IJynn young
Primary care in 2005:
the challenges ahead
The opportunities for community nurses have never been more
exciting. But, says Lynn Young, there's always room for improvement
ecent years have seen a plethora of new roles
Ri and titles emerge in the community. Here are
a few: GPs, nurses and practitioners with
special interests, first contact care nurses and practi-
tioners, advanced nurse practitioners (the Evercare
model), public health nurses, the family health nurse
in Scotland and the community matron in England,
Many people suggest that the community has
always been afflicted with far too many different
kinds of nurse - health visitors, district nurses, prac-
tice nurses, nurse practitioners, registered nurses and
healthcare assistants working in various teams, men-
tal health, learning disabiiity and children's commu-
nity nurses. It seems obvious that the public would
be better served by a touch of streamlining and
merging of roles and functions.
If the community module was increased in nurse
graduate pre-registration programmes would it be
essential to spend a further academic year in order to be a
fully functioning district nurse or health visitor?
Traditional community nursing, plus the addition of
the proposed new roles, makes for a glorious pot
pouni. But what chance do we now have of devel-
oping a modern, fit-for-purpose nursing workforce
able to meet government and community needs and
demands? Maybe it is a bit tike shopping: when a
new garment is bought one should be thrown away
- unless you happen to live in a castle.
Liberating the Talents (Department of Health 2002)
provided bold statements on how community nursing
should be organised in the future, which were warmly
welcomed by some and considered a shade too radical
for others. And, 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 modern
primary care nursing workforce.
If the UK is to expand primary care capacity and
capability new solutions have to be found. Questions
have to be asked. For example, if the community
12 iuihirity heafth care [ Vol 14 No 10 ] December 2004
module was increased in nurse graduate pre-regis-
tration programmes would it be essential to spend
a further academic year in order to be a fully func-
tioning district nurse or health visitor? I am merely
asking the question.
What we must confront though, is the thorny mat-
ter of taking registered nurses away from practice
and into the classroom while we complain about
communities suffering from a shortage of nurses.
Maybe we need to look more seriously at distance-
learning opportunities, day-release schemes and the
value of high quality mentorship, preceptorship and
supervision. I do not work in the middle of the world
of education, so cannot profess to express expert
views. What is required is a healthy debate, with the
inclusion of all relevant stakeholders, so that we are
able to describe what an appropriate modern primary
care nursing workforce could look like and how it
should be prepared.
In the meantime a number of PCTs are exploring
alternative ways of preparing their nurses for the
increasingly demanding community. Many people
have wanted a primary-care-led NHS, as referred to
in the NHS Improvement Plan (DoH 2004) for many
years now, and, if we are to get one, the workforce
has no choice but to be different from the past.
We must be radical and blast the mythology of the
past. A number of newiy registered nurses are able
to function in the community, without the traditional
post-registration two years spent in hospital. Aver-
age student nurses are now 28 years, not 18, so
have life and work experience before embarking on
their nursing degree or diploma. Confidence and an
ability to care for oneself are essential community
nurse attributes and more often found in the mature
than the young. Demographic char)ges in the work-
force and the public are significant and need to be
at the centre of discussions taking place on the
design of community nursing.
What can organisations do to encourage nurses to
work beyond 60 years? Experienced community
nurses are almost impossible to replace in terms of
added value. Surely the opportunity to work shorter,
more flexible hours and to have roles with less physical
demand, but more teaching, supervision and mentorship is possible? I
recently met a ferociously energetic practice nurse, aged 70 years who,
quite clearly, was enthusiastic, up to date and interested, but happy to
reduce her working hours. 1 am convinced that we must work harder to
encourage mature nurses to hang around a little longer Once again, it is
alt about exploring new solutions, not hopelessly looking at the old ways
of solving workforce issues.
Life is never perfect but there \s a strong case to be made that the
opportunities for community nurses have never been more exciting. The
new GM5 contract, the anticipated NSF on long-term conditions, the
drive (yet another one) to provide health care in the community rather
than the local hospital, the call for community nurses to have indicative
budgets and real authority {in the form of a community matron) paints
an attractive piaure for our newly qualified nurses.
General practice has much soul searching to do too. It is no good
bleating on about the shortage of praaice nurses when doors are closed
to student nurses for their clinical placements and the terms and con-
ditions for GP employed nurses are not equal to nurses employed by
the NHS, If experienced community nurses are seeking early retirement,
and we seem unable to recruit the right numbers into the community,
we must take a hard and honest look at the culture and working con-
ditions of the organisation concerned.
Healthy relationships are critical. The nature of the interaction which
takes place between clinicians and patients, and between clinicians and
clinicians is more relevant to harmonious working and excellent care
provision than any number of systems and processes, let alone exces-
sive inspection and regulation. When nurses moan about the power of
doctors and managers it is wise to reflect on their problems, pressures
and personal insecurities. Believe me, they often feel without power,
under attack and confused. Understanding others, who are different
from us, can be challenging, but if we achieve progress in terms of
knowledge of their perspectives and experience, the development of a
modern and successful primary care workforce maybe possible.
It has been a hugeiy demanding year for all primary care folk, not sim-
ply the nurses- Next year will bring a general election and more change,
so be prepared- Please take a much deserved restful and joyful break over
the holiday time, if you possibly can •
Lynn Young is Primary Health Care Adviser, RCN a n d
Associate Editor, Primary Health Care
Rffcrences
Lic|virtmcnt of Health (2002) Liberating the Tittents: Itdpirjg PCT?; and Nurses h- Sh-liwr
. Uindon. ncpjrtnifnl nf Hi-altli-
nc[Mrtmirnt of Health (2004) NHS tmf'nn'atient PUn. Pulling Pivplc dl thv Hvarl of
Piihlic Scniccs. U-mdon. Department of Health.
Drcnnan V et al (20M) Flcxilile career mutes fur primory cart. Primary Health Cam.
14.9.14-15-

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