GP pathfinders ‘ploughing on regardless’ during pause - RCN

Published: 06 June 2011

New commissioning consortia in England are “ploughing on” regardless of the ‘pause’ and establishing new and inconsistent structures that are not transparent and may not be fully accountable, a survey by the Royal College of Nursing (RCN) has shown. As a result, the RCN is reiterating its call for a nurse to have a guaranteed place on every GP consortia board, enshrined in law, when the Health Bill returns to parliament.

The RCN has found evidence of the changes which are already in place despite the ‘pause’, ‘listening exercise’ and the Prime Minister’s comments about the importance of nurse involvement[1]. The information comes from enquiries to 162 consortia across England. Fewer than one in three (30.5%) of those who responded have a nurse at board level. The RCN has welcomed the opportunity for reflection represented by the pause, while expressing alarm about the reality on the ground - that consortia are implementing new and inconsistent structures without waiting for the findings of the NHS Future Forum.

The RCN is also seriously concerned about the transparency and accountability of these new public bodies which will have responsibility for all aspects of health care in the long term. Of the 162 pathfinder consortia the RCN were able to contact, only 36 were able to provide a response, a response rate of only 22%, a worrying indication about both transparency and accountability. Many more consortia have been established without contact details being available to allow for scrutiny. The RCN is urging the government to heed the results of the listening exercise and work with the new consortia to ensure that they are not proceeding too hastily into new structures which may not be fit for the future.

The RCN has been calling for nurses to have a guaranteed role in commissioning services since the white paper was published last year. Nurses are in a unique position as the only profession able to combine knowledge and skills from all areas of health and social care, and their involvement in commissioning provides innovative ideas for bringing teams and sectors together, redesigning services, understanding budgets and working across boundaries.  86% of RCN members in a recent survey said that they recognised that nurses should have a central role in commissioning patient services, and the RCN is warning that without this involvement, patient care may suffer [i].

Dr Peter Carter, Chief Executive & General Secretary of the RCN said:
“We have welcomed the government’s listening exercise as an opportunity to reflect and to achieve a good outcome for patients. However, while the listening exercise has been going on, events on the ground have not stood still, and ninety per cent of people in England are now covered by pathfinder consortia. The new arrangements are proving inconsistent in their structures, and are failing to abide by the vision set out for involving professions and communities to ensure that the care provided is of the highest possible quality.

Dr Carter added:

“Make no mistake – nurse involvement on commissioning consortia would not be simply a token gesture – patients will feel the consequences. Ultimately, the consortia must be accountable to their patients, and the lack of nursing involvement at every level is just one example of the difficulties they may face in the future. The RCN is very clear that the expertise nurses have is so valuable it has to be real and it has to be enshrined in law.

“Nurses are a hugely important part of any commissioning team, because they follow the patient throughout their care and have a unique range of skills and experience. Nurses involved in commissioning have a breadth of knowledge which no-one else has, such as understanding how hospitals link to community care, how specialists can help cancer patients, and how to implement public health measures. Without these skilled nurses, some consortia are operating in the dark.”

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Notes to editors

Experienced and talented nurses bring huge value n the form of skills and knowledge to effective commissioning. The RCN has identified the following reasons why nurses are indispensible to commissioning. Nurses:
• Ensure that commissioning reaches far beyond medicine and management and into health improvement and quality aspects of care;
• Are key to unlocking resources from traditional patterns of service and  investing them into new multi agency partnerships which focus on improved public health, better self care and the reduction of health inequalities;
• Engage with their  colleagues when existing services need to be reviewed and redesigned, according to local health strategies;
• Have expertise in budget management and understand the resource implications of the decisions made by Board members. They are also able to inform fellow commissioners of the potential impact on patient care and outcomes when plans for service redesign or the decommissioning of services are being explored;
• Review current research and scan horizons to determine how services are provided nationally, internationally and from independent health care sectors;
• Are experienced in managing healthcare systems and can identify which clinicians to engage with to determine how services can best be provided;
• Are able to take the lead in developing improved integration between the various parts of the health and social care services;
• Have a long history of working across organisational boundaries and operate within networks which encourage clinicians to challenge existing practice and outdated ways of working in order for best practice to be implemented.

The RCN contacted 162 pathfinder consortia between March and May 2011 by letter and telephone.

36 positive responses were received. Of these,
• 11 pathfinders had board level representation for nurses (one was defined as a non-voting member),
• 5 had vacancies or plans for nurses at board level,
• 9 had nurse representation at a lower level (clinical sub-committee or similar),
• 9 had no board level representation. In two instances the situation was unclear.

For further information, interviews or illustrations please contact the RCN Media Office on 0207 647 3633, press.office@rcn.org.uk or visit http://www.rcn.org.uk/news/mediacentre.php

Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.