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Practice nurses need to take on specialist roles

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Practice and community nurses will need to provide more specialist roles to meet the demands of primary care states a report by The King's Fund.

Specialists in out-of-hospital settings: findings from six case studies found that specialist knowledge was too concentrated in hospitals despite the drive to move care into the community.

The report was based on six case studies that are piloting ways to deliver care outside of hospital. One of the key messages that came out of report was that specialist consultants should support those who work in primary care and the community to enhance their specialist knowledge to provide these services in the community.

The report found that this approach led to better patient experience, improved the management of chronic conditions and reduced waiting times. However, it is unlikely to significantly reduce cost.

Peter Carter, the RCNs chief executive, said: 'Since 2010 there has been a 4 per cent reduction in the overall community nursing workforce. This reduction in nurses more than doubles to 9 per cent when health visitors are excluded.

'Practice and district nurses offer a wide range of care, from one-off advice to helping people manage long-term conditions and keeping people out of hospitals. Nursing staff have repeatedly shown how they can adopt extended roles to provide more specialist care. These community teams are already working under a great deal of pressure, with too few resources and too few staff.

'Without urgent investment in the nursing workforce, the public are being short changed.

'There needs to be investment in community services as the changing demands facing the health service cannot be ignored.'

Ruth Robertson, fellow at The King's Fund, said: 'Our research uncovered great examples where hospital consultants working with their colleagues outside hospital has improved patient care. Implementing this new way of working is a challenge when budgets are constrained, the acute care workforce is focused on delivering consultant cover in hospital seven days a week and general practice is functioning under severe pressure. However, doing so offers enormous benefits to patients and brings the vision of a more integrated NHS that bit closer.'

One of the case studies of the featured in the report was a child health general practice hub comprising two or three general practices in inner north-west London. The aim of the hub was to ensure that children received care in the community for common childhood ailments such as fever, constipation and asthma, through open access clinics with practice nurses and health visitors. Pediatric consultants from St Mary's Hospital attended meetings at the practices every few weeks to discuss specific cases.

The other case studies included a rheumatology clinic in Haywood, a dermatology and minor surgery service in Sunderland and a diabetes clinic in Portsmouth and South East Hampshire.

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