I was at Heathrow, returning from holiday when my sister phoned to tell me that our father was dying. I rushed home to find the out of hours GP trying to persuade my sister that 'the best place for your father is in hospital where he will get proper care'. She said 'I can't let you admit him. My sister would kill me and my dad wants to stay at home.'
Unlike the doctor, the local district nurses knew our family well. After a somewhat 'robust discussion' he agreed to ring the DN team and of course (but much to the GP's surprise) my dad was started on the end of life pathway immediately. And this was a bank holiday.
My concern is that as we move forward with primary care that community nurses' roles are misunderstood and undervalued. Some district nurses I speak to still haven't forgotten the 'down banding' they experienced during Agenda for Change. I worry that the nursing profession talks more to itself than to other professions or to commissioners.
It is very frustrating to watch first health visiting and then district nursing numbers fall to critical levels before everyone suddenly wakes up to child protection or care closer to home and then we scrabble to reverse it. As a former PCT commissioner I remember losing the debate with finance about cuts to health visitor numbers. We need better measures of nursing outcomes not just patient experience, safety or activity, like outcome stars.
In a recent Twitter discussion about a new shared vision for London's community services we discussed the idea of 'adopting a commissioner'. The best way to make visible what primary and community nurses do, or could do, is for commissioners to experience it themselves. When Bill Bratton, New York City's then chief of police wanted to transform the transit system he made the decision-makers ride the crime-ridden subway.
Make your impact unforgettable by bringing clinical commissioners into your world, where you and your patients are the experts, not them. Do it at the coalface and do it now.