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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 module was increased in nurse graduate pre-regis-

Ri and titles emerge in the community. Here are

a few: GPs, nurses and practitioners with
special interests, first contact care nurses and practi-
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
tioners, advanced nurse practitioners (the Evercare asking the question.
model), public health nurses, the family health nurse What we must confront though, is the thorny mat-
in Scotland and the community matron in England, ter of taking registered nurses away from practice
Many people suggest that the community has and into the classroom while we complain about
always been afflicted with far too many different communities suffering from a shortage of nurses.
kinds of nurse - health visitors, district nurses, prac- Maybe we need to look more seriously at distance-
tice nurses, nurse practitioners, registered nurses and learning opportunities, day-release schemes and the
healthcare assistants working in various teams, men- value of high quality mentorship, preceptorship and
tal health, learning disabiiity and children's commu- supervision. I do not work in the middle of the world
nity nurses. It seems obvious that the public would of education, so cannot profess to express expert
be better served by a touch of streamlining and views. What is required is a healthy debate, with the
merging of roles and functions. inclusion of all relevant stakeholders, so that we are
able to describe what an appropriate modern primary
If the community module was increased in nurse care nursing workforce could look like and how it
should be prepared.
graduate pre-registration programmes would it be In the meantime a number of PCTs are exploring
alternative ways of preparing their nurses for the
essential to spend a further academic year in order to be a increasingly demanding community. Many people
fully functioning district nurse or health visitor? have wanted a primary-care-led NHS, as referred to
in the NHS Improvement Plan (DoH 2004) for many
Traditional community nursing, plus the addition of years now, and, if we are to get one, the workforce
the proposed new roles, makes for a glorious pot has no choice but to be different from the past.
pouni. But what chance do we now have of devel- We must be radical and blast the mythology of the
oping a modern, fit-for-purpose nursing workforce past. A number of newiy registered nurses are able
able to meet government and community needs and to function in the community, without the traditional
demands? Maybe it is a bit tike shopping: when a post-registration two years spent in hospital. Aver-
new garment is bought one should be thrown away age student nurses are now 28 years, not 18, so
- unless you happen to live in a castle. have life and work experience before embarking on
Liberating the Talents (Department of Health 2002) their nursing degree or diploma. Confidence and an
provided bold statements on how community nursing ability to care for oneself are essential community
should be organised in the future, which were warmly nurse attributes and more often found in the mature
welcomed by some and considered a shade too radical than the young. Demographic char)ges in the work-
for others. And, in last month's Primary Health Care. force and the public are significant and need to be
Drennan et al (2004) eloquently described how Cam- at the centre of discussions taking place on the
den Primary Care Trust set up a project aimed at seek- design of community nursing.
ing new approaches to developing a more modern What can organisations do to encourage nurses to
primary care nursing workforce. work beyond 60 years? Experienced community
If the UK is to expand primary care capacity and nurses are almost impossible to replace in terms of
capability new solutions have to be found. Questions added value. Surely the opportunity to work shorter,
have to be asked. For example, if the community more flexible hours and to have roles with less physical

12 iuihirity heafth care [ Vol 14 No 10 ] December 2004

demand, but more teaching, supervision and mentorship is possible? I clinicians is more relevant to harmonious working and excellent care
recently met a ferociously energetic practice nurse, aged 70 years who, provision than any number of systems and processes, let alone exces-
quite clearly, was enthusiastic, up to date and interested, but happy to sive inspection and regulation. When nurses moan about the power of
reduce her working hours. 1 am convinced that we must work harder to doctors and managers it is wise to reflect on their problems, pressures
encourage mature nurses to hang around a little longer Once again, it is and personal insecurities. Believe me, they often feel without power,
alt about exploring new solutions, not hopelessly looking at the old ways under attack and confused. Understanding others, who are different
of solving workforce issues. from us, can be challenging, but if we achieve progress in terms of
Life is never perfect but there \s a strong case to be made that the knowledge of their perspectives and experience, the development of a
opportunities for community nurses have never been more exciting. The modern and successful primary care workforce maybe possible.
new GM5 contract, the anticipated NSF on long-term conditions, the It has been a hugeiy demanding year for all primary care folk, not sim-
drive (yet another one) to provide health care in the community rather ply the nurses- Next year will bring a general election and more change,
than the local hospital, the call for community nurses to have indicative so be prepared- Please take a much deserved restful and joyful break over
budgets and real authority {in the form of a community matron) paints the holiday time, if you possibly can •
an attractive piaure for our newly qualified nurses.
General practice has much soul searching to do too. It is no good Lynn Young is Primary Health Care Adviser, RCN a n d
bleating on about the shortage of praaice nurses when doors are closed Associate Editor, Primary Health Care
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, Rffcrences
and we seem unable to recruit the right numbers into the community, Lic|virtmcnt of Health (2002) Liberating the Tittents: Itdpirjg PCT?; and Nurses h- Sh-liwr
. Uindon. ncpjrtnifnl nf Hi-altli-
we must take a hard and honest look at the culture and working con-
ditions of the organisation concerned. nc[Mrtmirnt of Health (2004) NHS tmf'nn'atient PUn. Pulling Pivplc dl thv Hvarl of
Piihlic Scniccs. U-mdon. Department of Health.
Healthy relationships are critical. The nature of the interaction which
Drcnnan V et al (20M) Flcxilile career mutes fur primory cart. Primary Health Cam.
takes place between clinicians and patients, and between clinicians and 14.9.14-15-

Do you offer moving and

handling training courses?
Would you like your course to have the For nurses, there is no
RCN stamp of approval? better mark of approval

Gaining approval from the RCN allows you to use

our name - a guarantee from us of the quality of
your course.

RCN approved courses In moving and handling enable

individuals 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 and
administrative requirements

Our standards are developed by a panel of experts.

Contact the RCN Accreditation Unit for your application

pack by phone on 020 7647 3647, or email or visit our website