and expertise more widely available in community nursing teams,’ she added.