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The joined-up future of primary care services

Crystal Oldman explains the thinking behind the QNI and the RCN's new report Outstanding Models of District Nursing

On Tuesday 21stMay 2019, the QNI and the Royal College of Nursing published a report entitled Outstanding Models of District Nursing. It is the result of a yearlong process of consultation with a wide range of stakeholders, including individuals and carers who had been in receipt of the District Nursing service. Key stakeholders also included District Nurses, executive nurses, professional leads, commissioners, the voluntary sector, higher education and General Practitioners.

There was a clear consensus about what needs to be in place to support the District Nursing service to thrive, including co-location with colleagues in GP practice, wherever physically possible and a service which is commissioned 24/7 so that the out-of-hours GP service does not have to pick up where the District Nursing services closes in the late evening.

None of this will be a surprise to those working in the District Nursing service and many would welcome such a change, particularly in the light of the establishment of the new Primary Care Networks (PCNs) across England. As they bed down into being the ‘new normal’, these structures will provide an excellent opportunity for nurses to work more closely together across primary and community services.

Of course this already happens in many areas, especially where there has been an experience of co-location for some time. In many Primary Care Homes, collaboration between the General Practice Nurses and the nurses of the District Nursing service is the normal working relationship; indeed, collaboration between professional groups and partnership working with a focus on population health is the expectation of a Primary Care Home. It plays directly into what people expect and need at a local level from their health services – the whole team working together no matter what organisation they are employed by, with a focus on improving health at the individual and population levels and ensuring accessibility of joined up services.

Nurses who work in the community and primary care are good at this approach; our education and training supports partnership working, negotiating with services within health, social care and the voluntary sector while acting as the patient advocate to ensure the best possible experience of care. At an individual level, clinical skills are developed to meet patient need and continue to be advanced as required, working as a critical partner within the multidisciplinary team.

Nurses are also in an ideal position to understand and analyse patterns of health, illness and behaviour which are the result of inequalities – and to act upon these to address the underlying causes, such as housing conditions. Community nurses are regular correspondents with local authority housing departments, supporting the case for individuals and families whose health is severely impacted by overcrowded, damp conditions in the home to be offered more suitable accommodation.

Collecting and collating the data on local patterns of disease and underlying causes can also be the catalyst for a change of approach at a population level and again nurses are ideally placed to introduce innovations and new ways of working to address, for example, increasing levels of diabetes, with group consultations, exercise and weight loss programmes within the community.

As the PCNs are established, I anticipate that many nurses will continue to lead on new ways of working to improve the health of the local community. As suggested by Suzanne Gordon, the award winning author with whom the QNI continues to work, at the same time, we must also learn to articulate our value a little more clearly.