The listening exercise has been completed. Many nurses participated in this exercise as part of the NHS Future Forum, as members of advisory groups, such as the chief nursing officer’s commissioning group, and through participating in the many events across the country. But what does this mean for nurses now?
The listening exercise confirmed many of the principles that matter to us: improving patient care, putting patients first and patients as partners in decision-making. The government’s response to the NHS Future Forum’s report shows how it will improve its proposals to ensure that commissioning involves a range of health professionals and to recognise the importance of strong clinical leadership. It states that:
“Clinical commissioning is at its best when it is a collaboration of professionals, based on a shared drive for continuous quality improvement and greater integration of services.”
To reflect this, GP commissioning consortia will be renamed clinical commissioning groups (CCGs) and their governing bodies must include at least one registered nurse. They will be under a stronger duty to obtain clinical advice and, where relevant, to ensure that this advice comes from a range of health professionals. Further, health professionals will have an integral role in commissioning through clinical networks and new clinical senates.
Clinical networks will be bolstered to cover more areas of care and have a stronger role in commissioning. Clinical senates will be established for doctors, nurses and other professionals to come together to give expert advice on integrated patient care. Nurses will be central in developing and providing advice through these new bodies.
The decisions that nurses take, from the point of care for individual patients to commissioning of services for communities, often determine local opinions of the NHS. Nurses are already “quality champions”, by becoming increasingly involved in designing as well as delivering services, and bringing their clinical and service knowledge to commissioning they can improve patient experience and health outcomes for local communities.
The CNO commissioning group and other networks are currently ensuring that the breadth and depth of the nursing contribution to effective commissioning is understood and valued, and enables more nurses to get involved.
We have summarised this as reach, knowledge and skills, resources, and relationships. Nurses have the professional reach into all aspects of health and care, and our work engages us with families and communities as well as individual patients, bringing a wide perspective to commissioning. In particular, nurses often lead care at the interface of NHS services with public health and social care. Effective integration of services is a priority and makes a real difference, especially for some of the most vulnerable patients. Nursing skills and knowledge will provide a significant contribution to commissioning effective services across these interfaces and for these groups. Additionally, nurses’ reach, skills and knowledge often extend to those who are not registered with a GP practice, such as homeless people. CCGs will have a duty to commission for these groups and will need this nursing input.
Nurses are very aware of the challenge of delivering high-quality care at a time of financial austerity, and we have demonstrated how we can improve productivity with sustained high quality. The ability to do this is fundamental to commissioning, and we need to be confident in using these skills.
Leadership profiles of nurses show particular strengths in building and sustaining relationships. Effective relationships between patients and professionals, communities and commissioners and across organisations will be critical to implementing the government’s plans for modernising the NHS, and nurses in leadership positions, in particular, will have opportunities and responsibilities to make a difference nationally and locally.
In the future, the NHS will see new organisations with nurse leaders at the forefront of delivering improvement nationally and locally. As nurses we need to understand that service improvement and redesign requires all of us to contribute, whether as practitioners, provider leaders or commissioners. We must be willing to learn the new skills and have confidence in the many nursing attributes that will make us effective commissioners. We need to take up the new opportunities that will ensure that the potential of nursing leadership and influence is realised at all levels to improve care and health outcomes for patients.
