PCT — executive nurses

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The role of executive nurses

As the extended role of nurses continues to develop, PCT executive nurses (directors of nursing) will likely become key customers for NHS influencers. Such nurses may have a seat on the board and may also become involved in clinical governance and the quality agenda. While directors of nursing on NHS trust boards have been common for some time, this is another relatively new development for PCTs.

NHS influencers should not forget that PCTs are both purchasers and providers, and will have a number of community beds inherited from the community trusts, which many PCTs absorbed in their creation. With the link up with community health services, PCTs are the employers of large numbers of health visitors, district nurses, school nurses, etc.

Developing key roles for nurses and midwifes
NHS influencers might also like to note the publication, Developing key roles for nurses and midwifes: a guide for managers. The NHS Plan sets out ten key roles for nurses including more clinical tasks, referrals and prescribing. This booklet provides NHS managers with examples of where nurses are working ‘smarter’ with lots of case studies.

Liberating the talents
Also Liberating the talents: helping primary care trusts and nurses to deliver the NHS Plan is yet another publication worth examining. This is a practical guide designed to provide PCTs and frontline nurses with a new framework for organising and delivering primary care nursing services — practice nurses, midwives, health visitors and district nurses — and to develop a ‘coherent strategic direction based on a 'one-service' approach where hospital and primary care nursing and health and social care become integrated around the patient journey.’ The framework envisages having more nurses with advanced and specialist skills to support generalists and to provide more secondary care in community settings, first contact care and to lead public health programmes. The growing number of prescribing nurses also needs to be put into the mix here.

Nurses expand their roles
Nurses continue to expand their roles:

• There are now over 500 nurse consultants in hospitals.
• The first nurse-led PMS pilot was set up over five years ago. Nurse-led general practices now under ‘enhanced’ PMS arrangements include those at Meadowfields, Derbyshire and the Great Bridge Partnerships for Health in Tipton.
• Findings from two separate polls show that most people would be happy to allow nurses to deliver out-of-hours (OOH) care. This is relevant because most GPs are expected to opt out of OOH care and nurses could pick this up, accelerating the growth of nurse-led services and the development of wider roles.

The new GP contract is certainly expected to provide both primary and secondary care nurses with the opportunity to expand their roles and specialist areas. With nurses continuing to expand their roles (not just in prescribing), companies will need to have a more strategic approach across the whole organisation — from HQ to representatives, from sales through to marketing and medical information, etc.

This approach might also need to be different to traditional medical customers — nurses probably now need to be involved in their own right in market access strategies; nurses now need to be at roundtables and members of advisory groups and nurses need targeted marketing materials and so on.

Health minister Stephen Ladyman and chief nursing officer Sarah Mullally launched The chief nursing officer’s review of the nursing, midwifery and health visiting contribution to vulnerable children and young people. Announced as part of the government's Green Paper Every child matters, the recommendations include improving health services for school-aged children by increasing the number of school nurses. The report calls for PCTs to aim for a school nurse in every secondary school and its cluster of primary schools; strengthening the public health role for midwives and children’s nurses and recognising the important role GP practice nurses can play in child health.

The re-emphasis on school nursing services is particularly interesting with regard to CDM, asthma and diabetes/obesity as well as teenage pregnancy/sexual health and linked to the children’s NSF.