Letter from the adviser - Lynn Young

Published: 17 October 2011

Many practice nurses working in England will be interested in becoming involved in the anticipated new clinical commissioning groups.

Now that it has been announced that nurses must be included in the commissioning arrangements, the RCN is hoping for energetic nurses to consider playing an important part in local service redesign. But we need to be clear, as I am becoming a little uncomfortable about some of the language being used.

Patients getting the right service

Commissioning groups are not about professional representation, but, they are about bringing nursing skills, knowledge and experience to the commissioning agenda. Which is, after all, about patients and the public getting the services they need, not nurses looking after or representing nurses.

The NHS throughout the United Kingdom is in big financial trouble, while at the same time having to face up to ferocious population health problems.

The reasons for this are well known – an ageing population, fewer people paying tax, more people demanding a pension, and a time bomb in terms of lifestyle conditions such as diabetes and liver disease.

Nursing staff working in general practice see the impact of poor lifestyle every day they are at work. It must be so frustrating working with people to manage their health, when the truth is that they could have so easily been prevented in the first place. When we consider these issues, commissioning quickly follows. How can we best spend local money to help prevent and manage disease?

If practice nurses are thinking of putting themselves forward to join the world of health commissioning they need to do so with their eyes wide open. Commissioning is a tough job and even tougher if it is to be done wisely. And another thing, we are not capable of commissioning new services, unless other existing services are cut, thus releasing cash to fund the development of different services.  In today’s climate commissioners will be charged with making tough and often very unpopular decisions.

Enhancing commissioning

It is never easy to close a hospital and even when commissioners decide that such action is in the interest of local people it isn’t uncommon for marches to begin and numerous pleading letters to be sent to various relevant MPs. Petitions are signed, presented to 10 Downing Street, and the Health Secretary intervenes and demands that the hospital must be kept open. It is easy to tweak services and commission - a little bit of redesign here and there, but closing a hospital in order to revolutionise local health care is another matter altogether.

None of this should deter nurses who believe that they are capable of enhancing commissioning, but I am a great believer in dealing with reality, rather than how we would like things to be. In the meantime there is talk going on regarding the negotiation of a new contract for general practice (the last one was agreed in 2004) but at the time of writing this I have no more information to give you. Time marches on and it seems that startling and unexpected news is a constant in our busy lives.

Lynn Young