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IJynn young

Primary care in 2005:the challenges aheadThe opportunities fo r comm unity nurses have never been moreexciting. But, says LynnYoung, there's always room for improveme

R iecent years have seen a plethora o f n ew rolesand tit les emerge in the co mm unity. Here area few: GPs, nurses and practitioners withspecial interests, first con tact care nurses and p racti-tioners, advanced nurse practitioners (the Evercaremodel), public health nurses, the family health nursein Scotland and the com mun ity m atron in England,

Many people suggest that the community hasalways been af f l ic ted with far too many di f ferentkinds of nurse - health visitors, district nurses, prac-tice nurses, nurse practitioners, registered nurses andhealthcare assistants wo rkin g in various teams, m en-tal he alth, learning disabiiity and children's com mu -nity nurses. It seems obvious that th e public w ou ldbe better served by a touch of streamlin ing andmerging of roles and functions.

If the com munity module was increased in nursegraduate pre-registration programmes wou ld it be

essential to spend a furthe r academic year in order to be afully func tioning district nurse or health visitor?

Traditional community nursing, plus the addition ofthe proposed new roles, makes for a glorious po tpouni. But what chance do we now have of devel-oping a m odern, f i t -for-purpose nursing w orkforceable to m eet government and com munity needs anddemands? M aybe i t is a b i t t ike shopping : whe n anew garment is bought one should be thrown away- unless you hap pen to live in a castle.

Liberating the Talents (Department of Health 2002)provided bold statements on how community nursingshould be organised in the future, wh ich were warm lywelcom ed by some and considered a shade too radicalfor others. An d, in last month's Primary Health Care.Drennan et al (2004) eloquently described how Cam-den Primary Care Trust set up a project aimed at seek-ing new approaches to developing a more modernprimary care nursing workforce.If the UK is to expa nd prim ary care capacity a ndcapability new solutions have to be found. Questions

mod ule was increased in nurse graduate pre-regtration programmes would it be essential to spea further academic year in order to be a fully funtioni ng d istrict nurse or health visitor? I am merasking the question.

Wha t we m ust confront though, is the thorny mter of taking registered nurses away from practiand into the c lassroom whi le we complain abocommunit ies suffer ing from a shortage of nurseMaybe we need to look more seriously at distanclearning opportunities, day-release schemes and tvalue of h igh quality mentorship, preceptorship asupervision. I do n ot work in the middle of the w oof education, so cannot profess to express expviews. What is required is a healthy debate, with tinclusion of all relevant stakeholders, so that we aable to describe what an appropriate modern primacare nursing workforce could look l ike and howshould be prepared.

In the m eantim e a num ber of PCTs are exploria l ternat ive ways of prepar ing their nurses for tincreasingly demanding community. Many peohave wante d a primary-care-led NHS, as referredin the NHS Improvement Plan (DoH 2004) for mayears now, and, if we are to get one, the workfohas no choice bu t to be different fro m the past.

We must be radical and blast the m ythology of tpast. A number of newiy registered nurses are ato function in the comm unity, without th e traditiopost-registration two years spent in hospital. Avage stude nt nurses are now 28 years, not 18,have life and wo rk experience before embarking their nursing degree or diploma. C onfidence and abil ity to care for oneself are essential communnurse attributes and more often foun d in the m atthan the young. Demographic char)ges in the woforce and the public are significant and need to at the centre of d iscussions taking place on tdesign of com munity nurs ing.

What can organisations do to encourage nurseswork beyond 60 years? Exper ienced communnurses are almost impossible to replace in termsadded value. Surely the opportunity to work short

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demand, but more teaching , supervision andmentorship is possible? Irecently met a ferociously energetic practice nurse, aged 70years who,quite clearly, was enthusiastic, up to date and interested, but happy toreduce her workin g hours. 1 am convinced that we must work harder toencourage mature nurses to hang around a little longer Once again, it isalt about exploring new solutions, nothopelessly looking at the old waysof solving w orkfo rce issues.

Life is never perfect but there \s a strong case to be made tha t theopportunities for community nurses have never been more exciting. Thenew GM5 contract , the anticipated NSF on lon g-term conditions , thedrive (yet another one) to provide health care in thecommunity ratherthan the local hospital, the call for community nurses to have indicativebudgets and real authority {in the form of a community matron) paintsan attractive piau re for our newly qualified nurses.

General practice has muc h soul searching to do t o o . It is no g o o dbleating onabout the shortage of praaice nurses wh en doors are closedto student nurses for their clinical placements and the terms and con-di t ions for GP employed nurses are not equal to nurses employed bythe NHS, Ifexperienced community nurses are seeking early retirement,an d we seem unable to recruit the right numbers into the community,we must take a hard and honest look at the cul ture and workin g con-ditions of the organisation concerned.

Healthy relationships are critical. Thenature of the interaction whichtakes place between clinicians and patients, and between clinicians and

clinicians ismore relevant to harmonious working and excel lent careprovision th an anynumber of systems and processes, let alone excessive inspection and re gulation. W hen nurses moan abo ut the p owe r odoctors and managers it is wise to reflect on their problems, pressuresand personal insecurit ies. Believe me, they often feel without powerunder at tack and confused. Understanding others, who are d i f ferenf ro m us, can be cha l leng ing , but if we achieve progress in te rms oknowledge of their perspectives and experience, the development of amo dern and successful primary care workfo rce m aybe possible.

It has been ahugeiy demand ing year for all primary care folk, not simply the nurses- Next year will br ing a general election and more ch angeso be prepared- Please take a much deserved restful and joyful break overthe holiday time, if you possibly can

L y n n Y o u n g is Pr ima ry He a l t h Ca re Ad v i s e r , RCN an dAssociate Editor, Primary Health Care

RffcrencesLic|virtmcnt ofHeal th (2002) Liberating the Tittents: Itdpirjg PCT?; andNurses h- Sh-liw. Ui n d o n . n cp j r t n i fn l nfHi-altli-nc[Mrtmirnt ofHeal th (2004) NHS tmf'nn'atient PUn. Pulling Pivplc dl thv Hvarl ofPiihlic Scniccs. U-mdon. Dep ar t m en t of Heal th .Drcnnan V et al (20 M) Flcxil ile career m utes fur p r i m o ry ca r t . Primary Health Cam.14.9.14-15-

Do you offer moving andhand ling tra ining courses?Would you like your course to h ave theRCN stamp of approval?Gaining approval from the RCN allows you to useour name - a guarantee from us of the quali ty ofyour course.RCN approved courses In moving and handling enableindividuals and groups: to carry out manual handling activities safely, with

minimal threat to their musculo-skeletal health to maintain accurate records and documentation

that comply with professional, legal andadministrative requirements

Our standards are developed by a panel of experts.

Contact the RCN Accreditation Unit for your applicationpack by phone on 020 7647 3647, or email

For nurses, there is nobetter m ark of approval

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