RE: BMJ Editorial on health visiting fragmentation

[Guest guest]

Well done Woody!

Sally

Dear and Liz,

I only had 15 minutes to digest that editorial, compose an eletter and

send

it off to the BMJ before the hospital library I was visiting closed

on

Saturday, but I hope I did some good in the limited (c.200) words

at:

http://www.bmj.com/cgi/eletters/333/7580/1185

Sadly, the BJGP which told me in that they would print a similar

letter

sent in February about the needs of child health/development

within

primary care, have not done as they said...

Much happiness in 2007!

Woody.

Quoting Cowley <sarah@...>:

> , many thanks for drawing this to our attention. I found

it

> encouraging that the writer is as well informed as he is about

the

> situation in health visiting, but he seems to be struggling to

find a

> positive way forward. I guess it

would be good to pen a response; if

> only there was more

time!

>

>

>

>

> On 8 Dec 2006, at 07:36, Coles

wrote:

>

> > See BMJ Editorial cut and

pasted below.

> > I am glad to say the suggestion that " promoting healthy

lifestyles

> > could carry on outside general practice with lay trainers so

that

> > GPs and primary care nursing professionals would have more

time for

> > patients with acute and chronic diseases " is rejected

in some

> > senses but to suggest that it is only targetted health

promotion

> > that should remain without any reference to the limitation

of

> > targetting and risk assessment is regretable.

> >

> > BMJ 2006;333:1185-1186 (9 December),

doi:10.1136/bmj.39043.386019.80

> > Editorials: The future of primary care nurses and health

visitors

> > Increasing fragmentation threatens the primary healthcare

team

> >

> > New policies, new contracts, and financial pressures have

altered

> > the roles of primary care nurses and health visitors and

their

> > relationship with general practitioners (GPs). How will the

primary

> > care trust survive?

> >

> > In remote areas of some rich nations (such as rural

Australia)

> > highly trained nurses provide the core of primary medical

care for

> > adults and children. In many developing nations (such as

Bangladesh

> > and China) locally trained nurses tend to work in hospitals

and

> > private clinics in towns, whereas health care in rural

communities

> > often depends on lay medical aides and occasionally doctors.

In the

> > United States nurses manage care for chronic disease.1

> >

> > In the United Kingdom, some nurses are employed by

independent

> > contractor GPs, while others including health visitors are

attached

> > to general practice teams but are paid and managed by

primary care

> > organisations. They have worked alongside GPs for many

years: good

> > communications between such primary care professionals lead

to

> > better quality care for patients with complex clinical and

social

> > problems.

> >

> > Pressure to save money, improve patient access, and

tackle

> > shortages in the medical workforce has led the UK government

to

> > develop alternatives to traditional general practice. These

include

> > National Health Service (NHS) walk-in centres, NHS Direct,

primary

> > care trust medical services, and alternative provider

medical

> > services. These changes threaten the traditional primary

healthcare

> > team and raise questions about the future of primary care

nursing

> > and health visiting.

> >

> > Nurses and health visitors are withdrawing from primary

healthcare

> > teams in England for two main reasons. Firstly, their

numbers are

> > declining. A third of primary care nurses and health

visitors are

> > approaching retirement age,2 and training restrictions,

vacancy

> > freezes, and staff cuts have exacerbated the shortfall. The

number

> > of health visitors is the lowest for 12 years.3 Recent

proposals in

> > Scotland advocate that specialist community nurses and

health

> > visitors are replaced by

generic community nurses.4 In England,

> > some health visitors have moved to new children's centres.

The

> > recruitment of " community matron " managers from

district nursing

> > has also left gaps in the primary care nursing

workforce.

> >

> > Secondly, primary healthcare trusts are threatened by

competition,

> > which has altered the way that primary care providers view

each

> > other. The UK government is keen to develop alternative ways

of

> > providing health care, and by stimulating competition it

hopes to

> > improve quality and value for money. Clinical services run

mainly

> > by nurses and nurse practitioners are thought to provide

better

> > access for patients at less cost. Such nurses may take on

senior

> > posts with considerable strategic and operational

responsibility.

> > In England, practice based commissioning, with general

practices

> > taking control of budgets for secondary care services,

may

> > stimulate other innovations where privately or self employed

nurses

> > work for specialist services.

> >

> > None the less, other factors may encourage nurses to remain

in

> > primary healthcare trusts led by GPs. Primary care nurses

see an

> > opportunity to become entrepreneurs5 as alternative

(private)

> > providers embracing " social enterprise. " However,

they are hesitant

> > to leave the clinical support, relative financial security,

and

> > pensions provided by the NHS. In addition, the 2003 GP

contract6

> > has stimulated many practices to think about staffing and

skill mix,

> > 7 which has led to initiatives to improve the professional

status

> > of nurses. New systems that reward practices for good

management of

> > chronic diseases have highlighted the financial and

clinical

> > importance of input from nurses. Many general practice

nurses are

> > acquiring advanced skills in diagnosis and prescribing;

others are

> > taking strategic and leadership roles or even becoming

practice

> > partners.

> >

> > Fitzpatrick8 suggests that many aspects of promoting

healthy

> > lifestyles could carry on outside general practice with

lay

> > trainers so that GPs and primary care nursing professionals

would

> > have more time for patients with acute and chronic

diseases.

> > Although general practice does need to define its

boundaries

> > regarding social care and education, we think that

targeted

> > promotion led by nurses still has a place in general

practice.

> >

> > It is time to re-examine the divisions of power,

responsibility,

> > and rewards within general practice primary healthcare

trusts. We

> > believe that such trusts should remain central to the

provision of

> > primary care but wonder whether changes in the role of

primary care

> > nurses and health visitors, and the fragmentation of the

> > organisations that employ them, will have a negative effect

on

> > patient care and discourage democratic team work.

> >

> > Derrett, general practitioner1, Lydia Burke,

senior

> > lecturer2

> > 1 Barton House Group Practice, London N16 9JT , 2

Middlesex

> > University, London N19 5LW c.j.derrett@... l.burke@...

> > References

> > Wagner EH. The role of patient care teams in chronic

disease

> > management. BMJ 2000;320:569-72.[Free Full Text]

> > Audit Commission. A focus on general practice in England.

AC, 2002.

> > www.rcgp.org.uk/pdf/ISS_SUMM02_11.pdf

> > Amicus. Hewitt ignored warnings on health visitor crises.

2006.

> > www.amicustheunion.org/default.aspx?page=3826

> > ish Executive Health Department. Review of nursing in

the

> > community steering group minutes. SEHD, July 2006.

> > www.scotland.gov.uk/Topics/Health/NHS-Scotland/nursing/

> >

communitynursing/Steering-Group/steering-group-minutes/July.

> > Young L. Community nurses, social enterprise and community

interest

> > companies. Primary Health Care 2006;16:5.

> > Department of Health. New primary care contracts—what they

mean for

> > employers of nurses in general practice. London: DOH,

2003.

> >

www.natpact.nhs.uk/uploads/pcc/Employers_of_GP_nurses.pdf

> > ish Executive Health

Department. Framework for nursing in

> > general practice. SEHD, 2004.

www.sehd.scot.nhs.uk/practicenursing/

> > index.htm

> > Fitzpatrick M. The future of general practice. Br J Gen

Pract

> > 2006;56:801.[Medline]

> >

> >

> >

> >

> > Dr Coles PhD BA RHV RGN

> > Research Fellow

> > Department of Child Health

> > Cardiff University, School of Medicine

> > Heath Park

> > Cardiff CF14 4XN

> > Telephone

> > Direct line 02920 74 2160

> > Department Secretary 02920 743374/5

> >

> >

> > http://www.cardiff.ac.uk/medicine/child_health/research/community/

> > prevention

> > http://www.core-info.cf.ac.uk/

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Well done Woody!

Primhe will publish it!

From:

[mailto: ] On Behalf Of Sally Kendall

Sent: 11 December 2006 09:45

Subject: Re: BMJ

Editorial on health visiting fragmentation

Well done Woody!

Sally

Dear and Liz,

I only had 15 minutes to digest that editorial, compose an eletter and send

it off to the BMJ before the hospital library I was visiting closed on

Saturday, but I hope I did some good in the limited (c.200) words at:

http://www.bmj.com/cgi/eletters/333/7580/1185

Sadly, the BJGP which told me in that they would print a similar letter

sent in February about the needs of child health/development within

primary care, have not done as they said...

Much happiness in 2007!

Woody.

Quoting Cowley <sarahsacowley (DOT) free-online.co.uk>:

> , many thanks for drawing this to our attention. I found it

> encouraging that the writer is as well informed as he is about the

> situation in health visiting, but he seems to be struggling to find a

> positive way forward. I guess it would be good to pen a response;

if

> only there was more time!

>

>

>

>

> On 8 Dec 2006, at 07:36, Coles wrote:

>

> > See BMJ Editorial cut and pasted below.

> > I am glad to say the suggestion that " promoting healthy

lifestyles

> > could carry on outside general practice with lay trainers so that

> > GPs and primary care nursing professionals would have more time for

> > patients with acute and chronic diseases " is rejected in some

> > senses but to suggest that it is only targetted health promotion

> > that should remain without any reference to the limitation of

> > targetting and risk assessment is regretable.

> >

> > BMJ 2006;333:1185-1186 (9 December), doi:10.1136/bmj.39043.386019.80

> > Editorials: The future of primary care nurses and health visitors

> > Increasing fragmentation threatens the primary healthcare team

> >

> > New policies, new contracts, and financial pressures have altered

> > the roles of primary care nurses and health visitors and their

> > relationship with general practitioners (GPs). How will the primary

> > care trust survive?

> >

> > In remote areas of some rich nations (such as rural Australia)

> > highly trained nurses provide the core of primary medical care for

> > adults and children. In many developing nations (such as Bangladesh

> > and China)

locally trained nurses tend to work in hospitals and

> > private clinics in towns, whereas health care in rural communities

> > often depends on lay medical aides and occasionally doctors. In the

> > United States

nurses manage care for chronic disease.1

> >

> > In the United

Kingdom, some nurses are employed by

independent

> > contractor GPs, while others including health visitors are attached

> > to general practice teams but are paid and managed by primary care

> > organisations. They have worked alongside GPs for many years: good

> > communications between such primary care professionals lead to

> > better quality care for patients with complex clinical and social

> > problems.

> >

> > Pressure to save money, improve patient access, and tackle

> > shortages in the medical workforce has led the UK government

to

> > develop alternatives to traditional general practice. These include

> > National Health Service (NHS) walk-in centres, NHS Direct, primary

> > care trust medical services, and alternative provider medical

> > services. These changes threaten the traditional primary healthcare

> > team and raise questions about the future of primary care nursing

> > and health visiting.

> >

> > Nurses and health visitors are withdrawing from primary healthcare

> > teams in England

for two main reasons. Firstly, their numbers are

> > declining. A third of primary care nurses and health visitors are

> > approaching retirement age,2 and training restrictions, vacancy

> > freezes, and staff cuts have exacerbated the shortfall. The number

> > of health visitors is the lowest for 12 years.3 Recent proposals in

> > Scotland

advocate that specialist community nurses and health

> > visitors are replaced by generic community nurses.4 In England,

> > some health visitors have moved to new children's centres. The

> > recruitment of " community matron " managers from district

nursing

> > has also left gaps in the primary care nursing workforce.

> >

> > Secondly, primary healthcare trusts are threatened by competition,

> > which has altered the way that primary care providers view each

> > other. The UK

government is keen to develop alternative ways of

> > providing health care, and by stimulating competition it hopes to

> > improve quality and value for money. Clinical services run mainly

> > by nurses and nurse practitioners are thought to provide better

> > access for patients at less cost. Such nurses may take on senior

> > posts with considerable strategic and operational responsibility.

> > In England,

practice based commissioning, with general practices

> > taking control of budgets for secondary care services, may

> > stimulate other innovations where privately or self employed nurses

> > work for specialist services.

> >

> > None the less, other factors may encourage nurses to remain in

> > primary healthcare trusts led by GPs. Primary care nurses see an

> > opportunity to become entrepreneurs5 as alternative (private)

> > providers embracing " social enterprise. " However, they are

hesitant

> > to leave the clinical support, relative financial security, and

> > pensions provided by the NHS. In addition, the 2003 GP contract6

> > has stimulated many practices to think about staffing and skill mix,

> > 7 which has led to initiatives to improve the professional status

> > of nurses. New systems that reward practices for good management of

> > chronic diseases have highlighted the financial and clinical

> > importance of input from nurses. Many general practice nurses are

> > acquiring advanced skills in diagnosis and prescribing; others are

> > taking strategic and leadership roles or even becoming practice

> > partners.

> >

> > Fitzpatrick8 suggests that many aspects of promoting healthy

> > lifestyles could carry on outside general practice with lay

> > trainers so that GPs and primary care nursing professionals would

> > have more time for patients with acute and chronic diseases.

> > Although general practice does need to define its boundaries

> > regarding social care and education, we think that targeted

> > promotion led by nurses still has a place in general practice.

> >

> > It is time to re-examine the divisions of power, responsibility,

> > and rewards within general practice primary healthcare trusts. We

> > believe that such trusts should remain central to the provision of

> > primary care but wonder whether changes in the role of primary care

> > nurses and health visitors, and the fragmentation of the

> > organisations that employ them, will have a negative effect on

> > patient care and discourage democratic team work.

> >

> > Derrett, general practitioner1, Lydia Burke, senior

> > lecturer2

> > 1 Barton House Group Practice, London

N16 9JT , 2 Middlesex

> > University, London

N19 5LW c.j.derrettqmul (DOT) ac.uk

l.burkemdx (DOT) ac.uk

> > References

> > Wagner EH. The role of patient care teams in chronic disease

> > management. BMJ 2000;320:569-72.[Free Full Text]

> > Audit Commission. A focus on general practice in England. AC,

2002.

> > www.rcgp.org.uk/pdf/ISS_SUMM02_11.pdf

> > Amicus. Hewitt ignored warnings on health visitor crises. 2006.

> > www.amicustheunion.org/default.aspx?page=3826

> > ish Executive Health Department. Review of nursing in the

> > community steering group minutes. SEHD, July 2006.

> > www.scotland.gov.uk/Topics/Health/NHS-Scotland/nursing/

> > communitynursing/Steering-Group/steering-group-minutes/July.

> > Young L. Community nurses, social enterprise and community interest

> > companies. Primary Health Care 2006;16:5.

> > Department of Health. New primary care contracts—what they mean

for

> > employers of nurses in general practice. London: DOH, 2003.

> > www.natpact.nhs.uk/uploads/pcc/Employers_of_GP_nurses.pdf

> > ish Executive Health Department. Framework for nursing

in

> > general practice. SEHD, 2004. www.sehd.scot.nhs.uk/practicenursing/

> > index.htm

> > Fitzpatrick M. The future of general practice. Br J Gen Pract

> > 2006;56:801.[Medline]

> >

> >

> >

> >

> > Dr Coles PhD BA RHV RGN

> > Research Fellow

> > Department of Child Health

> > Cardiff University, School of Medicine

> > Heath Park

> > Cardiff

CF14 4XN

> > Telephone

> > Direct line 02920 74 2160

> > Department Secretary 02920 743374/5

> >

> >

> > http://www.cardiff.ac.uk/medicine/child_health/research/community/

> > prevention

> > http://www.core-info.cf.ac.uk/

> >

> >

> >

> >

> >

> >

> >

> >