Chair of NHS Clinical Commissioners Nurses’ Forum and NEW Devon CCG chief nursing officer Lorna Collingwood-Burke discusses how nurses can influence policy and practice locally
General practice nurses are an essential part of our local workforce, pivotal to the effective delivery of care within the system. It’s true to say they haven’t always been given the recognition they deserve, a fact recently highlighted by chief nursing officer Jane Cummings, when the 10-point action plan for general practice nursing was published. On launching this plan, she outlined a determination to change this – something I also feel passionate about and that I am working towards, both nationally in my role as chair of the NHS Clinical Commissioners (NHSCC) Nurses’ Forum, and locally, as the chief nursing officer at Northern, Eastern and Western (NEW) Devon clinical commissioning group (CCG).
Part of this is about making sure practice nurses’ voices are heard, particularly in light of challenges in the health and care system that will affect them, such as the need for recruitment and retention of more skilled practice nurses as the workload of those currently in post increases. Making sure practice nurses are listened to is something that we, as executive commissioning nurses, can make happen – and something practice nurses can encourage their CCGs to make happen. I wholeheartedly encourage practice nurses to get involved in the work of their CCG; it’s important to remember that we are general practice membership organisations and that this is not just about GPs. Practice nurses are valued as highly as their GP colleagues in their contributions to our work.
Getting involved with your CCG
There are a number of different ways that practice nurses can get involved with their CCG – some formal and some less formal.
My advice to practice nurses is to get in touch with your CCG in the first instance to find out where your wealth of skills and experience can be most effectively put to use. The best person to contact will vary from place to place: in my CCG, there is a practice nurse lead, but there may not be in others. There will, however, be a nurse representative on all CCG governing bodies. It’s really important for CCGs to have good engagement with practice nurses to find out about the support they need, and also to hear their ideas on what could be done better. Commissioning nurses are well placed to help provide professional leadership and to find solutions. Similarly, if you have ideas that can improve patient care and service delivery or address workforce challenges, we want to hear them so we can look at how we can implement those ideas more widely.
Once you’ve got in touch, your local CCG lead may be able to tell you about other opportunities to get involved with; for example, sitting on working groups or reference groups on issues ranging from patient safety and service delivery, to professional matters such as revalidation and appraisal. This engagement is just one way to help ensure your work is appropriately recognised and to raise the profile of practice nurses.
Sitting on your CCG’s governing body
There are also more formal opportunities, including sitting on the CCG’s governing body. Each CCG will have a registered nurse on its board: this is a statutory requirement. However, how this works is – again – different across the country.
Many CCGs employ full-time chief or executive nurses with accountability and responsibility for specific statutory duties, usually (but not exclusively) relating to quality. Areas of responsibility include, for example, quality assurance of service provision, safeguarding, acting as the Caldicott Guardian, and equality, diversity and inclusion. This is the case with my role – I have these responsibilities alongside being the board’s nurse representative.
Sometimes the roles are separate, and nurses on the governing body’s board have more of an independent ‘lay member’ role. These roles require little in the way of time (generally a couple of days each month), but a significant portfolio of skills and experience.
In some CCGs there may also be more than one nurse on the governing body. For example, in NEW Devon CCG, we have a practice nurse who is a partner in the general practice she works in and was elected to represent member practices in her locality. She is also a locality vice chair, so she sits on her locality board as well as the governing body, bringing a different perspective to the discussions. The exact responsibilities will differ between CCGs, but whatever they are, sitting on the governing body is an important role and will involve responsibility for advocating for nursing, quality and patient safety.
My advice, again, is to contact your local and other CCGs to see if there are opportunities to apply for these posts, and looking on NHS Jobs or in the relevant press to see what is being advertised.
Working for your CCG
There are also other roles within the CCG for nurses, outside of the governing body or executive nurse role. These are sometimes short-term opportunities on specific projects, such as our future workforce in practice nursing, which also provides an opportunity for working with other stakeholders like the Academic Health Science Networks (AHSNs). Then there are other roles, such as a practice nurse lead or jobs related to improving patients’ experience of service delivery and developing better pathways of care – something in which practice nurses have excellent skills and experience.
These roles may be available on a full or part-time basis. Often, nurses have the flexibility to carry on working in their practice, and at a minimum, they should undertake enough clinical days to maintain their CPD. It is mandatory for all nurses in my CCG to continue with their clinical practice part time, and I think most CCGs would be more than willing to negotiate on the matter. Not only is it better for the individual, the practice and the CCG if a nurse remains in practice – enabling them to gain and enhance their skills in a multitude of important areas – but also, it will boost the nurse’s credibility when engaging with local practice nurses.
Getting into these roles depends on their individual requirements, your own experience, and what work is being undertaken in your CCG, but it’s really just a matter of keeping an eye out for the jobs that come up locally and making yourself known. I am keen for practice nurses to see working in their local commissioning system as a valid career option, and part of the wider career pathway.
In some cases, if a job looks interesting but is targeted at GP candidates, it might still be worth speaking to your local CCG nurse lead about it. I’m certainly aware of cases where a role that was initially advertised to attract GPs was subsequently filled by a practice nurse. Part of what I want to do – like many commissioning nurses – is to challenge preconceptions and get out of the style of thinking that certain roles can only be undertaken by a particular professional, just because that’s the way it has always been done. We need a diverse range of professionals contributing to the services we commission and practice nurses are very capable, highly skilled practitioners in their own right, with a valuable perspective to bring to CCGs.
Practice nurse networks
Creating a network for practice nurses is an important way that CCGs can support and help practice nurses to thrive. I would really encourage practice nurses to get fully involved in creating these networks; they can provide a vital forum not only for supporting each other in what can, at times, be an isolating role, but also for enabling nurses to come together and work collectively to influence the local system.
Many CCGs will already have created networks in some shape or form. Last year, the NHSCC Nurses’ Forum published the report The role of the nurse on the CCG governing body, which highlighted networks as one way in which CCGs were leading the nursing profession in their area. It included a best practice case study from South Cheshire and Vale Royal CCGs, where a practice nurse membership council was established, chaired by the practice nurse quality lead, with representatives from each of the local GP practices. This provided a forum for discussion of challenges unique to the nurse role, which could then be fed back to the CCG governing body, and the opportunity for discussions of proposals from the CCG governing body that affect patient care.
These might not exist everywhere, or may take on different forms. But either way, they are crucial as they bring practice nurses together and, therefore, can give you a strong voice to influence the issues that matter the most to you and your patients.
Influencing the local system
There are opportunities both inside and outside CCGs to influence the local system. If this is something you want to do, I would suggest that you take advantage of opportunities to learn more outside of your standard clinical learning days that come your way.
If there is a day focused on practice development, particularly where it can influence the role of the practice nurse, or a session about your local sustainability and transformation partnership’s plans for the area, then go along. If you want to influence change, the more you know the better.
Aside from being involved with your CCG, there are numerous other opportunities that give you the chance to influence the system for the better. For example, community education provider networks influence primary care education and training, and AHSNs are crucial in supporting the development and spread of innovative new practices. Locally we are looking to develop ‘communities of practice’ across our system, which bring professionals together to focus on learning from best practice.
